MICN - Online applications NOT available for Initial MICN's

Effective Immediately!! Applications submitted during the last seven (7) calendar days of the month may be delayed due to Agency workflow. Applications will be processed as soon as workflow allows.

Download the MICN Application form (below) and complete all steps required to become authorized as an MICN in the counties of Amador, Calaveras, Mariposa, and Stanislaus. 

  • Minimum one (1) year experience as an R.N. and six months experience in critical care or emergency department nursing.
  • Completed and signed MICN  pdf application (286 KB)
  • MICN Course Completion Certificate
  • Current and valid California R.N. license, copies of both front and back, or printout from BreEZe showing current license status.
  • Current ACLS Card (front and back)
  • Copy of photo identification (for example a California Drivers License)
  • Submit the 4 MCI Field Operations Modules (http://www.mvemsa.org), in compliance with Agency policy # 853.00 - Prehospital Training Standards
  • Payment of the $100.00 non-refundable application fee
  • Take and pass with a minimum of 75%, the Regional MICN Authorization Exam
  • Take and pass with a minimum of 80%, the Regional ALS Treatment Protocol Exam
  • Satisfactorily complete 10 ALS Radio calls. These calls must be documented on the Regional ALS Radio Call Evaluation Form and evaluated by an authorized Base MICN or Base Physician working in a Base Hospital Emergency Department. You may not obtain your 10 ALS calls until you have passed the Regional MICN Authorization and Regional ALS Treatment Protocol exams..
  • Digital photo taken on site by Agency staff.

MICN Re-authorization - Online and Walk-in Applicants

  • Submit a completed and signed pdf application (286 KB)   hard copy), or by submitting online application below, that includes copies of:
    • Current and valid California R.N. license, copies of both front and back, or printout from BreEZe showing current information
    • Copy of photo identification (for example a California Drivers License)
    • Proof of successful completion of 16* hours of Continuing Education (must be CE Certificates, cannot be a list of courses/hours completed).  MUST be relating to ALS care obtained during the current authorization period. 
    • Submit the 4 MCI Field Operations Modules (http://www.mvemsa.org) not dated earlier than 90 days prior to re-authorization, (*you will receive a CE Certificate for 4 hours that can be used for this authorization period), in compliance with Agency policy # 853.00 - Prehospital Training Standards
  • Payment of the $50.00 non-refundable application fee
  • Digital photo taken on site by Agency staff, or provide a passport style photo (passport photo or clear headshot with plain backgound), if applying online.
  • A late fee of $15 will be assessed for authorizations processed after the expiration date.

For Online  Applications:

  • Please allow 5-7 business days for application processing and issuance of an MICN Reauthorization card once all requirements have been met.  NO EXCEPTIONS.
  • Please make sure you have all required documents, including the passport style photo, saved and available for uploading PRIOR  to starting the application process.
  • You will need to submit:
    • All items listed above for MICN Re-authorization
    • A passport style photo (actual passport photo or a headshot against a blank wall).
    • Pay all fees, if applicable.
  • Applications will not be processed until all required documents have been submitted and approved.  Incomplete applications will be maintained for up to 60 days to allow for submission of additional required documents.  All incomplete applications will be considered abandoned after 60 days.
  • ALL FEES PAID ARE NON-REFUNDABLE.
  • Incomplete applications that expire during processing shall be subject to a 15.00 late fee.

MICN Re-Authorization Application

 

Our Mission

"To ensure the appropriate provision of quality pre-hospital care services to the public in a cost effective manner as an integrated part of the overall health care system."

Providing the framework for quality emergency medical services to the citizens of Alpine, Amador, Calaveras, Mariposa, and Stanislaus Counties.

Contact Info

Mountain Valley EMS Agency

1101 Standiford Ave, Suite D1
Modesto, CA 95350

Tel: (209) 529-5085
Fax: (209) 529-1496

Office Hours

M-F 8:00am - 4:30pm
Closed 12:00pm - 1:00pm

Certifications

Monday: 10:00am - 4:30pm
Tue-Thu: 8:00am – 4:30pm
Friday: 8:00am – 12:00pm
Closed 12:00pm - 1:00pm (every day)