Get Stroke Center Application - - Missouri Department Of Health ... - Health Mo

This guide provides a clear and supportive approach to completing the Stroke Center Application from the Missouri Department of Health. It breaks down each section of the form, helping users to navigate through the process with ease.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Begin by selecting the designation level requested, ranging from Level I to Level IV, based on your facility's qualifications.
3. Provide the required hospital information, including the name of the hospital, address, telephone number, city, and zip code. Ensure accuracy for certification purposes.
4. Fill in the professional information by listing the names and roles of key personnel, such as the chief executive officer, chairman/president of the board of trustees, stroke medical director, and program manager.
5. In the resource information section, detail the stroke caseload, team activations, and available facilities such as ICU beds, CT scan capability, and MRI capability.
6. Certify the accuracy of the provided information by obtaining signatures from the necessary individuals, including the hospital chief executive officer and other key staff.
7. Attach the required documentation outlined in Section B, including organizational charts, job descriptions, and supporting narratives, to ensure a complete application.
8. Finally, review all entries for completeness and accuracy, then save, download, or print the completed application form for submission.

Complete your application online to ensure your facility is recognized as a stroke center.