77 Ill. Adm. Code 515.APPENDIX I
I Credentials of General/Trauma Surgeons Level I and Level II Pediatric Trauma Centers
Section 515
Section 515.APPENDIX I Â Â Credentials
of General/Trauma Surgeons Level I and Level II Pediatric Trauma Centers
List each surgeon by name
Check appropriate requirements
met
Signed by CEO/Hospital
Administrator
Surgeon
Name
Meets
requirements of Section 515.2035(b) or 515.2045(b)
Meets
requirements of Section 515.2035(c) or 515.2045(c)
Signature
Hospital
CEO/Administrator
Typed
Name
Hospital
CEO/Administrator
Date