This version of the State EMS Forms was posted on this site on 02/15/2005, and reviewed without change 11/07/2008. Last revised by the state on 10/17/2005.

The State Emergency Medical Services (EMS) Board voted December 10, 2003 to accept as the standard for electronic data collection the National Highway Transportation and Safety Administration (NHTSA) Uniform Prehospital Data Set Version 2.0. The EMS Board also adopted an identified subset from this document for minimum reporting data for Tennessee Emergency Medical Services as required in Rule 1200-12-1-.15 (2) (c)

Effective January 1, 2005 the state will only accept data submission through the web site or in the format of the NHTSA Uniform Prehospital Data Set Version 2.0.

Click on the thumbnails below to view a full sized image.

Select the following to view a printable Acrobat (.PDF) version. 

Tennessee EMS Data Set 12/2003(.PDF,49.77k)

Click on the following links to view the corresponding files:

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