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CENTRAL REGISTRY

MOBILE INTENSIVE CARE NURSE AUTHORIZATION & RE-AUTHORIZATION

On this page:
How Do I Become Authorized? | Application Forms & Fees | Authorization Policy | FAQs

HOW DO I BECOME AUTHORIZED?


To be eligible for MICN authorization you must:
  1. Be currently licensed as a registered nurse, in good standing, in California.
  2. Have at least six (6) months experience as a full-time RN in a critical care area in the past two (2) years. Prehospital liaison nurse (PLN) must verify experience by completing the verification section of the MICN application.
  3. Successfully complete MICN course.
  4. Successfully pass the San Joaquin County EMS Agency ALS Policy Examination with a minimum score of 80% on a closed book examination of San Joaquin County Policies.
  5. Submit the required documents to the EMS Agency (see below).
Initial Authorization
  1. MICN Authorization Application with Affidavit within 6 months of successfully completing MICN course.
  2. Copy of current State of California Registered Nurse License.
  3. Copy of a valid state or federal ID.
  4. Copy of MICN Course Completion.
  5. Copy of current ACLS card.
  6. A copy (front and back) of your current CPR card for the Professional Rescuer or Healthcare Provider issued from the American Heart Association, American Red Cross, or another program approved by the EMS Agency.
  7. Current and valid Trauma Nursing Core Course (TNCC).
  8. Copy of Course Completion for ICS 100/200 or HICS/HEICS IV equivalent.
  9. Application fee (non-refundable).
Re-Authorization
  1. MICN Authorization Application with Affidavit. Submit application 30 (thirty) days prior to the expiration date of current MICN Authorization.
  2. Copy of current State of California Registered Nurse License.
  3. Copy of a valid state or federal ID.
  4. Copy of current ACLS card.
  5. A copy (front and back) of your current CPR card for the Professional Rescuer or Healthcare Provider issued from the American Heart Association, American Red Cross, or another program approved by the EMS Agency.
  6. MICN Continuing Education Form.
  7. Attendance of a Policy and Skills Review (PSR) course within 6 months of expiration and achieve a minimum score of 80% on a closed book examination of San Joaquin County Policies.
  8. Application fee (non-refundable).

APPLICATION FORMS & FEES


Application and Related Forms

During the COVID-19 pandemic: All EMS personnel who must submit an initial or renewal personnel application are encouraged to submit their applications via mail. You may send the applications to PO Box 220, French Camp, CA 95231. No visitors will be allowed. Personnel wishing to submit an application in person will need to make an appointment prior to arrival by calling 209-468-6818 effective immediately. Fees

All fees are non-refundable.

Application Fee: $209.00 (effective July 1, 2020)
Late Fee: $47.00 (effective July 1, 2020) for an application submitted after lapse
Replacement Card: $26.00 (effective July 1, 2020)

Personal checks are not accepted. Acceptable payment methods are cash, Debit, Visa, MasterCard, Discover, or money order. We strongly discourage sending cash by mail.

AUTHORIZATION POLICY


View the MICN Authorization Policy >>

POLICY AND SKILLS REVIEW (PSR) SCHEDULE AND REGISTRATION


You must be pre-registered to attend. Click here to view schedule and register.

FREQUENTLY ASKED QUESTIONS


Q: What are acceptable CE Hours for my MICN re-authorization?

Formal classes related to prehospital care and/or emergency nursing; participation in field care audit; up to 8 hours of observation time on a SJC ALS ambulance.

Q: Can I fax in my application?

No. You may bring your application in or mail it in, but it must have original signatures.