Pediatric Readiness Checklist

This form is a tool for agencies to assess their pediatric readiness.

EMS Short Form

This form is designed to be left at the receiving facility. This provides a short overview of patient care until your chart is completed.

School Bus Release Form

This form is the IDPH Region 2 school bus refusal release form.

IDPH Training Application

This form is for applying for a training course.

Agency Information Change Form

This form is used to update agency contact information for MCAEMS and IDPH

IDPH Request to Modify/Amend

This form is for modifying/amending approved system plans and vehicles.

Medication Replacement - BLS

Medication replacement for BLS units

Medication Replacement - ILS

Medication replacement for ILS units

Medication Replacement - ALS

Medication replacement for ALS units

Combined Supply List

This is a combined list of the state and system equipment requirements

IDPH Non-transport Inspection Form

This is the inspection form for non-transport agencies. It only covers the state minimums.

IDPH Transport Inspection Form

This is the inspection form the state uses for inspections of transport units. It only covers BLS equipment.

Non-Transport Provider Form

This is an application for a new non-transport agency

IDPH Alternate Rural Staffing/Response

This form is for applying for a waiver to use either alternative rural staffing or alternate response mode.