Nys doh 5065-2026

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  1. Click ‘Get Form’ to open the NYS DOH 5065 in our platform.
  2. Begin by filling in your EMT Number and Social Security Number. Ensure that you print neatly in UPPER CASE letters as required.
  3. Complete your personal information, including Last Name, First Name, Address, City, State, and Zip Code.
  4. Enter the Agency Code of your participating agency. This is crucial for processing your recertification.
  5. Affirm your legal status regarding misdemeanors or felonies by signing and dating the affirmation section.
  6. Document your completed EMT Refresher Training hours in the designated section. Make sure to total them accurately.
  7. Attach a copy of your current CPR certification card (front and back) as instructed.
  8. Fill out the Skill Competency Verification section, ensuring that both the Medical Director/Training Officer signs it.
  9. Finally, affirm that all statements are true by signing and dating at the bottom of the form before mailing it postmarked no less than 45 days prior to expiration.

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