TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER f: EMERGENCY SERVICES AND HIGHWAY SAFETY
PART 515 EMERGENCY MEDICAL SERVICES, TRAUMA CENTER, COMPREHENSIVE STROKE CENTER, PRIMARY STROKE CENTER AND ACUTE STROKE READY HOSPITAL CODE
SECTION 515.APPENDIX I CREDENTIALS OF GENERAL/TRAUMA SURGEONS LEVEL I AND LEVEL II PEDIATRIC TRAUMA CENTERS


 

Section 515.APPENDIX I  Credentials of General/Trauma Surgeons Level I and Level II Pediatric Trauma Centers

 

List each surgeon by name

 

Check appropriate requirements met

 

Signed by CEO/Hospital Administrator

 

 

Surgeon Name

 

Meets requirements of Section 515.2035(b) or 515.2045(b)

 

Meets requirements of Section 515.2035(c) or 515.2045(c)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

Hospital CEO/Administrator

 

 

 

 

 

 

 

 

 

 

 

 

Typed Name

Hospital CEO/Administrator

 

Date

 

(Source:  Added at 25 Ill. Reg. 16386, effective December 20, 2001)