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LA EMS AED Form - new dhh louisiana 2026
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- Click ‘Get Form’ to open the LA EMS AED Form in the editor.
- Begin by filling out the 'Entity/Person' section. Enter your name, point of contact, address, phone number, fax number, and email address accurately.
- Next, provide details about the Automated External Defibrillator (AED). Fill in the acquisition date, serial number, make, model, and location of the AED.
- In the following section, include information about the licensed physician or advanced practice registered nurse involved in your program. Enter their name, license number, address, phone number, fax number, and email.
- Finally, type your name in the electronic signature field to confirm your understanding of compliance requirements. Include your title and date before submitting.
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