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Get Idph Non Transport Inspection Form

State of Illinois Illinois Department of Public Health Emergency Medical Services EMS Systems Non-transport Provider Application Use this form only to add NON-TRANSPORT service to a currently approved transport provider. EMS System Name EMS System Number EMS System Address State EMS Medical Director Name City ZIP Code EMS System Coordinator Name Provider Name Provider Address Provider Contact ALS Phone Number ILS B/D BLS E-mail Address FRD CC.

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