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Metropolitan Police Department

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300 Indiana Avenue, NW, Room 5059, Washington , DC 20001
Phone: (202) 727-9099
Fax: (202) 727-4106
TTY: 711
Email: mpd@dc.gov

Agency Performance

EMS Sponsorship Form

This form is used to notify the District of Columbia Department of Health of a change in an EMS Provider’s sponsoring agency. Only certified EMS agencies are authorized to provide this information to the Department of Health.

This form should be submitted to the Department of Health at the time the sponsorship action becomes effective. The Medical Director of the EMS Agency must approve the notification request prior to submission to the Department of Health

 

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