Get Mn Stemi Receiving Center Designation Application 2019

Filling out the MN STEMI Receiving Center Designation Application online requires careful attention to detail to ensure that all necessary information is provided. This guide will walk you through each step of the application process to help you submit a complete and accurate application.

Follow the steps to successfully complete the application.

1. Use the ‘Get Form’ button to access the application form and open it for editing.
2. Begin by identifying your primary and secondary contacts. Choose two representatives from your hospital. The primary contact will complete the application and address any follow-up questions, while the secondary contact is a backup in case the primary contact is unavailable.
3. Fill out the application form, ensuring that you indicate which nationally-recognized certification for STEMI care your hospital currently holds. If your certification is not on the provided list, email the Minnesota Department of Health’s Cardiovascular Health Unit to verify compliance.
4. Provide documentation of your certification by including a copy of your hospital’s certificate or official certification letter. This must include the name of the certification body, the certification received, the date it was issued, and the expiration date.
5. Prepare the CEO attestation letter. This must be signed by your hospital's CEO or administrator and should confirm the accuracy of the application. You can adapt the language from the provided template.
6. Once you have compiled all required documents (application form, documentation of certification, and CEO attestation letter), submit them as PDFs to the designated email address.

Take the next step and begin completing your MN STEMI Receiving Center Designation Application online today!