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McLean County Area EMS System

1609 Northbrook Dr Ste 8
Normal, IL 61761

Phone: 309-827-4348
Fax: 309-808-4235

2017 © 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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