REMAC FORMS

09.26.08

• Continuing  Medical Education (CME) & Call Audits (CA)

• Regional Credentialing Applications

  • ALS/ILS Providers

  • Medical Control Physicians

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If you are unable to download or print a document, please contact the Westchester Regional EMS office by sending an email to  wremsco@wremsco.org , or calling (914) 231 - 1616.

CONTINUING MEDICAL EDUCATION (CME)  & CALL AUDITS (CA)

• CME Request Form
  (To request REMAC approval of CME hours.)

• Student CA/CME Sheet - 3/12/08
  (Provider's copy of CA/CME Attendance.)

• CME/CA Attendance Sheet -  3/12/08
  (CME/CA attendance sign-in roster sent to Regional Office.)

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REMAC CREDENTIALING - Providers

• New Applicants

  • Original Credentialing Application (fillable PDF)
    (For new regional providers seeking MAC cards.)

  • Original Agency Support Form (fillable PDF)
    (Proof of affiliation with Primary Agency for MAC card.)
    

• Information Update

  • ALS EMS Provider Information Update Form (fillable PDF)
    (To notify Regional Office personal information updates or to change primary agency.)
    

• Re-Credentialing

  • Credentialing Renewal Application (fillable PDF)
    (For providers renewing their MAC cards.)

  • Credentialing Renewal Support Form (fillable PDF)
    (Affirmation from Primary Agency regarding completion of re-credentialing requirements for renewing MAC card.)

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REMAC CREDENTIALING - Physicians

• New Applicants

  • Go to the Medical Control Page
    (For new regional physicians seeking MAC cards.)

• Change of Primary Hospital

  • Change of Primary Hospital Affiliation
    (To notify Regional Office of change of hospital affiliation.)

• Update Personal Information

  • Physician Update Form
    (To notify Regional Office of change of personal contact information.)

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