J Credentials of Emergency Department Physicians Level I and Level II Pediatric Trauma Centers

Section 515 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