ID Badge Request Form Submit form for new employees immediately on their orientation day Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Employee name *FirstLastEnter EXACTLY as it should appear on the ID Badge (do not use all CAPS) Job Title *ChooseBilling SpecialistClinical Transition CoordinatorCommunity ParamedicContracts SpecialistCustomer Success ChampionDivision ManagerEMS DriverEMTEMT-AEMT-BEMT-IFleet Maintenance ManagerGeneral ManagerInsurance Appeals SpecialistLieutenantLead Patient Care CoordinatorMedical Billing SpecialistMedical Insurance SpecialistNET DriverNurse PractitionerParamedicPatient Care CoordinatorPatient Care SpecialistShift CommanderSenior TelecommunicatorTelecommunicator ITelecommunicator IIOther (Type below)Other Job Title (if not listed above)Location *Choose LocationCorporateMEDCOMMNEGA-Northeast GeorgiaNWGA-Northwest GeorgiaECGA-East Central GeorgiaWCGA-West Central GeorgiaSEGA-Southeast GeorgiaSWGA-Southwest GeorgiaNETN-Northeast TennesseeSETN-Southeast TennesseeUMTN-Upper Middle TennesseeLMTN-Lower Middle TenneseeWTN-West TennesseeMSC-Midlands South CarolinaUSC-Upstate South CarolinaPDSC-PeeDee South CarolinaNIN-Northern IndianaCIN-Central IndianaCOH-Central OhioNOH-Northern OhioSOH-Southern OhioIL-IllinoisEMS-EventsDivision *Choose DivisionAdministrationEMS AdministrationEMS Customer SupportEMS OperationsExecutiveEvent ServicesFleet MaintenanceMIH AdministrationMIH Customer SupportMIH OperationsPatient AccountingSupport ServicesUpload Photo for ID Badge * Click or drag a file to this area to upload. MAXIMUM FILE SIZE 512 MB. See specific guidelines for photos here: https://amerimed.net/IDPhotosAdditional Comments or MessagesSubmit
