Get Mn Application For Waiver To Admit Trauma Patients When Arrival At Definitive Care Is > 120 Minutes

This guide provides step-by-step instructions for completing the MN Application for Waiver to Admit Trauma Patients when the arrival at definitive care exceeds 120 minutes. Whether you are new to filling out such applications or have some experience, this comprehensive guide will support you through each section of the form.

Follow the steps to successfully complete the application.

1. Press the ‘Get Form’ button to access the application form and open it in your chosen editor.
2. Begin by filling out the facility information section. Provide the hospital name, the name and contact details of the trauma program manager, the trauma medical director, and their respective email addresses.
3. In the application section, list all Level 1, 2, and 3 trauma hospitals to which trauma patients may be transferred in case of a deterioration in condition. Estimate how long it would take under normal conditions for a patient to reach those facilities.
4. Identify the EMS agencies that transfer trauma patients from your hospital. Clearly indicate the services provided by each agency, whether aeromedical, ground advanced life support (ALS), or ground basic life support (BLS).
5. Specify the types of trauma patients or conditions that may be admitted for observation. Include which tertiary hospitals these patients may be transferred to.
6. Explain the specific request and outline any normal circumstances that would prevent timely transfer to a tertiary hospital within the required 120-minute timeframe.
7. Check the appropriate box to confirm that the hospital's trauma admission and transfer policies support the application. Ensure that you attach either the current policies or confirm that previous submissions are still relevant.
8. Consider providing any additional information that may help support your application.
9. Complete the signature section with the CEO's name and the date. After completing the form, you can save your changes, download a copy, print it, or share it as needed.

Start filling out your application online today to support timely trauma care.