This version of the State EMS Forms was posted on this site on 8/30/2010, and revised by the state on 11/18/2004.

The Kentucky Board of Emergency Medical Services (KBEMS) is  working hard on their Kentucky  EMS Information System (KEMSIS) Data Reporting Module which is expected to be available to EMS Providers July 1, 2009.  This module is the third part of the former EMSIS program.  Previously KBEMS has been working with Grayco Systems on the Certification and Inspection Modules and now the Data Reporting module.  This module will be used to collect incident data from EMS Providers across the Commonwealth for creating reports for NEMSIS, Trauma Registry and Highway Safety.  KBEMS has developed a team with several EMS Billing Services that provide services to many of the Commonwealth’s EMS Providers.  This KEMSIS Team is working together to develop a very comprehensive program to meet the needs of our EMS Providers. Work has already started on the program and the projected start  for this program is July 1, 2009. 

KBEMS in conjunction with Grayco (KBEMS software developer)  has developed a National EMS Information System (NEMSIS) complaint database with explicit KEMSIS mandatory fields and expected KEMSIS validations. Grayco is working  with KBEMS to provide opportunities for Kentucky EMS Providers and 3rd party billing services to submit their data to KEMSIS electronically.  KEMSIS will have several methods for EMS Providers to deliver their incident data.

In the first phase, KBEMS along with Grayco is working with EMS Billing Services to develop KEMSIS Certified Programs.  Each vendor is required to be NEMSIS Gold or Silver Compliant (for Kentucky) and must also be willing to work within the KEMSIS dataset and required validations and/or auto-fill rules.  These third party programs will meet stringent testing requirements for NEMSIS and KEMSIS certification. Once these vendor programs pass KEMSIS certification then EMS Providers may use choose the certified program for reporting.   By July 1, 2009 all EMS providers would be welcomed to start reporting their data in Phase One using a KEMSIS Certified Vendor. Phase Two will be an interface created by Grayco that will allow any EMS Provider to enter their incident data directly in KEMSIS with a projected goal for completion of this phase by the end of September.  

It is our goal to have every EMS Provider  by July 1, 2010 to choose a KEMSIS Compliant method to start reporting their data. 

KEMSIS Implementation Plan v1.0 (.XLS, 65.50k)

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The Kentucky Board of Emergency Medical Services Ambulance Run Report rev.1998

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Kentucky EMS Information System Dataset 4/2009 (.XLS, 57.50k)

KEMSIS Procedures List Version 1.0 6/29/2009 (.PDF,83.12Kk)

Kentucky New Run Report Instructions  rev.1/2005(.PDF,205.67k)

KY Proposed Datasets rev 0.7 3/2006 (.PDF, 965.31k)

Preliminary  Incident Collection Dataset rev.0.8 (.PDF, 421.05k)

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