This form is intended for use by Life Support Agencies to request clinical privileges for individuals whom they have hired. This form is not to be used by individuals to request MCA Privileges for themselves.
Please run a Criminal History Check before submitting this form. If the history shows any reported items, it must be submitted to the MCA before privileges will be assigned.
Participants in the ID system must update their employee roster to add the new person. The system requires that the qualification for EMS licenses and Emergency Medical Dispatch be entered, at minimum.
The best way to do this is to put all of the files needed into a folder, zip it and then attach the zipped file. This progam only allows for a single upload.
MCA's do not all have the same requirements for document submission, so make sure you know the local requirements.
Note: The security code field provided
above is used to control email spam.
Please note that this field is case
The education calendar is a location for instructors to post new provider classes, CEUs and training opportunities for EMS providers throughout the area. To submit classes, please click on the Learn More link.
Please select this link to view shared educational materials by topic area.
To move to the Trauma Network pages, please click here.
To contact the Medical Control Authority for your area, please click here.