rev. 12/2023
Process For New Designation
Utah Stroke Receiving Facility Designation Application Process
Hospitals wishing to voluntarily designated as a Stroke Receiving Facility shall submit a letter of intent to the Utah Department of Health, Bureau of Emergency Medical Services and Preparedness stating interest in designation and request an application for designation as a Stroke Receiving Facility.
Upon receipt of the completed application, the Department shall review the application for completeness and schedule a site visit to the applicant hospital.
The department will review the findings of the site visit for compliance with elements outlined in the application. Upon completion of the site survey, a summary of the findings will be sent to the hospital administrator and stroke program representatives. Those findings will include the following:
- Hospital Stroke Program Strengths
- Recommendations pertinent to the stroke program application review
A report of those findings and a recommendation will be presented to Utah Department of Health and Human Services (Office of EMS), Executive Director approval or denial of recommendation for designation.
A certificate of designation as a Utah Stroke Receiving Facility will be provided to successful applicants indicating that the hospital has met all required criteria. Utah Stroke Receiving Facility designation shall be for a period of three (3) years from the date of the site visit.
Designated facilities must submit stroke data into the RedCap or Get With The Guidelines (GWTG), database system on a quarterly basis. Stroke data submission must be verified by contacting the Utah Department of Health and Human Services, Office of Emergency Medical Services Health Information and Data Analyst:
Yukiko Yoneoka, Health Informaticist
yyoneoka@utah.gov
Verifycation must be in writting from Yukiko Yoneoka. Please attach written verifycation while completing the Stroke Designation/Re-designation Application.
The Utah Department of Health, Bureau of Emergency Medical Services and Preparedness will determine data elements required to be reported.
Renewal Designation will commence following submission of a Re-designation Application.
Applications must be requested and submitted using THIS FORM ONLY.
Further questions should be addressed to:
Carl W. Avery, RN, CFRN
Utah Department of Health
carlavery@utah.gov
This form will auto-send to Carl Avery following form submission.