Provider Information Change Form

This form is used to update MCAEMS and IDPH if your contact information has changed.

IDPH License Reinstatement

For requesting a license to become reinstated

IDPH Fee Schedule

This is the fee schedule for new and renewing license

IDPH License Reactivation

For providers whose license is currently inactive and is requesting it to become active again

IDPH License Extension Request

For providers requesting a license extension

IDPH Inactive License Form

For providers who want to make their license inactive

IDPH Fee Waiver

This is for providers who serve only on a volunteer service or is part of the Illinois National Guard.

IDPH Military License Form

This form is for providers who are former/current military to apply for an IDPH EMS License