New Memorial Health EMS Provider

New Provider Information

First Name

Middle Initial

Last Name

Last 4 of SSN

Verify email address

Please list your primary agency within Memorial EMS:

Was your initial IDPH license course after January 1, 2018? Yes
No

If no, have you completed a bridge course for the Illinois Expanded Scope of Practice? Yes
No

Level of License

All current licenses, PALS, ACLS, Trauma certifications and CCT certifications should be on file with your employer.