K Elements for Submission for Designation, Redesignation or Change in Designation

Section 640.APPENDIX K   Elements for Submission for Designation, Redesignation or Change in Designation Level III Review •           Appendix A •           Resource Checklist for Level III •           Evaluation letter from Administrative Perinatal Center •           Vita for co-directors •           Credentials for  Obstetric (OB)/Family Practice (FP) physicians, Advance Practice Nurses (APN), Neonatology & Anesthesia •           Copy of OB/Peds Departmental Rules •           Maternal-Fetal Medicine (MFM), Neonatology Consultation/referral tool/QA reports for 3 months •           Mortality and Morbidity (M&M) statistics and description of the process/participation •           Transport statistics, both into and out of hospital •           Listing of educational classes •           Description of educational classes •           Description of CQI •           3 months of call schedules for OB, Maternal-Fetal Medicine and Neonatology (current and last 2 actual or 3 proposed schedules) Level II with Extended Neonatal Capabilities Review •           Appendix A •           Resource Checklist for Level II with Extended Neonatal Capabilities •           Evaluation letter from Administrative Perinatal Center •           Vita for Director of Neonatology, Maternal-Fetal Medicine (MFM), if appropriate •           Credentials for Obstetricians/Family Practice  physicians, Advanced Practice Nurses (APN), Neonatology & Anesthesia •           Copy of OB/Peds Departmental Rules •           Consultation/referral tool/QA reports for 3 months •           Mortality and Morbidity (M&M) statistics and description of process/participation •           Transport statistics, both into and out of hospital •           Listing of educational classes •           Description of CQI •           3 months of call schedules for OB, MFM and Neonatology as appropriate Level II Review •           Appendix A •           Resource Checklist for Level II •           Evaluation letter from Administrative Perinatal Center •           Credentials for Obstetrics (OB)/Family Practice (FP) physicians, Advance Practice Nurses (APN), Neonatology & Anesthesia •           Copy of OB/Peds Departmental Rules •           Consultation/referral tool/QA reports for 3 months •           Mortality and Morbidity (M&M) statistics and description of process/participation •           Transport statistics − out of hospital •           Listing of educational classes •           Description of CQI Level I Review •           Appendix A •           Resource Checklist for Level I •           Evaluation letter from Administrative Perinatal Center •           Credentials for Obstetrics (OB)/Family Practice (FP) physicians, Advance Practice Nurses (APNs), Neonatology & Anesthesia •           Mortality and Morbidity (M&M) statistics and description of process/participation •           Transport statistics − out of hospital •           Listing of educational classes •           Description of CQI Administrative Perinatal Center •           Network description •           Educational programs •           Network projects •           Discussion with representatives from Regional Network Hospitals •           Network participation •           Network evaluation •           Network challenges •           Network M&M statistics •           University integration