Get Bon Secours Application Status

Filling out the Bon Secours Application Status online can be straightforward with the right guidance. This guide will provide clear, step-by-step instructions to help you successfully complete the application.

Follow the steps to complete the application with ease.

1. Click the ‘Get Form’ button to obtain the application form and open it for editing.
2. Begin with the initial question regarding the planned use of the humanitarian use device (HUD). Indicate ‘Yes’ or ‘No’ to assess if the application pertains to evaluating safety or effectiveness.
3. If ‘No’ is selected, proceed to specify the location where the HUD will be used. Choose from options such as Memorial Regional, St. Mary’s, St. Francis, Richmond Community, or indicate 'Other' and provide details.
4. Provide the protocol name, if applicable. If there is not a specific protocol name, write a general description of the planned treatment use.
5. Fill in the details for the treating physician, including their name, title, address, phone number, and email. Indicate if they are a Bon Secours employee.
6. If there is a primary contact other than the treating physician, complete the fields for their title, phone number, and email, also specifying if they are a Bon Secours employee.
7. Complete the section for humanitarian use device information by entering the HUD name, HDE number, manufacturer, and FDA approved indication.
8. For each additional required document, label them as Document #1 to Document #6, providing summaries of each as necessary. Include detailed descriptions that cover how the physician plans to use the device and inform the patient of potential risks and benefits.
9. In the physician acknowledgment section, ensure that the treating physician signs and dates the form, confirming they agree to use the HUD in compliance with regulations and policies.
10. Finally, review the completed application for accuracy. You can save changes, download the application, print it, or share it as needed.

Take the next step in your application process by completing the form online today.