Wristband Project Request for Hospitals

TEXAS EMS WRISTBAND PROJECT: WRISTBAND REQUEST FOR HOSPITALS
    NCTTRAC has partnered with other RACs in developing a statewide wristband program to link pre-hospital and hospital records for both disasters and across the continuum of care.

     Each Facility will receive wristbands equal to the amount of one half of the Interfacility Transports from the previous year, on a first come, first served basis.

     Note: The wristbands will be distributed on a first come, first served basis to DSHS-licensed Hospitals.
Requesting Organization/Facility*
DSHS License Number*
Facility Type*
Requestor Full Name*
Requestor Position/Title*
Requestor Phone*
Requestor Email*
Number of Interfacility Transfers per month*
Pulsara User Accounts*
Should be Empty:

TEXAS EMS WRISTBAND PROJECT: WRISTBAND REQUEST FOR HOSPITALS