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JB Pritzker, Governor Copyright 2023 Financial & Professional Regulation Lead Third Party Examination
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IDPH Home Services Placement Agency Directory List of home services placement agencies as of January 2023, including facility name, address, phone number, license number, and license expiration date. Ownership for an Existing Health Care Facility
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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
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
You must enter a value. Pediatric Lead Poisoning High-Risk ZIP Code Areas - En Espaol - PDF
- Fillable PDF*, LEA Responcibilities Under AHERA - Fillable PDF*, Project Manager's Report Form - Fillable PDF*, Request for Variance Cover Sheet - Fillable PDF*, Assisted Living/Shared Housing Initial License Application
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Water Well Construction Report - Fillable PDF*
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endobj Much of the Illinois EMS licensing process can be accomplished online, using the links and forms available on this page. An agency that desires to provide out-of-hospital emergency medical care shall apply to the Iowa Department of Public Health. - PDF
Workers Compensation Opt-Out Form - PDF, Portable X-ray Medicare Certification - PDF
If you cannot update your profile you can print the below form and mail it to the Board office. Lead Program Contact Record and Order Form - PDF
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Application - PDF
Closed Loop Wells, Application for Original Youth Camp License - PDF
Vision Screening Worksheet -
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Cancellation of Employment/Supervision of Apprentice-
Requiring people to go through an administrative agency before filing a lawsuit is highly unusual. Illinois Emergency Medical Systems (EMS) license enclosed License #_____ I have attached my written request to the EMS medical director for inactive status. 0000001493 00000 n
5. Remember, you will not be allowed to function as an EMS provider until you have in your possession the new EMT-B license. Instructions
Plumber's License,
If you already have an account, log in. Report of Blood Lead Test Result - Filliable PDF, Certifications for Request for Inspection - Fillable PDF, Temporary Occupancy Policy - Fillable PDF*, Application for Manufactured Home Community (a/k/a Mobile Home Parks)
The Alabama Department of Public Health will verify an applicant's immigration status or naturalized/derived citizenship status using the SAVE Program effective August 1, 2016. A person currently licensed as an EMT, Intermediate, or Paramedic may only use their EMS license in 0000060338 00000 n
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Matrix 4D - Project Cost and Fee Verification - Fillable PDF*
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Agency Licensing Initial Application, Home Health, Home Services, Home Nursing and Placement
Performs routine vehicle, tool and facility maintenance on a daily basis. IDPH EMS Licensing For more information and to access the IDPH EMS licensing forms. Hospice Administrative Staff Changes - PDF
The Department also licenses stretcher vans, which must meet a defined set of safety feature requirements. Intended Mother Form - PDF
Licensees may utilize this site to update their contact information. Hospital Medicare Certification - PDF
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Matrix 4C - Interior Finishes - Fillable PDF*
Rabies Submission Form - PDF
Child Support Statement: 35 0 obj Enter your new address. <>/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)>> 0000003950 00000 n
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). Program Application, Nursing Education
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Reciprocity with the City of Chicago, Application for -
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Injury and Illness Report - PDF. Irrigation Contractor Surety Bond Forms
Water Well Sealing Form - Fillable PDF*
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Lead Risk Evaluation and Blood Lead Testing Guidelines - 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) How do I renew my EMT license if I am affiliated with an Illinois EMS system? Assessor, Application - PDF - Instructions
Emergency Medical Technician (EMT) Reciprocity Application - Fillable PDF
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Emergency Medical Services (EMS) Systems Licensing. Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Pregnancy Termination Initial Licensure - Fillable PDF*
Involuntary Termination of Residency Forms
Sign and submit the top portion of this form to your EMS system for renewal. 0000004256 00000 n
Lead License Renewal Application - PDF
Licensees may utilize this site if all criteria are met as outlined in the letter accompanying your license renewal notice. endstream
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The most important duties and responsibilities you'll want to include in a job description are: Preventing, combating and extinguishing fires with the goal of protecting . }Of|h{
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It costs nothing to change your name unless you want a duplicate license mailed out. License, Application for Examination for, Plumber's License,
'u s1 ^
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Agency Medicare Certification - PDF
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Ownership for an Existing Health Care Facility, Health Facilities Planning Board -
Hearing Conservation Annual
Irrigation Employee, Application for Registration for - PDF
Find a Licensee My Licenses File a Complaint Bureau of Professional Licensure Welcome to the Bureau of Professional Licensure license portal. Request for Duplicate License Certificate - Fillable PDF
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Emergency Medical Technician (EMT) Examination
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Address changes can be made ON LINE in the IDPH database listed below. Scholarship Program Application, Structural Pest Control: Business application, Non-Commercial, Structural Pest Control: Business License
Welcome to the Illinois Department of Public Health, Division of EMS and Highway Safetys online licensing site. Hospice Renewal
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Application for Restoration of Expired - PDF
Gestational Surrogate Form - PDF
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Manufactured Home Community Transfer Application
Report - PDF
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Please contact the Division at 217-785-2080 or at DPH.EMTLIC@illinois.gov with questions or for more information. Nursing Education
2nd payout after 6 months of employment. Licensees may utilize this site to update their contact information. <>/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)>> [28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R] Code Book Order Form - PDF
Structural Pest Control: Business application, Non-Commercial - PDF
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The Internet Archive offers over 20,000,000 freely downloadable books and texts. Social Worker/Worker Assistant Qualifications Review - Attachment D, Agency Manager Qualification Review - Attachment E, Home Health Agency Management Status Form, Home
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Emergency Department Approved for Pediatrics (EDAP) Nurse Practitioner Waiver - Fillable PDF
No If yes, contact IDPH, Division of Highway Safety at 217-785-2080 and request a personal history review packet. <>/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)>> Water Well Construction Report Instructions - PDF
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Waiver Application - PDF
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. Home Health, Home Services, Home Nursing and Placement
Apprenticeship Application Under JAC- PDF
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UCIA Background Check Form
Mail to: HHS Bureau of Professional Licensure Our mission is to protect and promote the lives of Illinois consumers. 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 0000000016 00000 n
Health Agency Agency Supervisor Qualifications Review - Attachment B, Home Health Agency
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Lead Assessment Form, Public Health Nurse Home - PDF
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EMS Service Programs shall submit a completed application and documentation that they meet or exceed the minimum requirements of Iowa administrative code 641-132. 1)"@JjA,c !Hs \,#n qA\[ r
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 Dialysis Medicare Certification - PDF
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Re-examination application - PDF - Instructions, Designation/Re-Designation of CSC, PSC or ASRH with National Certification - PDF
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Facility Medicare Certification, Application for Registration of Continuing Education, Electronic Roster for Plumbers Continuing Education, Plumber Application Child Support Certification, Plumber's License
from Vox: Next, housing reform must consider the many government administrative agency roles in supporting affordable housing. Application for Exemption from Certificate of Need Review and Permit
Agency Medicare Certification, Home
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Freestanding Emergency Center (FEC) Initial Licensure Application - Fillable PDF
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Request for Manufactured Home Installation Seals and Certificates
License Information License Application Forms Notice Resources & Publications Laws and Rules Contact Us Instrument Dispenser Inactive Status Request Form, Hearing
Home
Initial Licensure IDPH Administrative Code on EMT Licensure 2020 Transition to National Registry Testing (NREMT) IDPH Memo - July 2019 Adult Adopted Person
Plumber's License
IDPH licenses Emergency Medical Services provider agencies and their transport and non-transport vehicles to ensure compliance with equipment and staffing requirements, along with minimum build standards as adopted by the state and enforced through an inspection process. Occupancy Matrices
This fee is required by IDPH to process your new EMT-B license. 0000043534 00000 n
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: public education, fire inspections, etc.) IDPH Board. Marriage/Civil Union Record Files, Application for Verification of - PDF, Water Well, Application for Permit to Construct, Modify or Abandon a - Fillable PDF*
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 There is also a collection of 2.3 million modern eBooks that may be borrowed by anyone with a free archive.org account. Plumbing Notice of
Reasonable Accommodation Request for Examinees with Disabilities - Fillable PDF
Matrix 4A - UL Assembly Ratings - Fillable PDF*
*These are draft forms pending final approval of the rules. Which name do I submit for licensure? Correction of a Birth Certificate, Application for
Emergency Department Approved for Pediatrics (EDAP) Physician Waiver - Fillable PDF
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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. 0000003201 00000 n
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It is your responsibility and in your best interest to also keep your email address updated. Health Agency - Hospice Add or Remove Geographic Service Areas, Home Health
}piW$2L ( xb``g``a eP30p40! Instructions
Adoptive Parent Registration Forms
2020 Rule Changes FAQ FAQ on the implementation of the September 2020 rule changes in Chapter 131, 132 and 139 as well as changes to provider scope-of-practice. 0000002109 00000 n
Application - PDF -
38 0 obj application, Commercial, Structural Pest Control Certificate of
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Occupancy Matrices
Under the general direction of the Lieutenant, the Firefighter/EMT - Firefighter/Paramedic performs fire suppression, rescue operations, fire prevention activities (e.g. startxref
Adhere to the state guidelines of the IDPH licensure scope of practice. Stretcher Van Inspection Form - Fillable PDF
Facility Information Change Form - Fillable PDF*
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Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Allied Health Care Professional
(New July 01, 2023 wage scales are pending subject to . 0000028929 00000 n
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Lead Contractor 7-day Notice
These are draft forms pending final approval of the rules. I understand that during my . Matrix 4C - Interior Finishes - Fillable PDF*
HWkO_Q|X4mvugL!am' ANU:e qC 72i;> `: _Bs|L{_h['j Welcome to the Bureau of Emergency and Trauma Services (BETS). Then change your surname . Structural Pest Control Certificate of
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Personal History Statement: Have you ever been convicted or plead guilty of any felony offense? Project Submission Form for Freestanding Emergency Center - Fillable PDF
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Form - PDF
at what age can a child refuse visitation in utah; ventajas y desventajas de la terapia centrada en el cliente; humana otc pharmacy login; kindercare board of directors Sample Letters - Word, Freedom of Information Act Form - Fillable PDF*, Certifications for Request for Inspection - Fillable PDF
Lead Worker Application or En Espaol - PDF - Instructions
Structural Pest Control: Business License
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Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Hospital Initial Licensure - Fillable PDF*
FAQ for IAC 131, 132, 139 and The Iowa EMS Provider Scope-of-Practice Sept 2019 2020 Rule Changes Webinar Recording Iowa Administrative Code 131 Webinar Iowa Administrative Code 132 Webinar @L|Z"E
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Residency Involuntary Termination Form - PDF
Plumber Application Child Support Certification - PDF
Agency Add or Removes Services, Hospice Residence Initial/Renewal Application, Irrigation Contractor, Application for Registration for, Contractor's Test Certificate Lawn Sprinkler System, Irrigation Contractor Application Child Support Certification, Plumbing Contractor Registration Online Renewals, Irrigation Employee, Notice of Cancellation of Employment Registered, Irrigation Employee, Application for Registration for, Lawn Sprinkler System, Contractor's Test Certificate, Communicable Diseases Laboratory Test Requisition, Request for Respiratory/Influenza Testing, Lead Abatement/Mitigation Project, Notice of Commencement, Lead Assessment Form, Public Health Nurse Home, Lead Program Contact Record and Order Form, Lead Contractor Application
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