South Carolina Code of Regulations › Chapter 61 - DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL › Subchapter 61-7 - EMERGENCY MEDICAL SERVICES › Sec2 61-7.100 - DEFINITIONS, LICENSURE, AND CERTIFICATION › Section 61-7.100.103 - EMS Agency License Application

Current through Register Vol. 48, No. 6, June 28, 2024
A.
				Application. Applicants for licensure as an EMS Agency shall submit to the
				Department a complete and accurate application on a form prescribed and
				furnished by the Department prior to initial licensing. The EMS Agency shall
				ensure the application is signed by the owner(s) if an individual or
				partnership; by two (2) officers if a corporation; or by the head of the
				governmental department having jurisdiction if a governmental unit.
				Corporations or limited partnerships, limited liability companies, or any other
				organized business entity shall be registered with the South Carolina Secretary
				of State's Office if required to do so by state law.
B. The EMS Agency shall include the following
				with the application:
1. The name and address
				of the owner of the EMS Agency or proposed EMS Agency;
2. The name under which the EMS Agency
				applicant is doing business or proposes to do business;
3. A copy of the business license, if
				applicable, of the EMS Agency or proposed EMS Agency for the location of the
				service;
4. The number of
				Ambulances and/or emergency medical responder service vehicles and a
				description of each vehicle including the make, Vehicle Identification Number
				(VIN), aircraft tail number, model, year of manufacture, and other
				distinguishing characteristics to be used to designate the applicant's
				vehicles;
5. The location and
				description of the place or places, including substations, from which the EMS
				Agency is intending to operate;
6.
				Personnel roster representing all employees, members, volunteers, and
				affiliates associated with the service including, but not limited to,
				EMT-basics, AEMTs, Paramedics, Drivers, pilots, registered nurses,
				certification numbers, and expiration dates of their South Carolina and NREMT
				credentials, if applicable;
7. EMS
				Agency type(s) and the levels of capability for each type pursuant to Sections
				504 and 505 to be provided at each location;
8. Name, email address, and phone number of
				the following, if applicable;
a. EMS
				Director;
b. EMS Assistant
				Director;
c. Training
				Officer;
d. Data Manager;
e. Infection Control Officer;
f. Pediatric Emergency Care Coordinator, if
				applicable; and g. Medical Control Physician.
9. A copy of current Protocols and an
				authorized medication list both signed and dated by the Medical Control
				Physician;
10. Records for each
				Driver, pursuant to Section 503;
11. Liability insurance information, to
				include name of insurance company, agent, phone number, and type of coverage. A
				copy of insurance policies shall be furnished to the Department upon request.
				The minimum limits of coverage shall be six hundred thousand dollars
				($600,000.00) liability and three hundred thousand dollars ($300,000.00)
				malpractice per occurrence. Applicants that claim "self-insured" status shall
				provide documentation showing the specific coverages as outlined
				above;
12. A copy of the EMS
				Non-Dispensing Drug Outlet Permit from the South Carolina Board of Pharmacy,
				when applicable;
13. A copy of the
				EMS Agency's current registration Certificate from the Department's Bureau of
				Drug Control and registration Certificate from the United States Drug
				Enforcement Administration, when applicable;
14. A copy of the EMS Agency's Clinical
				Laboratory Improvement Amendments (CLIA) Certificate of Waiver from the federal
				Centers for Medicare and Medicaid Services (CMS), when applicable;
15. A copy of the EMS Agency's Infectious
				Waste Generator Registration issued by the Department, or if an out of state
				EMS Agency, the respective home state equivalent; and
16. Additional information if requested by
				the Department, such as affirmative evidence of the applicant's ability to
				comply with this regulation.