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Request to Modify/Amend Approved System Plan - Illinois ... - idph state il 2025

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The document is a request form from the Illinois Department of Public Health for modifying or amending an approved Emergency Medical Services (EMS) system plan. It outlines the necessary information and options for providers to upgrade, downgrade, or modify their EMS services, including changes to response areas, access procedures, and vehicle requirements. The form requires signatures from the applicant and EMS Medical Director for approval.

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