EmailMeForm
Application For Accreditation
1. Complete this initial application.
2. Return to the CAMTS office the $1000.00 application fee.
3. Attach the Aircraft Hull and Liability Insurance Certificate. (see bottom of this form)
4. You will then receive the Program Information Form (PIF) by email.
5. You have up to 1 year to complete the PIF.
6. Submit the PIF and the attachments requested following the instructions on the PIF.
7. Your site visit will be scheduled within 4 – 6 weeks of receiving the PIF.
8. An accreditation decision will be made at the next Board of Directors meeting. The Board meets three times a year.
PIF DUE DATES -
For the Spring Meeting - PIF due December 15
For the Summer Meeting - PIF due March 15
For the Fall Meeting - PIF due June 15
Name of Medical Transport Service
Mailing Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Web Site
Name and Address of Hospital (if hospital affiliated)
Business Phone
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Principle Contact
First
Last
Title
Email
Phone
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Meeting Goal
Spring
Summer
Fall
How will you pay the application fee -
Check
Credit Card
(PIF will be emailed once we receive check)
(There will be a processing fee added if paying with card card - your payable invoice will be emailed shortly and PIF will be emailed after paid.)
Total number of bases
A base is defined as any place aircraft/ambulance and medical crew are located.
Aircraft Hull and Liability Insurance Certificate
Add File
Description of Service
(Check all that apply to your service)
Types of Service
RW (ALS)
RW (Critical Care)
FW (ALS)
FW (Critical Care)
Ground (ALS)
Ground (BLS)
Ground (Critical Care)
Medical Escort (Basic Care)
Medical Escort (Advanced Care)
Other Surface (boat, ATV, snowmobile etc.)
Special Operations
Transports Request Accepted
RW
FW
G
ME
Other Surface
Burns
Cardiac
IABP
Trauma
Pediatric (PICU)
High Risk OB
Adult
Neonatal
Size of the Service
(Dedicated aircraft/ambulance(s) are used for more than 1 transport per month for any consecutive six month period) Do not count back-ups - should be the number of aircraft you have on-line (meaning staffed and ready to go) at any one time.
RW
FW
G
ME
Other Surface
Total number of transports in most recent fiscal year
Total number of dedicated aircraft/ambulance(s)
RW
FW
Ambulance and/or Other Surface
ME
FAA Cert #/EASA Cert#/ TC Cert#/ Other (please state number and which it is)
Company Name/Owner/Operator
Address
Privacy Policy
*
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Go here to view - https://www.camts.org/privacy/
Office use only -
Date received:
Program Number:
Entered into database:
Payment received:
Emailed PIF:
Sent Packet: