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McLean County Area EMS System

1609 Northbrook Dr Ste 8
Normal, IL 61761

Phone: 309-827-4348
Fax: 309-808-4235

2017 © McLean County Area EMS. All rights reserved.



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IDPH Forms

pdf/word logoNew EMT Reciprocity Application
pdf/word logoIDPH Ambulance Inspection Form
pdf/word logoEMT Relicensure Recommendations
pdf/word logoNon-Transport Inspection Form

IDPH Forms (updated December 2015)


System Forms

Mandated Clinical Event Reporting Form

Patient Outcome Request Form

Infield Upgrading Report Form

System Incident Report Form (Online)

System Improvement Oppurtunity Report Form (Online)

System Entry Packet

Remediation Plan

Instructor's Record (Timesheet for Registry Instructor)

System Wide Crisis Form

Generic CE Roster

EMS System Compliments or Recognition Form

Experience Shift Summary

Continuing Education Record

F.A.S.T. Stroke Screening Form

Ambulance Availability Form

MCAEMS ALS Agency Inspection Checklist

MCAEMS ILS Agency Inspection Checklist

MCAEMS BLS Agency Inspection Checklist

MCAEMS First Responder Agency Inspection Checklist

ALS Medication Replacement Form

ILS Medication Replacement Form

BLS Medication Replacement Form

Refusal Form

Preceptor Paramedic Student Final Eval Form

Registration Form for all EMS Classes

Background Check Form

Regional School Bus Release Form


Renewal Forms

pdf/word logoIDPH Extension Application
pdf/word logoIDPH Inactive-Reactivation Form
pdf/word logoIDPH Renewal Notice

More information on renewals can be found here. Also, please check out this brochure from IDPH.

Quality Related Forms

pdf/word logoIncident Report Form (Paper Form)
pdf/word logoIOR Form (Paper Form)
pdf/word logoService Excellence Form (Paper Form)

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