Prepared for Pediatrics Documents
Emergency Medical Services Recognition Program
All application documents, supplemental forms, and support documents are formatted as Adobe fill-in documents and can be completed online and then saved locally for upload, or saved and completed locally for upload.
Please Review Program Document Clarifications here
Program Materials:
- Program Handbook
- Application Process (Version 1.4 updated 11/1/2025)
- Additional Equipment and Supplies (Version 1.4 updated 11/1/25)
Application Documents:
Supplemental Forms:
- General Attestation
- EMS Outreach Log
- Safe Transport Attestation
- CPST Information and Activity Log
- Performance Improvement Report
- Disaster Readiness Log
Support Documents:
Required Documents
Emergency Department Recognition Program
The Prepared for Pediatrics – Emergency Department Program is currently being developed. Please check back for more information in early 2026.
Pediatric Voluntary Recognition (PVRP) Form
Each form is a fillable pdf. Click on the link, when the document displays, open the document in Adobe FIRST and then download the document and save locally. You must open in Adobe first in order to preserve the digital signature section on each form.
Once forms are completed submit via email attachment to dspencer@pehsc.org.
- Application form for agencies updating information or requesting a downgrade in level. If an Agency desires to upgrade, complete the application and all additional Compliance Reporting Forms associated with the level being upgraded to.
What forms do I need to complete?
Pediatric Emergency Care Coordinator Info Sheets
(All sheets are in the pdf format)