Ill. Admin. Code tit. 77, § 547.500 - Application Requirements

a) Applications shall be submitted to the Department at the following address:

Regional Ambulance Services Grant Project

Illinois Department of Public Health

Division of Emergency Medical Services

525 W. Jefferson St., 3rd Floor

Springfield, Illinois 62761

b) Applications shall include the following:

1) The officer or agency designated by the regional ambulance service to be responsible for administering grant funds;

2) The results of the needs assessment conducted pursuant to Section 547.400;

3) The organization and responsibilities of the Board;

4) The operations budget of the regional ambulance service, including projections on how and when the regional ambulance service will become self-sufficient, and a description of local financial support or in-kind service;

5) A staffing plan for the regional ambulance service;

6) An agreement by the applicant to ensure that the requirements of the Emergency Medical Services Systems Act will be met;

7) A description of the proposed interaction between any existing ambulance services and the regional ambulance service;

8) A description of the support of the local medical communities for the regional ambulance service;

9) A plan for quality management, including an evaluation of the project to be submitted to the Department after the first six months of operation, that indicates:

A) the amount of grant funds expended and a description of expenditures;

B) changes that have occurred in service provided as a result of the grant project; and

C) an evaluation of the effectiveness of the officer or agency designated by the regional ambulance service to be responsible for administering grant funds;

10) A description of a plan for the provision of education for ambulance service personnel and a plan for public education by the regional ambulance service;

11) A description of the responsibilities of service providers, including maintenance of vehicles and equipment;

12) A description of the communications system that will be used by the regional ambulance service; and

13) The name, address, and telephone number of the person to whom questions and information concerning the application and the grant project are to be directed.

Notes

Ill. Admin. Code tit. 77, § 547.500