Section 547.500  Application Requirements

a)         Applications shall be submitted to the Department at the following address:

Regional Ambulance Services Grant Project

Illinois Department of Public Health

Division of Emergency Medical Services

525 W. Jefferson St., 3rd Floor

Springfield, Illinois  62761

b)         Applications shall include the following:

1)         The officer or agency designated by the regional ambulance service to be responsible for administering grant funds;

2)         The results of the needs assessment conducted pursuant to Section 547.400;

3)         The organization and responsibilities of the Board;

4)         The operations budget of the regional ambulance service, including projections on how and when the regional ambulance service will become self-sufficient, and a description of local financial support or in-kind service;

5)         A staffing plan for the regional ambulance service;

6)         An agreement by the applicant to ensure that the requirements of the Emergency Medical Services Systems Act will be met;

7)         A description of the proposed interaction between any existing ambulance services and the regional ambulance service;

8)         A description of the support of the local medical communities for the regional ambulance service;

9)         A plan for quality management, including an evaluation of the project to be submitted to the Department after the first six months of operation, that indicates:

A)        the amount of grant funds expended and a description of expenditures;

B)        changes that have occurred in service provided as a result of the grant project; and

C)        an evaluation of the effectiveness of the officer or agency designated by the regional ambulance service to be responsible for administering grant funds;

10)         A description of a plan for the provision of education for ambulance service personnel and a plan for public education by the regional ambulance service;

11)         A description of the responsibilities of service providers, including maintenance of vehicles and equipment;

12)         A description of the communications system that will be used by the regional ambulance service; and

13)         The name, address, and telephone number of the person to whom questions and information concerning the application and the grant project are to be directed.