New York State Department of Health
Bureau of Emergency Medical Services
EMS Agency Personnel Roster
Agency Name
Agency Code
Date Submitted
Page
List All Personnel Alphabetically
Last name, DOH-2828 (8/14)
DOB
First name
DOH Certified Personnel
MM/DD/YY
DOH issued
ID number
Expires
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Level of Certification (check one)
CFR
EMT
AEMT
CC
P
of
Check Other Levels
CPR/AED
First Aid