Policies and Procedures
  • North Region EMS Policy Manual

    Policies and Procedures for the System

    Click to Download

    Region X Multiple Patient Management Plan

    Multiple Patient Management Plan

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    NMnrEMSS MCI Reference Forms

    Training worksheets to accompany the MPMP

    Click to Download

IDPH License Renewal
  • Renewal Directions

    To be completed 60 days prior to IDPH expiration if NMnrEMSS is your Primary EMS System:

    1. Pay IDPH fee via online payment portal and PIN number received in the mail. Save proof of payment receipt. 

    2. Verify completion of all System Requirements on EMS1 >> My Dashboard >> Assignments >> Credential Training 100%

    3. Complete IDPH License Renewal Form

    4.Complete NMnrEMSS License Renewal Request

    5. Submit completed packet to your Medical Officer for verification:

    • NMnrEMSS License Renewal Request
    • Proof of IDPH payment
    • IDPH License Renewal Form
    • Valid AHA BLS CPR card
    • 100 hours of System approved CE

  • NMnrEMSS Renewal Request Form

    To be submitted with your completed packet by your department Medical Officer to NMnrEMSS.

    Click to Download

    IDPH License Renewal Form

    For license renewal, a Renewal/Child Support form must be submitted. Download here

    Click to Download

    IDPH Online Payment Portal

    Once paid, save the recipt of payment to submit with your renewal application to NMnrEMSS.

    Click to Follow

NREMT License Renewal
  • NREMT License Renewal Request

    To be completed by March 1 of expiration year

    1. Ensure you are affiliated with Northwestern Medicine Lake Forest Hospital

    2. From My Certification Dashboard follows steps 1, 2, & 3  to input CE hours

      >> Click to watch video

    3. Pay for re-licensure through NREMT website

    4. Email sarah.bond@nm.org to notify your file is ready for renewal

System Forms
  • Letter of Good Standing and CE Report Request

    In order to transfer Primary or Secondary Affiliation from North Region EMS System to another System, NMnrEMSS must send a Letter of Good Standing and Continuing Education report to your new System. Please submit this request  and allow up to 30 days for processing. Submit to EMS System Coordinator Evert Gerritsen via email:

    Click to Download

    Request for Clarification

    To request clarification of patient care or provider/hospital communication, please download and submit to EMS System Coordinator Evert Gerritsen via email:

    Click to Download

Restocking Forms
  • Ambulance Equipment Restock Form

    For ambulance equipment restock, please fill out attached form and submit to EMS System Coordinator Evert Gerritsen via email.


    Please ensure the alternative point of contact listed is a department employee that works weekdays or is a department number with a voicemail account that is checked regularly. 

    Click to Download

    Pharmacy Restocking Form

    For expired medication exchange, or non-transport exchange, please fill out attached form and submit to EMS System Coordinator Evert Gerritsen via email.


    Click to Download

Vehicle Inspection Forms
  • IDPH Ambulance Inspection Form

    For ALS transport vehicles, inspections include the attached IDPH inspection form and the NMnrEMSS ALS Non-Transport form.

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    ALS Ambulance Inspection Form

    ALS Ambulance NMnrEMSS Equipment and Medications List

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    ALS Non-Transport Inspection Form

    ALS Engine/Squad NMnrEMSS Equipment and Medications List

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IDPH Forms
  • Reciprocity Application

    If you are an out-of-state EMS provider needing to apply for your Illinois License, please download and submit. Ensure you sent in the completed packet all at once. Failure to do so will result in rejection and the need to begin the process again. 

    Click to Download

    License Extension Request Application

    If you are unable to complete the required Continuing Education hours by your license expiration, you may file an Extension Request Application with IDPH prior to expiration. 

    Click to Download

    Inactive License Request Application

    To request inactive status on your IDPH license, submit form to IDPH and notify NMnrEMSS. 

    Click to Download

    Reactivation Request Application

    If your IDPH license has been de-activated and you are ready to reactivate, please complete this form and send a reactivation request to evert.gerritsen@nm.org

    Click to Download

    Special Event Application

    In order to provide EMS care for a Special Event, this form must be submitted 45 days prior to the event. 

    Click to Download

    Training Program Application

    In order to receive credit for courses completed in-house, an EMS Training Program form must be submitted annually for your department. 

    Click to Download