Initial EDAP or SEDP Application Forms

Follow these instructions to initiate the process to obtain recognition as an Emergency Department Approved for Pediatrics (EDAP) or Standby Emergency Department for Pediatrics (SEDP):

1. Complete the Request for EDAP or SEDP Recognition and obtain the appropriate signatures.
2. Using the Emergency Department Pediatric Plan Guideline and the EDAP requirements or SEDP requirements, complete an EDAP/SEDP Initial Pediatric Plan Application Checklist. Attach all requested supporting documentation (credentialing forms, schedules, policies, procedures, protocols, guidelines, plans, etc.).
   
3. Complete and obtain signatures on the following credentialing forms:
   
   • Emergency Department Physician Credentialing Form
     
   • Fast Track/Urgent Care Physician Credentialing Form
     
   • Emergency Department Nurse Practitioner/Clinical Nurse Specialist/Physician Assistant Credentialing Form
     
   • Emergency Department Nursing Staff Credentialing Form
     
4. Complete the Hospital Pediatric Preparedness Checklist
   
5. Complete the EDAP/SEDP Pediatric Equipment Checklist
   
6. The Emergency Department Pediatric Plan shall follow the format outlined in the Emergency Department Pediatric Plan Guideline and include all required documentation. The plan shall also address how each of the EDAP/SEDP requirements is currently being or will be met. The Pediatric Plan shall be developed through interaction and collaboration with all other appropriate disciplines.
   
7. Any submitted requests for equipment waivers shall include the criteria by which compliance is considered to be a hardship and demonstrate that there will be no reduction in the provision of medical care.
   
8. The Inter-facility Pediatric Trauma and Critical Care Consultation and/or Transfer Guideline provides additional resource information related to pediatric inter-facility transfer and consultation and can be used in the development of the Emergency Department Pediatrics Plan.
9. Submit the original signed application form and one paper copy of the Emergency Department Pediatric Plan (including supporting documentation) to the address listed below. The paper copy should be single-sided and unstapled. In addition, submit a digital application as outlined by the EMSC Program, using the electronic application forms on the IDPH Division of EMS website.
   
   EMSC Coordinator
   Division of EMS and Highway Safety
   Illinois Department of Public Health
   422 S. 5th St.
   Springfield IL 62701
   
   
10. For questions regarding the application process, specific requirements, or supporting documentation, please contact the Division of EMS & Highway Safety at 217-785-2080 or DPH.EMSCProgram@illinois.gov.

• EDAP or SEDP Initial Application
• Request for EDAP or SEDP Recognition
• EDAP/SEDP Initial Pediatric Plan Application Checklist
• Emergency Department Physician Credentialing Form
• Fast Track/Urgent Care Physician Credentialing Form
• Emergency Department Nurse Practitioner/Clinical Nurse Specialist/Physician Assistant Credentialing Form
• Emergency Department Nursing Staff Credentialing Form
• Hospital Pediatric Preparedness Checklist
• EDAP/SEDP Pediatric Equipment Checklist