Adult Adopted Person - Partnership - PDF :[ru@e\w}4PL V:5sl*"5Uke;vL *g _ This site has been designed to be a resource for learning about Iowa's EMS system and to provide necessary information regarding EMS provider certification and renewal, andservice program authorization. 0000073177 00000 n Home Special Flood Hazard Area Location Request Form - PDF, Certificate of Child Health Examination Form - PDF, Comprehensive License, Application for Examination for, Plumber's License, Complaint Form - PDF endobj Health Agency Administrative Staff Changes, Home Health Agency Administrator Qualifications Review - Attachment A, Home Application (General Use) - PDF - Water Well Construction Report - Fillable PDF* 0000070678 00000 n Application, Pediatric Lead Poisoning High-Risk ZIP Code Areas, Non-flammable Medical Gas Storage and Mechanical System Requirements, Nursing Home Licensure Administrator Form, Nursing Home Licensure Alzheimers Special Care, Nursing Home Licensure Budgeted Financial Statement, Nursing Home Licensure Capacity & Level of Care, Nursing Home Licensure Licensure Information, Nursing Home Licensure Personal Data Sheet, Specialized Mental Health Rehabilitation Facility - License Application, Specialized Mental Health Rehabilitation Facility - Personal Data Sheet, Specialized Mental Health Rehabilitation Facility - Bed Capacity Form, Specialized Mental Health Rehabilitation Facility - Plan of Operation, Specialized Mental Health Rehabilitation Facility - Financial Statement, Application for Manufactured Home Community, Manufactured Home Community Transfer Application, Original Application for Manufactured Home Installer License, Renewal Application for Manufactured Home Installer License, Application for Manufactured Home Manufacturer License, Request for Manufactured Home Installation Seals and Certificates, Manufactured Housing Consumer Complaint Form, Migrant Labor Camp Original/Renewal License Application, OPT-SP-OTS Eye Examination Waiver Form 2009 - PDF Service Improvement Form - Fillable PDF Application for Youth Camp Construction Permit - PDF - Limited Liability Company - PDF A person currently licensed as an EMT, Intermediate, or Paramedic may only use their EMS license in trailer If so, what system number? 40 0 obj Plumber's License, 0000028622 00000 n Death Record Files, Application for Search of - PDF How to Apply for an EMS Personnel License at the EMT-R, EMT, AEMT or Paramedic Level Step 1A: Submit Application for EMS Personnel Licensure in LMS Step 1B: Complete Fingerprint Background Check (GAPS) Applicant Registration Step 2: Go and Get Fingerprinted General Requirements for ALL EMS license applications (EMT-R, EMT, AEMT, Paramedic) Application, Assisted Living/Shared Housing Initial License Application, Birthing Center Initial Licensure Application, Application for Original Campground License, Application for Campground Construction Permit, Special Flood Hazard Area Location Request Form, Certificate of Child Health Examination Form, Comprehensive 0000070833 00000 n 0000060338 00000 n Reciprocity with the City of Chicago, Application for - 41 0 obj 0000026686 00000 n Application for Restoration of Expired, Plumber's License, Closed Loop Wells, Application for Original Youth Camp License - PDF Agency Licensing Initial Application - Fillable PDF* active Iowa EMS certification will be changed to an inactive status. Please contact the Division of EMS and Highway Safety at 217-785-2080 or at DPH.EMTLIC@illinois.gov with questions or for more information. 0000028220 00000 n 0000035600 00000 n 0000000016 00000 n Outpatient Rehab Facility Medicare Certification - PDF Military Personnel Application - PDF for Permit, Hearing ems-license-reinstatement-application-061416 . 0000049137 00000 n Trauma Nurse Specialist (TNS) Examination Application, End Stage Renal - Corporation - PDF An inactive Iowa EMS certification may be reactivated in accordance with IAC 641-131.6(4). 36 0 obj Citizenship or Lawful Presence of an Alien. Illinois Emergency Medical Systems (EMS) license enclosed License #_____ I have attached my written request to the EMS medical director for inactive status. Home Health Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Dental Examination Form, Proof of School - PDFEn Espaol - PDF rxxC6~qz=0vvvMz8 Q23%C#"vF_6(bP8$%v #~xyj Insurance - PDF Ownership for an Existing Health Care Facility About Us . Under the general direction of the Lieutenant, the Firefighter/EMT - Firefighter/Paramedic performs fire suppression, rescue operations, fire prevention activities (e.g. endstream endobj 6 0 obj<> endobj 7 0 obj<>/Font<>/ProcSet[/PDF/Text]/ExtGState<>>>/Type/Page>> endobj 8 0 obj<> endobj 9 0 obj<> endobj 10 0 obj<>stream 0000043771 00000 n trailer EMS - Service Information. 0000000916 00000 n 0000026303 00000 n Matrix 4C - Interior Finishes - Fillable PDF* Mail to: HHS Bureau of Professional Licensure 0000007862 00000 n Last 4 digits of SSN 0000004897 00000 n <> Initial Licensure IDPH Administrative Code on EMT Licensure 2020 Transition to National Registry Testing (NREMT) IDPH Memo - July 2019 Applicant Information Last Name: First Name: MI: Home Mailing Address: City: State: Zip Code: Area Code and Phone Number: Email Address: Plumber's Emergency Medical Services (EMS) Systems Licensing, Please contact the Division at 217-785-2080 or at. Certifications for Request for Inspection - Fillable PDF Appeal Hearing Request Form - PDF, Birthing Center Initial Licensure Application - Fillable PDF*, Application for Original Campground License - PDF Program Application - PDF 0000043020 00000 n 0000040291 00000 n Legal Guardian Registration Forms, Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Application/Eligibility Voucher for Low-Cost Spay/Neuter - Fillable PDF*, Veterinarian Application/Agreement to Participate - Fillable PDF*, Asbestos Abatement Notification Form - Fillable PDF*, Asbestos Contractor Application Yes. Vision Conservation Annual from The Hill: The Supreme Court upholds administrative agency actions alleged to be arbitrary 92 percent of the time. IDPH EMS Licensing For more information and to access the IDPH EMS licensing forms. endobj * R4Gegy|5n^,9r:*aicjF,_R]hJ*3O\TF2\XgmZmq/"!,xdp.BzEscKJTA$$[H /$|b)vfeT0}}4 'U(~oPBWIDtZy$tQ&YLTj\ud~U]AC^R@8qO%l0*\/6pZVmO1;WRSnT=`g/![LZO*L?NX\"4\RY*1FIHP?jAu]&f(O7BJIm|9sqGRgXb?hsx8|O2 w,n"n?tpoT{z7. Facility - PDF - Instructions, Abestos in Schools, Responsibilities of IDPH Chicago Headquarters Offices 122 S. Michigan Avenue, 7th and 20th Floors Chicago, IL 60603 312-814-2793 69 W. Washington Street, 35th Floor Chicago, IL 60602 312-814-5278 IDPH Community Event Request Form Learn More Event/Outreach Request FOIA Requests News Media Language Access Services Hotline Numbers AIDS/HIV/STD 800-243-2437 0 0000027138 00000 n 0000048204 00000 n 0000040089 00000 n 74 0 obj 0000048768 00000 n Please contact the Division of EMS and Highway Safety at 217-785-2080 or at DPH.EMTLIC@illinois.gov with questions or for more information. <>/Border[0 0 0]/H/N/Rect[291.93896 185.15302 500.06104 175.15302]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems)>> Then change your surname . Q\;5bQH`;=r0`Vq JnB{4]wRMSS*Xsg1}tUL;EZy&:Pi&"9^: F^5.%B4gM)@,(\ \4L fPUZHN+sXk~0-ho]^$ K$Yis#PWz%lpai!H{\3LHYu%Ji3PD[WVdo,EPMO }8ud 0000049053 00000 n endobj Sample Letters - Word, Freedom of Information Act Form - Fillable PDF*, Certifications for Request for Inspection - Fillable PDF Specifically, Senate Bill 1306 would require the Illinois Department of Public Health to adopt the requirement within one year of the bill's signing. 0000004564 00000 n 0000072995 00000 n Enter your new address. Agency Licensing Renewal/Change of Ownership Application, Home Health Water Well Sealing Form - Fillable PDF* HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! If you need to create an account, use the button below. "ChpEObbG]!>E5o(fV+. Y&bH;rp}3Yy'wH9rp Adoptive Parent Registration Forms An individual can change their name with IDPH by emailing their EMS System a copy of their marriage license, divorce decree (front page and name change page only), or court order. %PDF-1.3 % 1st payout on 1st payroll check. Residency Involuntary Termination Form - PDF Structural Pest Control Certificate of 0000044504 00000 n Gestational Surrogate's Husband - PDF Lead License Renewal Application - PDF Reasonable Accommodation Request for Examinees with Disabilities - Fillable PDF Inactive/Reactivation Application, Emergency Medical Technician (EMT) Examination, Emergency Medical Technician (EMT) Reciprocity Application, Independent EMS License Renewal Request Form, Reasonable Accommodation Request for Examinees with Disabilities, Request for Duplicate License Certificate, Trauma Nurse Specialist (TNS) Examination Application, End Stage Renal State of Illinois | Illinois Department of Financial & Professional Regulation The Illinois Department of Financial and Professional Regulation. Water Well Pumps, Installation Report for - Fillable PDF* 0000062643 00000 n Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Hospice <> Hearing *These are draft forms pending final approval of the rules. Form - PDF Much of the Illinois EMS licensing process can be accomplished online, using the links and forms available on this page. 24 0 obj Plumber's License, The System files the appropriate paperwork with IDPH. settings Services account_balance Agencies supervised_user_circle Social. Lawn Sprinkler System, Contractor's Test Certificate - PDF, Communicable Diseases Laboratory Test Requisition - PDF )SI{ 0BO|cEs}Oq""TV}c`u-hSwi8J", `)O.l!5=;7~#PA#?`nz MpzyBwz0tR:R,Ja.+,!b8OnPVd;ZDv? 0000002154 00000 n - Sole Proprietor - PDF Multiple Hospice Location Questionnaire - PDF <>/Border[0 0 0]/H/N/Rect[48.5 279.61099 203.00702 269.61099]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems/res_sysListing)>> startxref Application for Retired, Plumber's License - Limited Liability Company - PDF <>/Border[0 0 0]/H/N/Rect[335.39197 173.15302 456.60803 163.15302]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems)>> prescribed by IDPH in rules adopted pursuant to the Act and the requirements of the EMS System in which he or she practices, as contained in the approved System Program Pla n. 2. Application for Exemption from Certificate of Need Review and Permit hb``a``Mf`e`8Abl,6^p``|0G29 `76h k@P47LYosM>FG Rl;0010`^ v@H%udtWi&',,adt~$Vw8K9;f"6 X0( public education, fire inspections, etc.) SUBPART C: EMS SYSTEMS. @L|Z"E y8_ORE_\)W-)D SmHw1x<0Jm6a]u` z IDPH- 3 rd Floor EMS 422 South 5 th Street Springfield, IL 62701 Resources EMS Licensing Online Fee Payment/License Verification EMS Active License Counts Forms EMS Extension Request Application EMS Independent Renewal EMS Authorization Release Information EMS License Reinstatement EMS License Renewal Brochure EMS Renewal Notice You may complete your renewal online at the website listed on the form. %PDF-1.3 % from Vox: Next, housing reform must consider the many government administrative agency roles in supporting affordable housing. Department of Public Health (IDPH). Allow 2-3 weeks for processing. 35 0 obj 0000040777 00000 n name change information: *Must include stamped or certified document (or photocopy of a stamped or certified) of one of the following: marriage certificate divorce decree court order naturalization document Marriage/Civil Union Record Files, Application for Verification of - PDF, Water Well, Application for Permit to Construct, Modify or Abandon a - Fillable PDF* endobj Have you operated under an EMS system? Address Change Form Click here to Access Online Services or to Apply Online Iowa HHS Bureau of Professional Licensure 321 E. 12th St. Des Moines, IA 50319 Phone: (515) 281-0254 Fax: (515) 281-3121 Online Licensure Services: http://ibplicense.iowa.gov Email: PLPublic@idph.iowa.gov Office Hours: |6N*0uQPh-$W!ZjF1l $px(SjfudV77a`}PNF27y0^-D-o:xmGu5Q= hgZe46z{I':(d*;\gXQ F&s,G}F\*hbsfSQ|w2Z P_/L3 @}'66@,T~yU2R$}ItH1.TA#;#2a `2o#\ 8!QCKPB {dSuh2p;lab$1KbZxRtZZV 55iP8::.4)!_]b_U1p2._kNE/{,@P%s7ZkTb3-bHKI)EGg!3Q!C{>&DGM`a0 Warning: You don't need to pay a separate company to change your address. %%EOF Once you have your IDPH emailed PIN and instructions for payment click here: IDPH Fee Payment Siteto pay your fee. Updating information online? 0000029229 00000 n Complete the LEMSS EMS Personnel Data Form (loyolaems.com), including . Plumbing Contractor Surety Bond Forms Checklist, Lead Public Information Disclosure * Home Bureau of Emergency and Trauma Services Emergency Medical Services EMS - AMANDA Portal Resources for Services EMS - AMANDA Portal Resources for Services AMANDA is the online registry and database for regulatory programs within the Bureau of Emergency and Trauma Services AMANDA Portal Structural Pest Control Technician application, Commercial, Structural Pest Control Certificate of 0000035991 00000 n You will need a credit or debit card and a valid email address. 0000005229 00000 n You must enter a value. 0000043601 00000 n - Fillable PDF*, Asbestos Professional Application The Internet Archive offers over 20,000,000 freely downloadable books and texts. 0000004256 00000 n 0000072793 00000 n Report - PDF Vision Examination Report (V-4) - %PDF-1.7 % 0000001085 00000 n 0000000816 00000 n Hearing 0000003055 00000 n <]>> Licensees may utilize this site to update their contact information. 2023 Iowa Department of Health and Human Services, Civil Commitment Unit for Sexual Offenders, Emergency Medical Services for Children (EMSC), Mobile Integrated Health - Community Paramedicine, Healthcare Coalitions Systems Development, Click HereFor Latest Information RegardingNovel Coronavirus (COVID-19), FAQ for IAC 131, 132, 139 and The Iowa EMS Provider Scope-of-Practice Sept 2019. 2nd payout after 6 months of employment. <> IDPH EMS LICENSING BROCHURE for INDEPENDENTS For more information regarding relicensure in the Silver Cross EMS System, please contact Marilyn MacBlane, EMS Operations Coordinator at 815-300-2900 for assistance. 0 pc3te^C~3WdZfl56* 3}awD#{/7;/P8&h5M6@4]iL`4U:YHh:Z6[ P c84T4HsZavQ6(FVg4XVq+s(hV8K-Z 0000004294 00000 n Plumbing Inspectors, Application for Examination for Certification of - PDF C1&?6 ~wP[!ScvFUiAl>P D STEP 2: Contact the LEMSS office To notify the System of your address change. %PDF-1.3 % Dialysis Medicare Certification - PDF Instrument Dispenser License Application Form, Hearing Lead Assessment Form, Public Health Nurse Home - PDF 26 0 obj qY]X~3|?tPb]GX6|prD c\ptw@=)=VytzwM0 H=,9E-3VA$@[@hC_ MgbET$?[W1_-]u_[G&7W"^_{YCZ_OPVsk 5novzs}c=pgrWG4wu\975I\Q. HWms8b_-F%olePoflYuK.:*,nut! J0Lq;g! startxref PDF, Affidavit of No Employees - PDF 0000002473 00000 n 0000004891 00000 n 0000007819 00000 n %PDF-1.4 % endobj Licensees may utilize this site to update their contact information. Springfield: 217-52 4-DoIT (217-524-3648) Chicago: 312-81 4-DoIT (312-814-3648) Technical Support Week Days (8A-5P, Monday-Friday) Contact the IDPH Helpdesk at 866-220-5247 or via email at DPH.Helpdesk@illinois.gov for Portal access and web-based application support. endobj Instrument Dispenser Inactive Status Request Form - PDF Full-Time. Matrix 4D - Project Cost and Fee Verification - Fillable PDF* endstream endobj 289 0 obj <>stream Matrix 4A - UL Assembly Ratings - Fillable PDF* 0000002586 00000 n My name is changing soon. <>/Border[0 0 0]/H/N/Rect[48.5 267.61099 200.46503 257.61099]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems/res_sysListing)>> Water Well Construction Report Instructions - PDF Division of EMS and Highway Safety's on-line licensing site. 0000040641 00000 n ILLINOIS DEPARTMENT OF PUBLIC HEALTH Emergency Medical Systems and Highway Services . Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Head/Spinal Cord and Violent Injury Registry (HSVI), EMS Dispatch Agency Certification Application, EMS Dispatch Agency Recertification Application, EMS Alternate Rural Staffing Authorization Request, EMS Ambulance Staffing Waiver Application, EMS Non-Transport Inspection Form Provider, EMS Non-Transport Application for Existing Transport Provider, Grant Accountability and Transparency (GATA). It is your responsibility and in your best interest to also keep your email address updated. Scholarship Program Application, Medical Student Scholarship 5 0 obj <> endobj Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Licensed Day Care Centers Form - Fillable PDF* Accredited - PDF, Asbestos Training Course Instructor Application - PDF, Asbestos Training Course Provider Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Hospital Initial Licensure - Fillable PDF* Instructions, Asbestos Worker Application 30 0 obj<>stream Requiring people to go through an administrative agency before filing a lawsuit is highly unusual. endobj Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Allied Health Care Professional Agency Add or Removes Services - PDF 0000002756 00000 n Correction of a Birth Certificate, Application for endobj The RH will then submit the completed paperwork to IDPH and notify your employer of the change in your level of licensure. Request for Duplicate License Certificate - Fillable PDF Renewal Application for Manufactured Home Installer License Lead Third Party Examination 4. endobj 0000040208 00000 n Stretcher Van Inspection Form - Fillable PDF 0000036476 00000 n 0000044485 00000 n <>/Border[0 0 0]/H/N/Rect[26 154.811 185.51801 144.811]/Subtype/Link/Type/Annot/URI(http://www.dph.illinois.gov/topics-services/emergency-preparedness-response/ems/licensing)>> 38 0 obj Emergency Medical Technician (EMT) Examination 0 0000004583 00000 n Licensure - PDF IDPH Administrative Code on EMT Licensure, Frequently Asked Questions Transition to National Registry Testing, IDPH Administrative Code on License Renewals, IDPH Change of Address & License Renewal Brochure, Region 11 EMS Medical Directors Consortium Memos, Mobile Integrated Healthcare Community Paramedic (MIH-CP). ;EXr )_dcQ+|d_\'|ws%z~w~wH/?#wo}{mp zGXMiR=QOU5z\TU;~>R?~\C*m6_?^9xZ?a{|OQXN9O|GOs&o*q5[Z?^L,6%.6z . 0000019702 00000 n Borrow a Book Books on Internet Archive are offered in many formats, including. Personal History Statement: Have you ever been convicted or plead guilty of any felony offense? 2023.2.17 - IDPH Reports 19 Illinois Counties at an Elevated Community Level for COVID-19 News - Friday, February 17 , 2023 2023.2.10 - IDPH Reports 15 Illinois Counties at an Elevated Community Level for COVID-19 The Department also licenses stretcher vans, which must meet a defined set of safety feature requirements. 0000027677 00000 n EMS System Application Instruction Guide Hospital Medicare Certification - PDF 30 0 obj Plumbing License Online Renewals Irrigation Employee, Application for Registration for - PDF If you already have an account, log in. endstream endobj 11 0 obj<> endobj 12 0 obj<> endobj 13 0 obj<> endobj 14 0 obj<> endobj 15 0 obj<>>>/Subtype/Form/Length 30184/Filter/FlateDecode/Name/Fm1/Matrix[1 0 0 1 0 0]/Resources<>>>/Type/XObject/BBox[-0.4984 -12.2794 9.92465 1.32792]/FormType 1>>stream If you cannot update your profile you can print the below form and mail it to the Board office. 0000043322 00000 n <> Note any name or address changes or corrections in the appropriate space. 0000043687 00000 n 0000035503 00000 n 0000056136 00000 n Application, Apprentice - PDF 0000040410 00000 n Contractor's Test Certificate Lawn Sprinkler System - PDF Water Well Contractor Online Renewal Agency Licensing Initial Application, Home Health, Home Services, Home Nursing and Placement Lead Risk Questionnaire, Childhood - En Espaol - En franais - PDF 37 0 obj 0000001345 00000 n We hope that you find this site informative and useful. 0000000016 00000 n 6. Outpatient Rehab Facility Medicare Certification, Notice of Involuntary Transfer or Discharge and Opportunity for Hearing for Nursing Home Residents Form, Alternate Rural Staffing and Response Authorization Request, Emergency Department Approved for Pediatrics (EDAP) Nurse Practitioner Waiver, Emergency Department Approved for Pediatrics (EDAP) Physician Waiver, Emergency Medical Systems Extension Application, Emergency Medical Systems 5 26 0000004945 00000 n trailer <]>> startxref 0 %%EOF 35 0 obj<>stream Waiver Application -Facts - PDF, Health <<0A5BC8D6A5C0114EA7E6320DFCBFFB09>]>> endobj Fire Detection; Fire Sprinklers; Fire Extinguishers endstream endobj 286 0 obj <>>>/MarkInfo<>/Metadata 61 0 R/Names 307 0 R/Pages 283 0 R/Perms/Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/StructTreeRoot 109 0 R/Type/Catalog>> endobj 287 0 obj <>stream hbbd``b` 3= "`^. HMs0{dI@%im'SH\}p }vN8,k"`I8ZdA^n=@)"P \=n'p M q. Plumbing Contractor Registration Online Renewals - Partnership - PDF 27 0 obj Lead Training Course Roster - PDF Birth Parent Registration Forms For address change, . Lead Program Contact Record and Order Form - PDF Emergency Department Approved for Pediatrics (EDAP) Physician Waiver - Fillable PDF Name changes must be processed with the IDPH EMS Division per the mail, submitting copies of legal documents acceptable to IDPH that verifies the name change. License Information License Application Forms Notice Resources & Publications Laws and Rules Contact Us Trauma Nurse Specialist Course Coordinators (TNSCC) Testing Application Submission 0000044334 00000 n Sixty (60) days prior to the expiration date on your license, you should receive a renewal notice form in the mail from the Illinois Department of Public Health, Division of EMS and Highway Safety. payable to the Illinois Department of Public Health. Occupancy Matrices In April 2015 the National HighwayTransportation Safety Administration reviewed Iowa's EMS system. 0000048970 00000 n License, Application for Examination for - PDF Freestanding Emergency Center (FEC) Initial Licensure Application - Fillable PDF for Permit - PDF, Audiogram Form . %%EOF Request for Manufactured Home Installation Seals and Certificates application, Commercial - PDF - Application for Exemption from Certificate of Need Review and Permit Normal operations will resume at 8:30 a.m. on Thursday, July 5. Health Agency - Hospice Add or Remove Geographic Service Areas, Home Health Surviving Relative of Deceased Adopted/Surrendered Person This section provides guidance . Surviving Relative of Deceased Adopted/Surrendered Person, Surviving Relative of Deceased Birth Parent, Ambulatory Surgical Treatment Center Initial Licensure, Ambulatory Surgical Treatment Center Medicare Certification, Ambulatory Surgical Treatment Center Project Submission Form, Ambulatory Surgical Treatment Center Renewal Licensure, Certifications for Request for Inspection, Matrix 4B - Through Wall/Floor Penetrations, Matrix 4D - Project Cost and Fee Verification, Matrix 4E - Fire, Smoke, Fire/Smoke Damper, Application/Eligibility Voucher for Low-Cost Spay/Neuter, Veterinarian Application/Agreement to Participate, Asbestos Training Courses, List of Illinois Workers Compensation Opt-Out Form - PDF, Portable X-ray Medicare Certification - PDF Welcome to the Illinois Department of Public Health, Division of EMS and Highway Safety's online licensing site. 33 0 obj Instrument Dispenser License Correction Form, Home Health, Home Services, Home Nursing and Placement xref Trauma Nurse Specialist (TNS) Application Instruction Guide Emergency Department Approved for Pediatrics (EDAP) Nurse Practitioner Waiver - Fillable PDF Cancellation of Employment/Supervision of Apprentice, Plumbing Contractor Application for Registration or Renewal, Allied Health Care Professional Agency Branch Questionnaire - Fillable PDF* 0000070466 00000 n - Corporation - PDF 0000001009 00000 n 0000042646 00000 n Instrument Dispenser License Application Form - PDF Matrix 4F - Air Balancing - Fillable PDF* 0000001117 00000 n Hospice Change Application, Apprentice, Plumber's 0000028929 00000 n 25 0 obj Change your address Attach documents to your license File a complaint Look up a list of licensees File a Complaint Make a complaint online. endobj Application for Campground Construction Permit - PDF Temporary Occupancy Policy - Fillable PDF* 5 0 obj <> endobj 0000002109 00000 n 0000043753 00000 n The Board primarily utilizes email for communication with the licensee. 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