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Agency Forms

Note that IDPH forms may require use of Internet Explorer to open

Form Name
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.
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