How to Fill Out and Submit the NYS EMT Recertification Form (DOH-5065)

The NYS EMT recertification form DOH-5065 is the application New York EMTs use to renew their certification through the Continuing Medical Education program without taking a refresher course or the written state exam. You document 45 hours of continuing education, collect signatures from your agency’s leadership, attach a copy of your current certification card, and mail the packet to the Bureau of Emergency Medical Services at 875 Central Avenue, Albany, N.Y. 12206 at least 45 days before your current certification expires.¹ The blank PDF lives on the Department of Health’s CME recertification page.²

Who the Form Is For

DOH-5065 is only for providers whose certification is still valid and whose sponsoring EMS agency is enrolled in the CME recertification program. All certification levels statewide — EMT, AEMT, EMT-CC, and Paramedic — can use the CME pathway if they meet the manual’s requirements.² You also need to be in continuous practice with that agency.¹

If your certification has already lapsed, or your agency isn’t enrolled in the CME program, this isn’t the right form. Reinstatement after expiration is a separate process through the Bureau; contact them directly to find out which path applies based on how long you’ve been expired.

What to Have in Front of You Before You Start

Gather these before you open the PDF:

Your current EMT certification card. A copy of the front and back has to go in the envelope.¹
Your six-digit New York EMS identification number, printed on the card.
Your Social Security number, which the form requires.¹
Your sponsoring agency’s code.
Detailed continuing education logs organized by category.
A current CPR card, which you must hold at the time of recertification.³

The 45 Hours of Continuing Education

EMT-level recertification through DOH-5065 requires 45 total CE hours, split into three parts:⁴

EMT refresher training, 20 hours of core clinical content.
Mandatory topics, 5 hours total: EMT mental health (1 hour), patient lifting and moving (1 hour), safe transport of pediatric patients (1 hour), and emergency vehicle driver training (2 hours).
Additional continuing education, 20 hours of electives on EMS patient care topics. Your training officer can confirm which courses count.

Finish all 45 hours before you submit. The form has a dedicated section for each category, and the courses and hours you list must match your agency’s training records exactly. Discrepancies get the form flagged.

Filling Out the Pages

The first instruction on the form is printed in bold: use upper case letters and complete every field. Incomplete forms are denied and returned,¹ and a form that bounces back to you after your expiration date puts your certification at risk.

Page one collects your name, address, city, state, zip code, EMT number, Social Security number, and agency code. Below that, you sign a participant affirmation agreeing to follow the CME Program Manual. A criminal history section asks you to affirm you have not been convicted of or currently charged with any misdemeanor or felony. If you have been, don’t sign that section. The Bureau will review the matter individually, and it isn’t necessarily an automatic bar to recertification.¹

The later pages are where you itemize your CE hours by category. Skill competency evaluations have to be documented using PSE Skill Sheets, which your Training Officer signs off on separately.¹

Signatures You Have to Collect

This is where most DOH-5065 submissions get tripped up. The form needs several signatures, and missing even one causes rejection:

Your own signature and the date, confirming the form is accurate.
The Physician Medical Director or Training Officer, attesting to your proficiency in the skills listed on the form.¹
A sponsoring agency representative, confirming your continuous practice with the agency and active participation in its CME program.¹
A Certified Instructor Coordinator on the 20-hour refresher section, with their printed name and CIC number.
A Training Officer on the skill competency section.

Don’t drop the envelope in the mail until every signature line is complete. Start the signature chase early. Catching a Medical Director for a signature in the final week before your deadline is the most common reason forms miss the 45-day cutoff.

Where and When to Mail It

Mail the completed form, together with a copy of the front and back of your current certification card, to:

Bureau of Emergency Medical Services
875 Central Avenue
Albany, N.Y. 12206²

The packet must be postmarked at least 45 days before your current expiration date.¹ That window exists so the Bureau has processing time and so a returnable error doesn’t push you past your expiration date. Send it certified so you have proof of the postmark.

One warning the form spells out plainly: submitting false statements or documents with the intent to fraudulently recertify can result in revocation of your certification, plus civil and criminal penalties.¹

After You Submit

Once the Bureau verifies your hours, signatures, and documents, a new certification card is mailed to the address on the form. Certifications issued after July 1, 2024 are valid for 48 months from the last day of the month in which the certificate was issued, up from the previous three-year cycle.⁵ Note the new expiration date as soon as the card arrives, and keep your own copies of the signed DOH-5065 and every CE certificate. If your agency ever loses its files or you move to a different service, your personal records are what save you from reconstructing years of training from memory.

If You Also Hold National Registry Certification

Completing DOH-5065 does not automatically renew your NREMT certification. The National Registry accepts state-EMS-office-approved education for the 10-credit local/state component of its 40-credit National Continued Competency Program,⁶ but the NREMT has its own hour breakdown and topic list. Review their requirements separately and plan your CE so a single set of hours covers both.

If You’re on Active Military Duty

If your certification expires while you’re on active duty or within six months of your release, you don’t have to complete DOH-5065 on deployment. New York offers an extension: after separation, submit the military extension request form with a copy of your official separation documentation, such as a DD-214 or Statement 2A. Your extended expiration date is calculated from your release date.⁷

1
New York State Department of Health. New York State Department of Health EMT Recertification Form DOH-5065
2
New York State Department of Health. Continuing Medical Education Program
3
DistanceCME. NY EMT/Paramedic CE Recertification Requirements
4
Wyoming County. DOH-5065 EMT-Paramedic Recertification
5
New York State Department of Health. Policy Statement 24-06
6
National Registry of Emergency Medical Technicians. Recertification
7
New York State Department of Health. Military Extension