Are you looking for more information on the South Carolina Department of Health and Environmental Control Form 2351? If so, then you've come to the right place. This form is used by healthcare professionals in South Carolina to report infectious illnesses, hospital admissions and other ailments. Whether you're a physician or medical student, understanding this form will help ensure you meet all your state's regulatory requirements when it comes time to document health-related information. In this post we'll explore what exactly Form 2351 is, who needs to use it and how to fill out each section correctly. Ready to get started? Let's take a closer look at everything related to DHEC Form 2351!
| Question | Answer |
|---|---|
| Form Name | Form Dhec 2351 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dhec 2351, SSN, ASHI, EMT |
SC DHEC DIVISION OF EMS & TRAUMA
Certiication Application Form
SC State Certiication Number
SC
SSN (Last 4 #s)
National Registry Certiication Number
National Registry Cert. Exp. Date
Level of Certiication (Check One)
EMT
PARAMEDIC
Last Name
First Name
Date of Birth (mm/dd/yyyy)
Mailing Address
City, State, Zip Code
Home Phone Number (Including Area Code)
Cell Phone Number (Including Area Code)
Attach the Following Credentials
Out of State Credential
OR
National Registry Credential
Attach a copy of your current Out of State or
NREMT Credential
(Out of State Credential must have at least 1 year remaining)
Additional Credential for Paramedics
Advanced Cardiac Life Support (ACLS) Credential
Attach a copy of your valid current ACLS Credential
ACLS credential MUST be one of the following:
AHA: ACLS
ASHI: ACLS
BLS (CPR) Credential
Attach a copy of a valid / current BLS Credential
BLS card MUST be one of the following:
AHA: BLS for the Healthcare Professional ARC: CPR for the Professional Rescuer ASHI: CPR Pro
SC State Criminal Background Check
Attach a copy of your lBT
ingerprint receipt
You may call IBT at
to make an appointment
SC DHEC EMS ORI #: SC920111Z
I hereby afirm that all statements on this form are true and correct, including the copies of all cards,
certiications, and attachments. It is understood that false statements or documents may be suficient cause for denial/revocation of my EMT
credential by SC DHEC. It is also understood that SC DHEC may conduct a full audit of all activities listed on this form at any time.
Your Signature (Must be original signature) & Date Signed
DHEC 2351 (09/2011) |
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL |