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 J CREDENTIALS OF EMERGENCY DEPARTMENT PHYSICIANS LEVEL I AND LEVEL II PEDIATRIC TRAUMA CENTERS

 

Section 515.APPENDIX J  Credentials of Emergency Department Physicians Level I and Level II Pediatric Trauma Centers

 

List each physician by name

 

Indicate full or part-time

 

Check all credentials that qualify physician for Illinois Trauma Center Emergency Departments

 

 

Physician

Name

 

F = Full Time

P = Part Time

 

ABEM/AOBEM AOA Certified or Prepared (ED Director must be certified)

 

10 hrs. per year approved CME & daily involvement in pediatric trauma care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

Hospital CEO/Administrator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Typed Name

Hospital CEO/Administrator

 

Date

 

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