LA EMS AED Form - new dhh louisiana 2026

1. Click ‘Get Form’ to open the LA EMS AED Form in the editor.
2. Begin by filling out the 'Entity/Person' section. Enter your name, point of contact, address, phone number, fax number, and email address accurately.
3. Next, provide details about the Automated External Defibrillator (AED). Fill in the acquisition date, serial number, make, model, and location of the AED.
4. 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.
5. 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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