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Oregon Ambulance Forms

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Ambulance Service Documents (pdf)


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Air Ambulance Documents (pdf)

Ground Ambulance Documents (pdf)

Other


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Instructions

These applications, inspection forms and other documents are currently in use by the the Public Health Division.

If an application is two or more pages, please print the pages "front to back." Be sure that you complete the licensing application by providing all the requested information and attach a check for the proper licensing fee. If an application is incomplete or does not have the proper licensing fee, the application will not be processed. Make the check payable to the Oregon Health Services. Return the completed application and check to:

Oregon Health Services
Business Services
PO Box 14260
Portland OR 97293-0260

 

All ambulance service and ambulance licenses expire and need to be renewed by June 30 of each year. If the ambulance service and ambulance license applications are received and processed prior to April 1, the licenses will expire on June 30 of the same year. If the applications are received and processed between April 1 and June 30, the licenses will expire on June 30 of the next year.

If your new or replacement ambulance is replacing one of your older ambulances, and you are not going to continue to operate it as an ambulance or you are not going to sell it to another ambulance operator in Oregon, you are to return the white and yellow copies of the ambulance license, the 3" X 6" window license and the 3" X 1" year-tag for that ambulance to the Health Services. If you are selling your old ambulance to another ambulance operator in Oregon, do not remove the 3" X 6" ambulance license from the window, however, remove and return the year-tag, the white and yellow copies of the ambulance license, and the name and address of the new owner of the ambulance to Health Services within ten days of the transaction.

IMPORTANT NOTES:
  • Ambulance service and ambulance licenses are not transferrable.
  • If you are purchasing and licensing a ground ambulance that was built prior to June 1, 1985, you must apply for and receive a variance from the Health Services in order to license and operate that ground ambulance.
  • If you are selling a ground ambulance that was built prior to June 1, 1985, to another ambulance service in Oregon, you must inform the prospective buyer, that they must apply for and receive a variance from the Health Services to license and operate that ground ambulance.

 

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