Get Nh Trauma Center Application And Pre-review Questionnaire (prq) 2019-2025

This guide provides comprehensive instructions for completing the New Hampshire Trauma Center Application and Pre-Review Questionnaire (PRQ) online. This document is essential for healthcare facilities seeking designation as trauma centers in New Hampshire.

Follow the steps to effectively complete your trauma center application online.

1. Click the ‘Get Form’ button to access the NH Trauma Center Application And Pre-Review Questionnaire (PRQ). This will allow you to open the form in a digital editor for completion.
2. Begin by filling in the Application Date. Select the appropriate Review Type; options include Initial, Renewal, or Pediatric Only. Each selection has specific requirements, so ensure you provide the correct designation.
3. Complete the Hospital Information section by entering the hospital's name, address, and details regarding key personnel involved in trauma care, including the Trauma Medical Director and the Trauma Program Manager.
4. Provide the hospital bed counts, including adult, pediatric, total licensed, staffed beds, average census, ICU beds, and operating rooms. Ensure to present accurate and current information.
5. Sign the application where indicated, confirming the accuracy of the information provided and your authority to submit the application on behalf of the hospital.
6. Compile and attach the required documentation as detailed in the application. It is crucial to gather all necessary attachments A-I and ensure they are included with your submission.
7. Complete the Pre-Review Questionnaire section by answering all questions thoroughly. Make sure to include any pertinent trauma data and submit it 30 days prior to your review date.
8. Once the form and attachments are completed, you have the options to save your changes, download a copy for your records, print the form, or share it according to your needs.

Start completing your NH Trauma Center Application and Pre-Review Questionnaire online today for timely processing and review.