2025 COE Letter of Intent Application

The LOI application for the 2024 cycle is open until January 6, 2025.

LE&RN Centers of Excellence (COE) in the Diagnosis and Treatment of Lymphatic Diseases (LD) have been designed to increase access to the best possible multi-disciplinary clinical care and services for individuals affected by LD and their families through a geographically diverse network of local and/or regional clinical centers. In addition to clinical and social services, the Centers will provide professional and lay education in the geographic areas they serve, are involved in LD clinical research, and work with LE&RN locally and internationally in its efforts to continually improve the lives of those affected by LD and their families.

This form is designed for institutions to indicate their interest in the LE&RN Centers of Excellence (COE). Review the standards and eight designations for COEs, and then complete the following form.

The online letter of intent (LOI) serves as the request to submit a full COE application. Prospective applicants will be notified via email if they are invited to submit a full application. If the committee determines the proposed application does not fit the goals and objectives of the requested LE&RN COE designation, the applicant will receive feedback as well as options to support future, amended applications.

Institution Name*

Institution Type*

Ex - Hospital, Clinic, University Medical Center, etc

Provide the address and phone number for the instutition's LD program.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Does the institution have a webpage dedicated to the LD services offered?*

YesNo

Webpage address

How long has the LD program been established?*

Provide the name, title, and email address for the person completing this LOI application.

Name*

PrefixFirst NameLast NameSuffix

Job Title*

Email*

example@example.com

Provide the name, title, and email address for the director of lymphatic services. The director provided here should sign the Letter of Intent (LOI).

Director's Name*

PrefixFirst NameLast NameSuffix

Director's Job Title*

Director's Email*

example@example.com

Provide the name, title, and email address for the co-director of lymphatic services. The director provided here should sign the Letter of Intent (LOI).

Co-Director's Name

PrefixFirst NameLast NameSuffix

Co-Director's Job Title

Co-Director's Email

example@example.com

Please enter the designation the institution feels qualified to attain (should be listed in the LOI). Please be advised that the designation is subject to approval by the Global Oversight Committee (GOC). The committee may decide the institution is better suited to apply for a different designation.

To read designation descriptions, click here.

What designation do you intend to apply for?*

Number of certified LE therapists or equivalent on staff:*

0123 or more

Therapists Explanation

Number of surgeons on staff performing lymphatic surgeries:*

0123 or more

Staff Surgeons Explanation

Number of surgeons performing lymphatic surgeries within referral network:*

0123 or more

Network Surgeons Explanation

Upload an ORGANIZATIONAL CHART. This chart should include all departments and/or clinicians that diagnose and treat all LD related issues. Be sure to indicate if any are off-site, including those that are in network or are referrals. PDF is preferred.

Organizational Chart*

Upload an ENCOUNTER-DIAGNOSTIC FLOW CHART. This documents the patient pathway from initial diagnosis (chief complaint, signs, symptoms, family and social history), to diagnostic testing (imaging, measurements), to procedures performed, to post-encounter referrals. Be sure to indicate if any departments and/or clinicians are off-site, including those that are in network or are referrals. PDF is preferred.

Encounter-Diagnostic Flow Chart*

Please enter the name and title of the person that has signed the LOI and then attach the letter. The document MUST typed on institution letterhead in English or it will not be accepted.

Preferred file types are PDF, Word document, or JPG.

The LOI should be a brief letter describing your institution's mission, general patient population demographics, current capabilities, and vision for serving the LD community. It should summarize currently provided and proposed services for diagnosing and treating LD. If your institution does not currently meet all the criteria for the desired COE designation, please briefly detail your plan to incorporate needed capabilities into currently provided services.

LOI Signer's Name*

First NameLast Name

LOI Signer's Title*

Letter of Intent*

The LOI serves as the formal request to submit a full application later. Prospective applicants will be notified via email if they will be invited to submit a full application.

If the committee determines the complete application would not fit with the goals and objectives of the LE&RN COE designations, the applicant will be provided feedback as to why the proposal was not a good fit and what options are available to support future, amended applications.

The Centers of Excellence (COE) Global Oversight Committee (GOC) will review this application and the letter of intent (LOI) submitted. The GOC will determine the institution's eligibility to apply for a COE designation.

The Lymphatic Education & Research Network (LE&RN) is not involved in the decisions for the COE process, nor do we have any influence in the process. LE&RN only facilitates the process for the GOC.

If you have any questions regarding the LE&RN COE program or the LOI process, please contact us at COE@LymphaticNetwork.org.