Submission Type:

New Application

Updated Application

Hospital Name

- Select -A.O. Fox Memorial Hospital (0739)A.O. Fox Memorial Hospital - Tri-Town Campus (8554)Adirondack Medical Center-Lake Placid Site (0306)Adirondack Medical Center-Saranac Lake Site (0324)Albany Medical Center - South Clinical Campus (0002)Albany Medical Center Hospital (0001)Arnot Ogden Medical Center (0116)Auburn Community Hospital (0085)Bellevue Hospital Center (1438)Bertrand Chaffee Hospital (0280)Blythedale Childrens Hospital (1138)Bon Secours Community Hospital (0708)BronxCare Hospital Center (1164)BronxCare Hospital Center (1178)Brookdale Hospital Medical Center (1286)Brooklyn Hospital Center - Downtown Campus (1288)Brooks-TLC Hospital System, Inc. (0098)Brooks-TLC Hospital System, Inc. (0114)Buffalo General Medical Center (0207)Calvary Hospital (10223)Calvary Hospital Inc (1175)Canton-Potsdam Hospital (0815)Carthage Area Hospital Inc (0379)Cayuga Medical Center at Ithaca (0977)Chenango Memorial Hospital Inc (0128)Claxton-Hepburn Medical Center (0798)Clifton Springs Hospital and Clinic (0676)Clifton-Fine Hospital (0817)Cobleskill Regional Hospital (10216)Columbia Memorial Hospital (0146)Community Memorial Hospital Inc (0401)Coney Island Hospital (1294)Corning Hospital (0866)Crouse Hospital (0636)Crouse Hospital - Commonwealth Division (9059)Cuba Memorial Hospital Inc (0037)David H. Koch Center For Cancer Care (10355)Degraff Memorial Hospital (0581)Delaware Valley Hospital Inc (0174)Eastern Niagara Hospital - Lockport Division (0565)Ellenville Regional Hospital (1002)Ellis Hospital (0829)Ellis Hospital - Bellevue Woman's Care Center Division (0848)Elmhurst Hospital Center (1626)Erie County Medical Center (0210)F.F. Thompson Hospital (0678)Faxton-St Lukes Healthcare St Lukes Division (0599)Flushing Hospital Medical Center (1628)Garnet Health Medical Center (0699)Garnet Health Medical Center - Catskills (0971)Garnet Health Medical Center - Catskills - G. Hermann Site (0968)Geneva General Hospital (0671)Glen Cove Hospital (0490)Glens Falls Hospital (1005)Good Samaritan Hospital Medical Center (0925)Good Samaritan Hospital of Suffern (0779)Gouverneur Hospital (0812)Guthrie Cortland Medical Center (0158)Harlem Hospital Center (1445)HealthAlliance Hospital Broadway Campus (0990)HealthAlliance Hospital Mary's Avenue Campus (0989)Helen Hayes Hospital (0775)Henry J. Carter Specialty Hospital (1486)Highland Hospital (0409)Hospital for Special Surgery (1447)Huntington Hospital (0913)Interfaith Medical Center (1309)Ira Davenport Memorial Hospital (0873)Jacobi Medical Center (1165)Jamaica Hospital Medical Center (1629)John R. Oishei Children's Hospital (0208)John T Mather Memorial Hospital of Port Jefferson New York Inc (0895)Kenmore Mercy Hospital (0267)Kings County Hospital Center (1301)Kingsbrook Jewish Medical Center (1315)Lenox Health Greenwich Village (9700)Lenox Hill Hospital (1450)Lewis County General Hospital (0383)Lincoln Medical & Mental Health Center (1172)Little Falls Hospital (0362)Long Island Community Hospital (0885)Long Island Jewish Forest Hills (1638)Long Island Jewish Medical Center (1630)Long Island Jewish Valley Stream (0518)Maimonides Medical Center (1305)Margaretville Hospital (0170)Mary Imogene Bassett Hospital (0746)Massena Hospital, Inc. (0804)Medina Memorial Hospital (0718)Memorial Hosp of Wm F & Gertrude F Jones A/K/A Jones Memorial Hosp (0039)Memorial Hospital for Cancer and Allied Diseases (1453)Mercy Hospital - Mercy Hospital Orchard Park Division (1723)Mercy Hospital of Buffalo (0213)Mercy Medical Center (0513)Metropolitan Hospital Center (1454)Mid-Hudson Valley Division of Westchester Medical Center (0180)Millard Fillmore Suburban Hospital (3067)Mohawk Valley Heart Institute, Inc (7528)Monroe Community Hospital (0414)Montefiore Med Center - Jack D Weiler Hosp of A Einstein College Div (3058)Montefiore Medical Center - Henry & Lucy Moses Div (1169)Montefiore Medical Center - Montefiore Westchester Square (1185)Montefiore Medical Center-Wakefield Hospital (1168)Montefiore Mount Vernon Hospital (1061)Montefiore New Rochelle Hospital (1072)Montefiore Nyack (0776)Mount Sinai Beth Israel (1439)Mount Sinai Brooklyn (1324)Mount Sinai Hospital (1456)Mount Sinai Hospital - Mount Sinai Hospital of Queens (1639)Mount Sinai Morningside (1469)Mount Sinai South Nassau (0527)Mount Sinai West (1466)Mount St Marys Hospital and Health Center (0583)NYU Langone Health-Cobble Hill (9753)NYU Langone Hospital-Brooklyn (1304)NYU Langone Hospitals (1463)NYU Langone Orthopedic Hospital (1446)NYU Winthrop Hospital (0511)Nassau University Medical Center (0528)Nathan Littauer Hospital (0330)New York Community Hospital of Brooklyn, Inc (1293)New York Eye and Ear Infirmary of Mount Sinai (1460)New York-Presbyterian David H. Koch Center (10139)New York-Presbyterian Hospital - Allen Hospital (3975)New York-Presbyterian Hospital - Columbia Presbyterian Center (1464)New York-Presbyterian Hospital - New York Weill Cornell Center (1458)New York-Presbyterian Lawrence Hospital (1122)New York-Presbyterian Westchester Behavioral Health Center (1047)New York-Presbyterian/Lower Manhattan Hospital (1437)NewYork-Presbyterian Brooklyn Methodist Hospital (1306)NewYork-Presbyterian/Hudson Valley Hospital (1039)NewYork-Presbyterian/Queens (1637)Newark-Wayne Community Hospital (1028)Niagara Falls Memorial Medical Center (0574)Nicholas H. Noyes Memorial Hospital (0393)North Central Bronx Hospital (1186)North Shore University Hospital (0541)Northern Dutchess Hospital (0192)Northern Westchester Hospital (1117)O'Connor Hospital (0165)Olean General Hospital (0066)Oneida Health Hospital (0397)Oswego Hospital (0727)Oswego Hospital - Alvin L Krakau Comm Mtl Health Center Div (0012)Our Lady of Lourdes Memorial Hospital (0043)Peconic Bay Medical Center (0938)Phelps Hospital (1129)Plainview Hospital (0552)Putnam Hospital (0752)Queens Hospital Center (1633)RUMC-Bayley Seton (1473)Richmond University Medical Center (1738)River Hospital, Inc. (0377)Rochester General Hospital (0411)Rockefeller University Hospital (1465)Rome Memorial Hospital, Inc (0589)Roswell Park Cancer Institute (0216)SBH Health System (1176)SJRH - Dobbs Ferry Pavillion (1124)SJRH - Park Care Pavilion (1099)SJRH - St Johns Division (1097)Samaritan Hospital (0756)Samaritan Hospital - Albany Memorial Campus (0004)Samaritan Hospital - St. Mary's Campus (0755)Samaritan Medical Center (0367)Saratoga Hospital (0818)Schuyler Hospital (0858)Sisters of Charity Hospital (0218)Sisters of Charity Hospital - St. Joseph Campus (0292)Soldiers and Sailors Memorial Hospital of Yates County (1158)South Nassau Communities Hospital Off-Campus Emergency Department (9691)South Shore University Hospital (0924)St Anthony Community Hospital (0704)St Catherine of Siena Hospital (0943)St Elizabeth Medical Center (0598)St Francis Hospital (0563)St Johns Episcopal Hospital So Shore (1635)St Luke's Cornwall Hospital/Newburgh (0694)St. Charles Hospital (0896)St. James Hospital (0870)St. Joseph Hospital (0551)St. Joseph's Hospital (0118)St. Joseph's Hospital Health Center (0630)St. Joseph's MC-St. Vincent's Westchester Division (1133)St. Joseph's Medical Center (1098)St. Mary's Healthcare (0484)St. Mary's Healthcare - Amsterdam Memorial Campus (0482)St. Peter's Addiction Recovery Center (9431)St. Peter's Hospital (0005)Staten Island University Hosp-North (1740)Staten Island University Hosp-South (1737)Stony Brook Eastern Long Island Hospital (0891)Stony Brook Southampton Hospital (0889)Stony Brook University Hospital (0245)Strong Memorial Hospital (0413)Sunnyview Hospital and Rehabilitation Center (0831)Syosset Hospital (0550)The Burdett Care Center (9250)The Unity Hospital of Rochester (0471)The Unity Hospital of Rochester - St. Mary's Campus (0412)The University of Vermont Health Network - Alice Hyde Medical Center (0325)The University of Vermont Health Network - Champlain Valley Physicians Hospital (0135)The University of Vermont Health Network - Elizabethtown Community Hospital (0303)The University of Vermont Health Network - Elizabethtown Community Hospital Moses Ludington (0309)UPMC Chautauqua at WCA (0102)UPMC Chautauqua at WCA (0103)UPSTATE University Hospital at Community General (0628)URMC Strong West (9531)United Health Services Hospitals Inc. - Binghamton General Hospital (0042)United Health Services Hospitals Inc. - Wilson Medical Center (0058)United Memorial Medical Center Bank Street Campus (0340)United Memorial Medical Center North Street Campus (0339)University Hospital SUNY Health Science Center (0635)University Hospital of Brooklyn (1320)Vassar Brothers Medical Center (0181)Westchester Medical Center (1139)Westfield Memorial Hospital Inc (0111)White Plains Hospital Center (1045)Winifred Masterson Burke Rehabilitation Hospital (1046)Woodhull Medical & Mental Health Center (1692)Wyckoff Heights Medical Center (1318)Wyoming County Community Hospital (1153)

Emergency Department PECC Physician

Full Name

Title Within Organization

Email

PECC Work Mailing Address

Address 2

City/Town

State/Province

- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP/Postal Code

Emergency Department PECC Nurse

Full Name

Title Within Organization

Email

PECC Work Mailing Address

Address 2

City/Town

State/Province

- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP/Postal Code

Emergency Department Medical Director

Full Name

Title Within Organization

Email

Emergency Department Nurse Director/Manager

Full Name

Title Within Organization

Email

Would you like to add additional PECC Coordinators?

- Select -YesNo

PECC Coordinator

Full Name

Email

Phone

PECC Coordinator

Full Name

Email

Phone

Level of Recognition that your hospital is applying for:

Pediatric Engaged

Pediatric Ready

Pediatric Innovator

ARC Commitment Letter Upload

Upload

Upload requirements

• One file only.
• 100 MB limit.
• Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

NPRP/ NPRA Gap Report Upload

Upload

Upload requirements

• One file only.
• 100 MB limit.
• Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Submit