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Illinois EMS Summit
April 6, 2017
8:30 - 4:30


















Want to register for a course? Click "System Education" located in the left navigation pane on this page, or click on the course link.

McLean County Area EMS System

705 North East Street
Bloomington, IL 61701

Phone: 309-827-4348
Fax: 309-827-2017

2010 © McLean County Area EMS. All rights reserved.



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IDPH Forms

pdf/word logoNew EMT Reciprocity Application
pdf/word logoIDPH Ambulance Inspection Form
pdf/word logoEMT Relicensure Recommendations
pdf/word logoNon-Transport Inspection Form

IDPH Forms (updated December 2015)


System Forms

Mandated Clinical Event Reporting Form

Patient Outcome Request Form

Infield Upgrading Report Form

pdf/word logoSystem Entry Packet (Fillable)
pdf/word logoRemediation Plan
pdf/word logoInstructor's Record (timesheet for Registry Instructors)
pdf/word logoSystem Wide Crisis Form
pdf/word logoGeneric CE Roster
pdf/word logoEMS System Compliments or Recognition Form
pdf/word logo Experience Shift Summary
pdf/word logoContinuing Education RecordField
pdf/word logoF.A.S.T. Stroke Screening Form
pdf/word logoAmbulance Availability Form
MCAEMS ALS Agency Inspection Checklist
MCAEMS ILS Agency Inspection Checklist
MCAEMS BLS Agency Inspection Checklist
pdf/word logoMCAEMS First Responder Agency Inspection Checklist
pdf/word logoALS Medication Replacement Form
pdf/word logoILS Medication Replacement Form
pdf/word logoBLS Medication Replacement Form
pdf/word logoRefusal Form
pdf/word logoEMS Run Card
pdf/word logoEMS Run Card
pdf/word logoPreceptor Paramedic Student Final Eval Form
pdf/word logoRegistration form for all EMS classes
Background Check Form

Regional School Bus Release Form


Renewal Forms

pdf/word logoIDPH Extension Application
pdf/word logoIDPH Inactive-Reactivation Form
pdf/word logoIDPH Renewal Notice

More information on renewals can be found here. Also, please check out this brochure from IDPH.

Quality Related Forms

pdf/word logoIncident Report Form
pdf/word logoIOR Form
pdf/word logoService Excellence Form

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