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  • Kish/VW EMS

    2727 Sycamore Rd, Suite 1A

    DeKalb, IL 60115

    Phone: 815-766-7563

    Email: Anthony.Woodson@nm.org

EMS Forms

Illinois Department of Public Health (IDPH) Emergency Medical Services (EMS) Rules and Regulations 
  • Main IDPH EMS Page
  • Illinois EMS Code (Rules)
  • Illinois EMS Act (Law)
IDPH EMS Forms and Links
  • EMS Licensing Online Fee Payment (EMS Licenses, Ambulance Service Providers)
  • EMS License Verification
  • EMS Authorization Release Information (Form)
  • EMS Extension Request (Form)
  • EMS Independant Renewal (Form)
  • EMS License Reinstatement (Form)
  • EMS Military License Request (Form)
  • EMS Inactive Request (Form)
  • EMS Reactivation Request (Form)
  • EMS Duplicate License Request (Form)
  • EMS Systems Fee Schedule (Form)
EMS Provider and Vehicle Licensing
  • Stretcher Van Application (Form)
  • EMS Ambulance Staffing Waiver Application (Form)
  • EMS Ambulance Inspection (Form)
  • EMS Equipment Waiver (Form)
  • EMS Non-Transport Inspection (Form)
  • EMS Non-Transport Provider Application (Form)
  • EMS Non-Transport Application for Existing Providers (Form)
  • EMS Special Event Request (Form)
  • EMS Stretcher Van Inspection (Form)
  • EMS System Plan Modification (Form)

 

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