Get Site Application For Level I - Mississippi State Department Of Health

Completing the Site Application for Level I with the Mississippi State Department of Health is a crucial process for hospitals seeking trauma center designation. This guide will provide you with a clear, step-by-step approach to ensure that you fill out the application accurately and efficiently.

Follow the steps to complete your Level I trauma center application successfully.

1. Click ‘Get Form’ button to obtain the application and open it in the designated format.
2. Enter the hospital ID in the provided field. This ID is unique to your facility and should be verified beforehand.
3. Fill in the level of pediatric application if applicable. Indicate the appropriate level according to your services.
4. Provide the hospital name clearly, ensuring it matches official records to avoid discrepancies.
5. Complete the mailing address section, including street, city, state, and zip code for communication purposes.
6. Specify the county in which your hospital is located. This information is essential for the application process.
7. Select the region your hospital belongs to as indicated by the Mississippi Department of Health.
8. Include the hospital website link for reference.
9. Name the chief administrative officer of the hospital and provide their email address for official correspondence.
10. Enter the main telephone number for the hospital, ensuring accuracy for potential follow-ups.
11. Fill in the name of the person completing the application along with their job title.
12. Provide the email address and telephone/fax number of the person completing the application.
13. Enter the date the application is submitted.
14. Proceed to the subsequent sections, which include multiple attachments such as organizational charts, qualifications of physicians, and other required documentation. Each tab refers to specific information that must be compiled and attached to the application.
15. Review all compiled information for completeness and accuracy before submission.
16. Save any changes made to the application, then you may download, print, or share the form as necessary.

Ensure your hospital's application is complete and submit it online today!