Emergency Department Entrance

Proctor Hospital EMS
Contact Information

(Last updated 8/8/2011)
EMS Office
EMS FAX
(309) 683-6186
(309) 683-6190
Proctor ED
(Recorded line)
Proctor ED FAX
CAREpoint/EKG Fax
(309) 683-6112

(309) 689-8627
(309) 683-6102
Maggi Ballard
EMS Coordinator
(309) 683-6180
or Email
Carrie Vaughn
EMS Admin Asst.
(309) 683-6186
or Email
Jim Hubler, MD, JD
ED Medical Director
(309) 691-1000
ext. 1559
or Email
Richie Springer
EMS Educator
(309) 683-6189
or Email

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EMS Agency Information


Proctor Hospital

Proctor Hospital looks forward to working with area EMS providers. Our goal is to work with the Peoria Area EMS System to help strengthen an already strong emergency medical delivery system in the area. As such, we will work with all area EMS providers, whether they elect to join the Proctor Hospital EMS System or not. If your agency would like to join the Proctor Hospital EMS System, we would be glad to have you part of our family.

Proctor Hospital is committed to ensuring that the new EMS System meets it's obligations to the member provider agencies and their staff. In order to ensure that we meet these obligations as we launch the new EMS System, Proctor Hospital EMS System will be limiting the number of Provider Agencies initially accepted into the EMS System to between 5 and 10 agencies the first year. The primary deciding factor in which agencies are accepted into the EMS System will be the date that a correctly completed application is received in the EMS Office. This includes all the requested supporting information on vehicles, personnel and radio licenses. Those agencies submitting their complete applications first will be considered first for acceptance into the EMS System. Other issues which may effect the decision include the size of the EMS Agency, location and status in their current EMS System.

Agencies which would like to apply to join the Proctor Hospital EMS System should follow the instructions below to make application. Upon receipt of the completed Agency Application Packet, the EMS System will review the agency’s application and will send approved applicants the Proctor Hospital EMS System Member Agency Agreement for your signature. Only complete packets with all forms and supporting documentation will be considered.

  1. Download each of these forms. These forms are electronic Acrobat forms and may be completed on your computer and then printed. You will need Adobe Acrobat Reader to open the form. To save the form on your computer, click File --> Save As in your browser.
    1. Agency Information Form
    2. Agency Roster Form
    3. Vehicle Information Form
    4. Personal Information Form
  2. Fill out one Agency Information Form for the agency desiring to join the Proctor Hospital EMS System.
    1. Complete the entire form.
    2. The form needs to be signed by the Chief, President or other authorized agent.
    3. Include a photocopy of the current IDPH wall license for your agency.
    4. Include a photocopy of the current FCC Radio license showing your agency licensed on MERCI (155.340) and any appropriate UHF MED channels.
  3. Fill out a Agency Roster Form for the agency desiring to join the Proctor Hospital EMS System.
    1. The individual completing the form should sign the form.
    2. List each EMS Provider which responds or works for the applicant agency.
    3. Before submission, check to ensure that each individual on the roster has completed and submitted a Personal Information Form.
  4. Complete a Vehicle Information Form for each EMS vehicle, ambulance and non-transport vehicle for which you are making application to the EMS System.
    1. Complete the entire form.
    2. The individual completing the form should sign the form.
    3. Include a photocopy of the current IDPH license for that vehicle.
  5. Have each EMS provider (individual) complete a Personal Information Form.
    1. Ensure that both pages of the form are completed.
    2. The form must be signed by the individual provider.
    3. Include a photocopy of all current IDPH EMS licenses held by that individual.
    4. Include a photocopy of all current certifications (such as CPR, ACLS, PHTLS, ITLS, etc.) held by that individual.
  6. Mail the completed application to:
    Maggi Ballard, RN, BSN, CEN
    EMS System Coordinator
    Proctor Hospital
    5409 N. Knoxville Ave
    Peoria, IL 61614-5076
  7. If you have any questions, please call Maggi Ballard at 1-309-683-6180 or E-Mail her at maggi.ballard@proctor.org