MICN Initial Authorization Application Confirmation

Thank you for submitting your application for Initial MICN Authorization. Though your application has been submitted, it will not be processed without submission of the following required documents:

  1. Copy of your current California State RN License.
  2. Copy of your current U.S. state-issued Driver’s License or photo ID.
  3. Copy of your current CPR certification card.
  4. Copy of your current ACLS or APLS certification card.
  5. Letter indicating proof of employment/recommendation from an S-SV EMS Agency Base Hospital.
  6. An S-SV EMS Agency Approved MICN course completion record issued within the past 12 months. If the course was completed more than one (1) year, but less than two (2) years prior to application or if it was a non S-SV EMS Agency regional course, you must also complete the following requirements within the past 60 days:
    1. Attend an S-SV EMS Agency Paramedic Accreditation class.
    2. Complete four (4) hours of ambulance ride-along with an S-SV EMS Agency approved ALS service provider with two (2) ALS contacts.
  7. Proof of six months (1040 hours) of ED clinical experience as an RN in the last 2 years.

Please note that it may take up to 7 – 10 calendar days to process your application and issue your authorization card once all requirements are met.

You may email required supporting documents not uploaded with your application to info@ssvems.com, (please include your name and application type in the email subject line) or mail/deliver them to the S-SV EMS Agency Rocklin Office:

  • 535 Menlo Drive, Suite A, Rocklin, CA 95765

If you choose to pay by Money Order ($100.00 Initial Authorization Fee), please mail or deliver it to the S-SV EMS Agency Rocklin Office at the address listed above. If you chose to pay by Debit/Credit Card, please click the “Pay MICN Fee” link below and you will be forwarded to our payment page (a $4.00 electronic processing fee is automatically added when paying by debit/credit card). Please contact us if you still need to sign up to attend an accreditation class, have any questions, or need further assistance.

⇒Pay MICN Fee⇐