Section 836IAC1-11-2. Application for certification; renewal

   (a) Application for basic life support nontransport provider organization certification shall be made on forms as provided by the agency, and the applicant shall comply with the following requirements:

(1) Applicants shall complete the required forms and submit the forms to the agency not less than sixty (60) days prior to the requested effective date of the certificate.

(2) Each vehicle with emergency medical services equipment required by section 4 of this rule shall be made available for inspection by the agency.

(3) The premises on which emergency medical service nontransport vehicles are stored shall be open during operating hours to the agency for inspection.

(4) Each application shall include the following information:

(A) A description of the service area.

(B) Hours of operation.

(C) Number and location of emergency medical services vehicles.

(D) Organizational structure, including names, addresses, and telephone numbers of the:

(i) owner;

(ii) chief executive officer;

(iii) chief operations officer;

(iv) training officer; and

(v) medical director.

(E) Current Federal Communications Commission license or letter of authorization.

(F) Location of emergency medical services nontransport provider organization's records.

(G) Proof of insurance coverage for vehicles if required by 836 IAC 1-3-6.

(H) Medical director approval form provided by the agency.

(I) Personnel roster form provided by the agency.

(J) A copy of the agreement with an ambulance service provider organization as required by subsection (e).

(K) Other information as required by the commission.

  (b) Upon approval, a certificate shall be issued by the commission.

  (c) The certificate:

(1) expires on the date appearing in the expiration date section of the certificate unless earlier revoked or suspended by the commission; and

(2) shall be prominently displayed at the place of business.

  (d) Application for emergency medical services nontransport provider organization certification renewal shall be made not less than sixty (60) days prior to the expiration date of the current certificate to assure continuity of certification. Application for renewal shall:

(1) be made on forms as provided by the agency; and

(2) indicate compliance with the requirements set forth for original certification.

  (e) Basic life support nontransport provider organizations shall have and maintain in place an agreement between the nontransport provider organization and an ambulance service provider organization certified under IC 16-31. The agreement shall:

(1) ensure that the nontransporting provider organization can be assured that patients treated shall be transported in a timely and safe manner; and

(2) not preclude another ambulance service provider organization, if available, from transporting the patients.

  (f) Each basic life support nontransport provider organization shall notify the agency within thirty (30) days of any change in the operation as outlined in the application. (Indiana Emergency Medical Services Commission; 836 IAC 1-11-2; filed May 15, 1998, 10:25 a.m.: 21 IR 3887; filed Apr 4, 2002, 9:15 a.m.: 25 IR 2509; filed Feb 20, 2003, 8:00 a.m.: 26 IR 2344; filed Jun 11, 2004, 1:30 p.m.: 27 IR 3526; filed Jul 31, 2007, 10:01 a.m.: 20070829-IR-836060011FRA; readopted filed Jul 29, 2010, 8:07 a.m.: 20100825-IR-836100267RFA; readopted filed Oct 31, 2016, 1:48 p.m.: 20161130-IR-836160328RFA)