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 H CREDENTIALS OF EMERGENCY DEPARTMENT PHYSICIANS LEVEL I AND LEVEL II

 

Section 515.APPENDIX H  Credentials of Emergency Department Physicians Level I and Level II

 

List each physician by name

 

Indicate full time 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 Eligible

 

 

Trauma Center approved prior to 1/1/2000

 

10 hrs. per year approved CME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

Hospital CEO/Administrator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Typed Name

Hospital CEO/Administrator

 

Date

 

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