Ohio Admin. Code 4766-2-02 - Application for initial or renewal licensure
[Comment: For dates and availability
of material incorporated by reference in this chapter of the Administrative
Code, see rule
4766-2-18
of the Administrative Code.]
(A)
A
An MTO applying for initial licensure shall
file with the board an "Application for Ambulance or
Mobile Intensive Care License" form in the English language, and shall submit
the completed application to the board
submit
to the board a completed application, in the English language, using the MTLS
online system :
(1) Accompanied by the
appropriate fees as set forth in rule
4766-2-03 of the
Administrative Code and;
(2) With
all required supporting documentation as set forth in this rule.
(B)
A
An MTO applying for
renewal of a license shall file with the board a
"Renewal Application for Ambulance or Mobile Intensive Care License" form in
the English language, and shall submit the completed application to the
board
submit to the board a completed
application, in the English language, using the MTLS online system :
(1) Accompanied by the appropriate fees as
set forth in rule
4766-2-03 of the
Administrative Code and;
(2) With
all required supporting documentation as set forth in this rule that must be
received by the board prior to the expiration date of the license.
(C) In addition to the
requirements set forth in section
4766.04
of the Revised Code, for each application the MTO applicant shall provide and
maintain documentation of:
(1) The name of
service, organizational structure, and address of applicant as follows:
(a) Name;
(b) Identification of organizational
structure as a corporation (whether for profit or not-for-profit); limited
liability company; partnership; limited liability partnership; government unit;
or sole proprietor (individual human);
(c) Tax identification (tax ID) number or
employer identification number (EIN);
(d) All other names under which applicant
plans to operate while using the same tax ID or EIN number. Business
organizations with different tax ID or EIN numbers cannot operate under the
same license;
(e) Copies of all
trade name registrations and fictitious name registrations for all other names
under which applicant plans to operate on file with the Ohio secretary of
state;
(f) Address of physical
location of applicant's headquarters (no post office box);
(g) Mailing address of applicant.
(2) All medicare provider
numbers;
(3) All medicaid provider
numbers;
(4) Highest level of
service to be provided;
(5) Service
areas including county and state;
(6) A list of the names of all officers,
directors, and/or owners of the MTO;
(7) The name, contact information, and state
of Ohio medical license number of the service's medical director;
(8) Proof that the medical director is in
compliance with the requirements for a medical director as set forth in rule
4765-3-05
of the Administrative Code.
(9) For
each satellite base, the MTO shall provide the physical address, city, county,
state, and zip code;
(10) The name
of the primary contact person(s), business or administrative office telephone
number, email address, and if applicable, office fax number;
(11) Year of manufacture, make, model,
vehicle identification number, odometer reading, and license plate number
(renewal only) of each ambulance or nontransport vehicle to be
permitted;
(12) A color photograph
of the side of applicant's vehicle displaying color scheme, insignia, monogram,
or other distinguishing characteristics. If multiple color schemes, insignias,
monograms, or other distinguishing characteristics are used, a color photograph
of each shall accompany application.
(a) Color
photographs shall be submitted to the division:
(i) With all initial
"Application for Ambulance or Mobile Intensive Care
License" forms
applications ;
and
(ii) Within thirty days of the
date a change is made to the vehicle's color scheme, insignia, monogram, or
other distinguishing characteristics.
(b) Digital photographs are
preferred.
(13) A
current certificate of liability insurance, in the name of the applicant,
listing the board as a certificate holder with a thirty day cancellation notice
as specified in section
4766.06
of the Revised Code:
(a) The actual name on
the license application shall appear on the certificate of liability
insurance;
(b) Each permitted
vehicle with vehicle identification number (VIN) shall be listed on the
certificate of liability insurance.
(D) An application that is not completed in
the manner as specified on the application or does not include all required
documentation shall be deemed incomplete.
(E) An application deemed incomplete shall
not be considered and may be returned with the notation to the applicant
indicating the reason the application is incomplete.
(F) Failure to provide the required documents
within thirty days of the date the initial "Application for Ambulance or Mobile Intensive Care License"
form
application is received by the
division may result in the application being deemed incomplete.
(G)
A
An MTO shall submit a completed "Renewal Application for Ambulance or Mobile
Intensive Care License" form
completed renewal
application , appropriate fees, and supporting documentation to the board
using the MTLS online system prior to the
expiration of the MTO's license in order to be considered timely.
(H) The certificate of licensure issued by
the board shall indicate the highest level of service the MTO is authorized to
provide.
(I) The board shall issue
licenses to MTOs that meet the criteria to provide the following levels of
service:
(1) Basic life support
(BLS) (two levels of licensure) ;
(a)
BLS emergency and
non-emergency; or
(b)
BLS non-emergency only;
(2) Intermediate life support;
(3) Advanced life support
(ALS) .
(J)
An MTO licensed
at the BLS non-emergency only level or an MTO licensed at the BLS emergency and
non-emergency level, intermediate life support level, or advanced life support
level operating an ambulance at the BLS non-emergency only level is subject to
the following requirements:
(1)
May transport an individuals who requires routine
transportation to or from a medical appointment or service if that person is
convalescent or otherwise nonambulatory and does not require medical monitoring
en route to the destination facility, aid, care, or treatment during transport
other than BLS care.
(2)
May not transport an individual who:
(a)
Is experiencing
an acute condition or a sudden injury or illness;
(b)
Has sustained an
injury and has not yet been evaluated by a physician;
(c)
Needs to be
transported from one hospital to another hospital if the destination hospital
is the same level or a higher level as the hospital of origin;
(d)
Is being
evaluated in an emergency room and for any reason must be transported to
another hospital for diagnostic tests that are not available at the first
hospital;
(e)
Is being medically monitored at the sending facility
and will continue to be medically monitored at the destination
facility;
(f)
Is being administered intravenous
fluids.
(3)
Nothing in this chapter prohibits a BLS non-emergency
only ambulance from transporting an individual to a non-medical event or social
gathering as long as the individual being transported meets the guidelines in
paragraphs (J)(1) and (J)(2) of this rule.
(4)
The medical
protocol for the EMT in a BLS non-emergency only ambulance shall address the
care, treatment, and transport of a patient whose medical condition worsens
during transport.
Notes
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.03, 4766.04, 4766.07
Prior Effective Dates: 07/02/2009, 04/16/2012, 06/15/2017
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