Independent Government / DEPARTMENT OF HEALTH DIVISION OF EMERGENCY MEDICAL SERVICES / DEPARTMENT OF HEALTH DIVISION OF ACCOUNTING / State Health Council / Department of Health Division of EMS / Department of Health / EMS / Emergency Medical Service / Division of EMS / / /
Position
general public response / additional medical director / Service Day Telephone Number Evening Telephone Number Fax Number Agency E-mail Address Squad Leader / Director Signature Date / above-named physician / DIRECTOR First Name Last Name Street Address / Squad leader / PHYSICIAN MEDICAL DIRECTOR / DIRECTOR AGREEMENT / MEDICAL DIRECTOR / Physician Medical Director for the above-named ambulance service / /
[removed]NORTH DAKOTA LICENSE RENEWAL APPLICATION INDUSTRIAL GROUND AMBULANCE NORTH DAKOTA DEPARTMENT OF HEALTH DIVISION OF EMERGENCY MEDICAL SERVICES & TRAUMA