Form Ioci 12-234 - Emergency Medical Services (Ems) Systems Independent Renewal - Illinois Department Of Public Health

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State of Illinois

Illinois Department of Public Health

Emergency Medical Services (EMS) Systems Independent Renewal

Independent Renewal Instructions

Submit the following information for Independent Renewal with the application.

1. A copy of your continuing education hours to equal at least 120 hours, complete with instructor’s signature, as follows:

• No more than 30 hours or percent of your continuing education should be in one subject area or medium.

• Any and all emergency medical technician didactic time; for example, classroom time; is acceptable as continuing

education hours on an hour for hour basis. However, you cannot have more than 30 hours continuing education in

one subject area, such as trauma, medical or cardiac.

• You cannot have more than 30 hours each of clinical, ambulance or online continuing education time.

• If you have attended college classes the continuing education credit received for each course is two times the

number of college credit hours assigned to the course. The subject areas must relate to your EMT training.

You must submit a transcript or official copy of your grade for the course along with a college catalog that

describes the course.

2. A copy of your current Healthcare Provider cardiopulmonary resuscitation card.

3. A short statement such as: “I am applying for renewal as an independent. I do not belong to an EMS system and

do not have an EMS medical director.” Be sure to sign and date the statement.

4. Felony history information and fee (if applicable).

5. Submit the completed Independent Renewal form with all required documentation to the address provided on the at-

tached form.

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