Rule 4766-2-02 | Application for initial or renewal licensure.
(A) An MTO applying for initial licensure shall 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) An MTO applying for renewal of a license shall 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 non-transport 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 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 is received by the division may result in the application being deemed incomplete.
(G) An MTO shall submit a 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 non-ambulatory 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.
(K) No applicant or licensed MTO shall submit false, misleading, or deceptive information in order to obtain a license or permit.
(L) A license is only valid for the MTO for which it is issued and is not transferable.
Last updated May 2, 2022 at 8:56 AM
Supplemental Information