Get Application For Designation Of Stroke Center - Health Ny

This guide provides clear instructions on how to accurately complete the Application For Designation Of Stroke Center - Health Ny online. It is tailored for users with varying levels of experience in filling out such forms, ensuring a straightforward process for all.

Follow the steps to successfully complete your application

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Fill in the facility name, address, city, state, zip code, phone number, county, and fax number. Ensure the accuracy of this information as it is crucial for identification.
3. Include the Permanent Facility Identifier and Operating Certificate numbers. These details aid in verifying your facility's credentials.
4. Provide contact information for the hospital Chief Executive Officer, including their name, phone number, fax number, and email address to facilitate communication.
5. List the Stroke Medical Director and Stroke Coordinators, along with their phone numbers, fax numbers, and email addresses. This ensures key personnel are reachable for any follow-up inquiries.
6. Complete the certification section by having the hospital CEO sign and date the application certifying that the information is accurate.
7. Prepare the Abbreviated Executive Summary. Summarize the capabilities of your Stroke Center in bullet format, focusing on the key elements and compliance with the criteria.
8. For each critical section, including Stroke Team, Education, 24/7 Capabilities, and Quality Assurance/Data, provide supporting documentation where required. Follow the instructions outlined in each section for completeness.
9. Review all entered information for accuracy and completeness. Ensure that all required attachments are properly numbered and attached to your submission.
10. Once the application is complete, save the document, and prepare to print or share the application as needed for submission.

Complete your Application For Designation Of Stroke Center - Health Ny online to ensure your facility is recognized for its stroke care capabilities.