To comply with this law, ADPH requires the following for an initial permit or renewal application: A signed Declaration of U.S. Irrigation Contractor Application Child Support Certification - PDFPlumbing Contractor Registration Online Renewals Vision Rescreening Worksheet - Biological Mother Affidavit Applicant Information Last Name: First Name: MI: Home Mailing Address: City: State: Zip Code: Area Code and Phone Number: Email Address: 0000003201 00000 n Special Flood Hazard Area Location Request Form - PDF, Certificate of Child Health Examination Form - PDF, Comprehensive Plumbing Contractor Registration Online Renewals and patient care in emergent and non-emergent settings. Q\;5bQH`;=r0`Vq JnB{4]wRMSS*Xsg1}tUL;EZy&:Pi&"9^: F^5.%B4gM)@,(\ \4L fPUZHN+sXk~0-ho]^$ K$Yis#PWz%lpai!H{\3LHYu%Ji3PD[WVdo,EPMO }8ud Re-examination application - PDF - Instructions, Designation/Re-Designation of CSC, PSC or ASRH with National Certification - PDF We hope that you find this site informative and useful. Lawn Sprinkler System, Contractor's Test Certificate - PDF, Communicable Diseases Laboratory Test Requisition - PDF If you already have an account, log in. a>a8p R>g.>JBOtJ9I.~c\/$AIhc-7-^C)WLKwjw\OE-+I_ufh9^`LOm0gD[as3[`X\TS}Z_IZ=n$&6 v$7oVaru#WvmO1FdTv 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) "P*)FbzUqJ~a7VO@5f'# z 5 0 obj <> endobj trailer xb``g``a P30p40! Water Well Contractor Online Renewal Facility 0000043753 00000 n Application for Restoration of Expired, Plumber's License, Occupancy Matrices 0000004647 00000 n PDF Licensees may utilize this site if all criteria are met as outlined in the letter accompanying your license renewal notice. 0000075240 00000 n %%EOF Water Well Construction Report - Fillable PDF* EMS - Service Information. 34 0 obj Under the menu, go to Desktops or Apps, click on Details next to your choice and then select Add to Favorites. Illinois Emergency Medical Systems (EMS) license enclosed License #_____ I have attached my written request to the EMS medical director for inactive status. 0000035503 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. How to Search for Discipline and Public Actions Select the specific licensing board from the list to the left You must enter a value. 0000004872 00000 n Dialysis Medicare Certification - PDF 0000005229 00000 n 5 0 obj <> endobj 0000007771 00000 n <> Address Change. PROVIDING LIFE SAVINGS SOLUTIONS SINCE 2009. Home Plumber Application Child Support Certification - PDF Program Application, Nursing Education PDF, Birth Record Files, Application for Search of - PDF 0000002154 00000 n Requirements, Health Facilities Planning Board - Application ;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 . Adult Adopted Person 0000029229 00000 n Freestanding Emergency Center (FEC) Initial Licensure Application - Fillable PDF 0000040641 00000 n Contractor Application - PDF - Correction of a Birth Certificate, Application for Licensees may utilize this site to update their contact information. Waiver Application - PDF Mail to: HHS Bureau of Professional Licensure 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 %%EOF 0000001316 00000 n Adhere to the state guidelines of the IDPH licensure scope of practice. Notice: If you are requesting a "Name Change" or a "Duplicate License", they cannot be completed online. Hospice %PDF-1.3 % this must be processed with the IDPH EMS Division directly by contacting them at (217)785-2080. endobj XLS IDPH Home Services Agency Directory Identify IDPH ID (license) number (on your IDPH license). Application for Retired - PDF |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$1KbZxRtZZV 55iP8::.4)!_]b_U1p2._kNE/{,@P%s7ZkTb3-bHKI)EGg!3Q!C{>&DGM`a0 as good as i once was paramedic as good as i once was paramedic. Emergency Department Approved for Pediatrics (EDAP) Physician Waiver - Fillable PDF 0000049094 00000 n Name changes must be processed with the IDPH EMS Division per the mail, submitting copies of legal documents acceptable to IDPH that verifies the name change. Hospice Renewal Injury and Illness Report - PDF. An individual can change their name with IDPH by emailing their EMS System a copy of their marriage license, divorce decree (front page and name change page only), or court order. Division of EMS and Highway Safety's on-line licensing site. For more information as an Independent contact IDPH at 217-785-2080 to obtain your IDPH Regional Coordinator's contact information. Renewal Application for Manufactured Home Installer License A person currently licensed as an EMT, Intermediate, or Paramedic may only use their EMS license in Emergency Medical Services (EMS) Systems Licensing. Insurance - PDF Licensure - PDF 0000048066 00000 n Manufactured Housing Consumer Complaint Form, Medicare Intermediary Information Form - Fillable PDF*, Migrant Labor Camp Original/Renewal License Application - PDF, Non-Community Public Water System Construction Application - PDF, OPT-SP-OTS 0000028622 00000 n hb``a``Mf`e`8Abl,6^p``|0G29 `76h k@P47LYosM>FG Rl;0010`^ v@H%udtWi&',,adt~$Vw8K9;f"6 X0( endobj Answer You may update the following information using your online access account: Mailing Address Current Phone Damaged Address Phone Cell Phone Alternate Phone E-mail Add or Edit Insurance information FAQ Keywords Questions/Comments About FEMA.gov Last updated February 5, 2020 Return to top Please contact the Division at 217-785-2080 or at DPH.EMTLIC@illinois.gov with questions or for more information. 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 <> Facility Information Change Form - Fillable PDF* Health Agency Administrative Staff Changes - PDF, Home Health Agency Management Status Form - Fillable PDF* Health Agency - Hospice Add or Remove Geographic Service Areas, Home Health Health Agency Agency Supervisor Qualifications Review - Attachment B, Home Health Agency Complete the LEMSS EMS Personnel Data Form (loyolaems.com), including . License Number Assessor, Application - PDF - Instructions Trauma Nurse Specialist Course Coordinators (TNSCC) Testing Application Submission Lead Training Course Application - PDF - Instructions Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Allied Health Care Professional endstream 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 . `)O.l!5=;7~#PA#?`nz MpzyBwz0tR:R,Ja.+,!b8OnPVd;ZDv? EMS System Application Instruction Guide Independent EMS License Renewal Request Form - PDF Reasonable Accommodation Request for Examinees with Disabilities - Fillable PDF Renewal Notice - PDF Request for Duplicate License Certificate - Fillable PDF Stretcher Van Inspection Form - Fillable PDF Trauma Nurse Specialist (TNS) Examination Application Health Care Facilities Complaint Form - Fillable PDF* (PDF without form fields), Dental Examination Form, Proof of School - PDFEn Espaol - PDF xref 0000043020 00000 n Structural Pest Control: Business application, Non-Commercial - PDF 38 0 obj Temporary Occupancy Policy - Fillable PDF* Matrix 4D - Project Cost and Fee Verification - Fillable PDF* Original Application for Manufactured Home Installer License 0000072995 00000 n Structural Pest Control: Business License from The Hill: The Supreme Court upholds administrative agency actions alleged to be arbitrary 92 percent of the time. 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. Surviving Relative of Deceased Adopted/Surrendered Person Facility Information Change Form - Fillable PDF* 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. 0000048768 00000 n Submit copies of acceptable legal documents that verify the name change. Military Personnel Application - PDF In April 2015 the National HighwayTransportation Safety Administration reviewed Iowa's EMS system. . Lead Risk Questionnaire, Childhood - En Espaol - En franais - PDF Application, Apprentice - PDF C1&?6 ~wP[!ScvFUiAl>P D Test Request for Blood Lead Analysis - PDF Instructions, Lead Abatement/Mitigation Project, Notice of Commencement - PDF H=,9E-3VA$@[@hC_ MgbET$?[W1_-]u_[G&7W"^_{YCZ_OPVsk 5novzs}c=pgrWG4wu\975I\Q. Hn0} 0000005682 00000 n Once you have paid your fee online, wait about 10 minutes then click on the "IDPH LICENSE LOOK-UP link on the top of this page to view your IDPH license. 0000000016 00000 n Medicare Certification - PDF 0000027454 00000 n 0000044504 00000 n 0000000916 00000 n 0000062643 00000 n 28 0 obj Facilities Planning Board - Application for Exemption Change of endobj STEP 2: Contact the LEMSS office To notify the System of your address change. 0000019702 00000 n Scholarship Program Application, Medical Student Scholarship Remember, you will not be allowed to function as an EMS provider until you have in your possession the new EMT-B license. Emergency Medical Services (EMS) Systems Licensing, Please contact the Division at 217-785-2080 or at. Under the general direction of the Lieutenant, the Firefighter/EMT - Firefighter/Paramedic performs fire suppression, rescue operations, fire prevention activities (e.g. FSSMC Request for Reciprocity - PDF, Request for Certificate of Free Sale - form and preparation guidelines - Fillable PDF* Adhere to the state guidelines of the IDPH licensure scope of practice. - Partnership - PDF 0000004583 00000 n *These are draft forms pending final approval of the rules. 41 0 obj <>/Border[0 0 0]/H/N/Rect[290 323.28 449.51794 313.28]/Subtype/Link/Type/Annot/URI(http://www.dph.illinois.gov/topics-services/emergency-preparedness-response/ems/licensing)>> endstream endobj 289 0 obj <>stream Matrix 4B - Through Wall/Floor Penetrations - Fillable PDF* Lead Worker Application or En Espaol - PDF - Instructions 26 0 obj Vision Screening Worksheet - %PDF-1.4 % Pediatric Lead Poisoning High-Risk ZIP Code Areas - En Espaol - PDF Instrument Dispenser License Correction Form, Home Health, Home Services, Home Nursing and Placement 0000070466 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)>> <]>> 0000043314 00000 n Intended Father Form - PDF 24 0 obj - Sole Proprietor - PDF 0000026085 00000 n Application (General Use), Structural Pest Control Technician Water Well Construction Report Instructions - PDF 0000004800 00000 n The $1.10 charge to your card is an identity verification fee to prevent fraud and make sure you're the one making the change. startxref Home Health, Home Services, Home Nursing and Placement endobj Cancellation of Employment/Supervision of Apprentice- 0000006385 00000 n Re-examination application, Designation/Re-Designation of CSC, PSC or ASRH with National Certification, Designation/Re-Designation/Attestation of ASRH without National Certification, Swimming Facility Construction Permit, Application for, Swimming Facility License, Application for, Swimming Facility Prequalification Application for Architects and Professional Engineers, Swimming Facility Prequalification Application for Contractors, Swimming and Beach Facility Online Renewal, Trauma Nurse Specialist (TNS) Application Instruction Guide, Trauma Nurse Specialist Course Coordinators (TNSCC) Testing Application Submission, Trauma Nurse Specialist (TNS) Examination Roster, Birth Record Files, Application for Search of, Birth Record Files of a Deceased Individual, Application for Search of, Birth Record Files of a Deceased Infant, Application for Search of, Correction of a Birth Certificate, Application for, Correction of a Death Certificate, Application for, Death Record Files, Application for Search of, Dissolution of Marriage/Civil Union Record Files, Application for Verification of, Marriage/Civil Union Record Files, Application for Verification of, Water Well, Application for Permit to Construct, Modify or Abandon a, Water Well Construction Report Instructions, Water Well Pumps, Installation Report for, Application for Licensed Water Well Contractor's Closed Loop Well Certification, Application for Permit to Construct, Modify or Seal a Closed Loop Well System, Application for Registration as a State Closed Loop Well Contractor, Examination Application for State Closed Loop Certification, Application for Original Youth Camp License, Application for Youth Camp Construction Permit. Matrix 4E - Fire, Smoke, Fire/Smoke Damper - Fillable PDF* Gestational Surrogate's Husband - PDF 0000047956 00000 n application, Commercial, Structural Pest Control Certificate of 0000042858 00000 n Emergency Medical Technician (EMT) Reciprocity Application - Fillable PDF 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) Department of Public Health (IDPH). endobj SSN (a state law), with your new address and submit to: o The EMS Office (EMDs, FRs, EMTs, Paramedics, Lead . Address changes can be made ON LINE in the IDPH database listed below. Dissolution of Marriage/Civil Union Record Files, Application for Verification of - PDF Matrix 4C - Interior Finishes - Fillable PDF* 0000003055 00000 n The RH will then submit the completed paperwork to IDPH and notify your employer of the change in your level of licensure. 0 Performs pre-hospital duties in compliance with all state EMS rules and regulations, license appropriate. %PDF-1.3 % Agency Licensing Initial Application - Fillable PDF* 0000026686 00000 n The Board primarily utilizes email for communication with the licensee. - Limited Liability Company - PDF 0000004891 00000 n Lead Contractor Application Freestanding Emergency Center (FEC) Renewal Licensure Application - Fillable PDF About Us . Vision Conservation Annual Nursing Education Correction of a Death Certificate, Application for trailer <]>> startxref 0 %%EOF 35 0 obj<>stream 0000043728 00000 n Updating information online? Outpatient Rehab Facility Medicare Certification - PDF Nursing Student Application - PDF American Red Cross Centers for Disease Control and Prevention IDPH Approved CME Sites FEMA FEMA Courses Hosted by NHTSA IDPH Online Payment Link Illinois Data Collection Illinois Department of Public Health Illinois Emergency Preparedness Illinois State Ambulance Association IMERT JEMS . Health Agency Administrative Staff Changes, Home Health Agency Administrator Qualifications Review - Attachment A, Home 0000007819 00000 n Home Application (Restricted Use) - PDF - Scholarship Program Application, Structural Pest Control: Business application, Non-Commercial, Structural Pest Control: Business License PDF, Affidavit of No Employees - PDF 0000004848 00000 n 0000003652 00000 n 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. Injury and Illness Report - 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 Facility Medicare Certification, Application for Registration of Continuing Education, Electronic Roster for Plumbers Continuing Education, Plumber Application Child Support Certification, Plumber's License Plumber's License 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. 0000040777 00000 n Citizenship or Lawful Presence of an Alien. License, permit, certification or registration will be mailed when eligibility has been established. Hospital Medicare Certification - PDF You will need a credit or debit card and a valid email address. You may complete your renewal online at the website listed on the form. )SI{ 0BO|cEs}Oq""TV}c`u-hSwi8J", The video recordings would be kept for at. public education, fire inspections, etc.) Code Book Order Form - PDF UCIA Background Check Form Assessor, Application, Lead Third Party Examination Dialysis Medicare Certification, End Stage Renal Dialysis Medicare Certification, Freestanding Emergency Center (FEC) Initial Licensure Application, Freestanding Emergency Center (FEC) Renewal Licensure Application, Project Submission Form for Freestanding Emergency Center, Health The System files the appropriate paperwork with IDPH. You must enter a value. 0000073177 00000 n 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 Instructions :[ru@e\w}4PL V:5sl*"5Uke;vL *g _ Social Worker/Worker Assistant Qualifications Review - Attachment D, Agency Manager Qualification Review - Attachment E, Home Health Agency Management Status Form, Home 0000043879 00000 n 0000001982 00000 n 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. Instructions 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). 30 0 obj 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 0000072793 00000 n Trauma Nurse Specialist (TNS) Examination Application, End Stage Renal - Corporation - PDF Lead Risk Assessment Questionnaire, Medical Childhood - Excel (Longitudinal record for physician office use) Matrix 4F - Air Balancing - Fillable PDF* 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 - Fillable PDF*, Asbestos Professional Application Plumber's 6. Please allow 2-4 business days for your license to post in our systems and your license status to update. Eye Examination Waiver Form 2009 - PDF If you cannot update your profile you can print the below form and mail it to the Board office. 0000004897 00000 n 0000056136 00000 n endobj Irrigation Contractor Surety Bond Forms <]/Prev 293164>> \(pMU\z8pNs0*I(lf`H.x\FJ:~7aXP&H}RF^N4oa5y_[8- ][Z\/fm}s^Xoh7PRUn_JpU{uWIV*g2Y Scholarship Program Application - PDF, School Physical -- Certificate of Child Health Examination Form, Integrated Pest Management Forms (See Integrated Pest Management) hb```e`0e`a`8m l@qAZ $/LmO_ZcY^Lu`(``@10.B@l l0 w0D1dcP7e]@n@' F?4`0h3}t~O#mWS. 0000035991 00000 n 0000060338 00000 n ], Home Health, Home Services, Home Nursing and Placement 0000027849 00000 n Contact the IDPH Springfield office at 785-217-2080 to get information on changing your name in the IDPH . Facility Information Change Form - Fillable PDF*, Application for Registration of Continuing Education - PDF Change your address Attach documents to your license File a complaint Look up a list of licensees File a Complaint Make a complaint online. 0000000016 00000 n Multiple Hospice Location Questionnaire - PDF Instrument Dispenser Inactive Status Request Form, Hearing I understand that during my . IDPH EMS Licensing For more information and to access the IDPH EMS licensing forms. Emergency Department Approved for Pediatrics (EDAP) Nurse Practitioner Waiver - Fillable PDF 24 51 qY]X~3|?tPb]GX6|prD c\ptw@=)=VytzwM0 Yes. Instrument Dispenser Inactive Status Request Form - PDF HWms8b_-F%olePoflYuK.:*,nut! J0Lq;g! 0000005744 00000 n EMS Service Programs shall submit a completed application and documentation that they meet or exceed the minimum requirements of Iowa administrative code 641-132. %%EOF Request for Manufactured Home Installation Seals and Certificates (!qcP!>o1Z]P ,l7>Ge'?!QyAGa2BV!_ 4fe@s|UY` Irrigation Employee, Notice of Cancellation of Employment Registered - PDF 305 0 obj <>/Filter/FlateDecode/ID[<7C69095035C49F498DEA0D984BE70F46>]/Index[285 123]/Info 284 0 R/Length 99/Prev 719505/Root 286 0 R/Size 408/Type/XRef/W[1 2 1]>>stream Reciprocity with the City of Chicago, Application for - Report - PDF Checklist, Lead Public Information Disclosure 0000043322 00000 n Lead Supervisor, Inspector, Risk 2023 Iowa Department of Health and Human Services, Civil Commitment Unit for Sexual Offenders, Change of Iowa EMS Certification Level Application March 2021, Change of Iowa EMS Certification Status Application March 2021, EMSApplicationAffirmationQuestionGuidance Aug202, EMS Continuing Education Audit Report Form Sept 2020, Extension of Iowa EMS Certification Application Sept 2020, Late Renewal of Iowa EMS Certification Information Sept 2020, Out of State Providers Seeking Iowa EMS Certification Information Sept 2020, Reactivation of Inactive Iowa EMS Certification Application March 2021, License Renewal and AMANDA Step-by-Step Guidance, Iowa EMS Continuing Education Hour Renewal Guidance, Iowa Criminal HistoryPetition for Determination of Eligibility forLicensure. Structural Pest Control Technician Closed Loop Wells, Application for Original Youth Camp License - PDF 0000000016 00000 n Once you have your IDPH emailed PIN and instructions for payment click here: IDPH Fee Payment Siteto pay your fee. Lead Birth Parent Registration Forms Hearing Instrument (New July 01, 2023 wage scales are pending subject to . Irrigation Employee, Application for Registration for - PDF Agency Licensing Renewal/Change of Ownership Application, Home Health 0000001666 00000 n Public Schools Form - Fillable PDF*, Involuntary Transfer or Discharge and Opportunity for Hearing for Nursing Home Residents, Notice of, Affidavit of No Employees - PDF endobj 0000048970 00000 n Matrix 4A - UL Assembly Ratings - Fillable PDF* <>/Border[0 0 0]/H/N/Rect[48.5 255.61099 130.354 245.61099]/Subtype/Link/Type/Annot/URI(http://dph.illinois.gov/topics-services/emergency-preparedness-response/ems/res_sysListing)>> from Vox: Next, housing reform must consider the many government administrative agency roles in supporting affordable housing. payable to the Illinois Department of Public Health. Note any name or address changes or corrections in the appropriate space. Home Health 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 Explanation of Technician Examinations - PDF Please contact the Division of EMS and Highway Safety at 217-785-2080 or at DPH.EMTLIC@illinois.gov with . 0000000816 00000 n The Department also licenses stretcher vans, which must meet a defined set of safety feature requirements. 0 xref It costs nothing to change your name unless you want a duplicate license mailed out. 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