Department of Health

Trauma Section LETTER OF INTENT

DH Form 1840, January 2010

   

 

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I, Gina Melby Chief Executive Officer, hereby
Type Name)

submit this Letter of Intent to the Department of Health, Division of Emergency Preparedness and
Community Support, Bureau of Emergency Medical Oversight, Trauma Section, to express an

interest JFK Medical Center in becoming
for

 

(Name of HOSpitaI)

a trauma center or in upgrading the trauma care services already being provided. I recognize the

following:
1. There are three categories of trauma centers: Level I, Level II, and Pediatric.
2. An applicant to be a Level trauma center must concurrently apply for and be approved as

a Level and Pediatric.

3. No general acute care hospital shall be approved solely as a pediatric trauma center
unless there are independent pediatric trauma patient care services within that facility, from
emergency department admission through rehabilitation, that are separate and distinct
from adult patient care services.

4. This completed form does not obligate my hospital to apply for trauma center approval.

5. There are three available applications. I have indicated below on the appropriate line the
application(s) wish to receive. (Note: If Level I is checked, you must also check
Pediatric.)

Level Trauma Level II Trauma Pediatric Trauma
Center Center Center

6. Section states that to be considered by the department a hospital that
submits a Letter of Intent must certify that its resolution to operate as a trauma center is
?consistent with the trauma services plan of the local or regional trauma agency, as
approved by the department, if such an agency exists.? Accordingly, our application is
consistent with the applicable local or regional trauma agency services plan.

Yes Not applicable

SIGNED BY: ?14an Wk! 6] ?02$ 

(ChiefExethil/e Of?cer) (Date)

 

 

Chief Executive Officer's Email Address: Gina.Melbv@HCAHealthcare.com

Hospital Mailing Address
(Street address) 5301 S. Congress Avenue
Atlantis, FL 33462

 

Contact Person Title: Gina Melby
Contact Person's Phone: (561) 965-7300

Contact Person?s Email Address: Gina.Melby@HCAHealthcare.com

RETURN To: Bernadette Behmke
Florida Department of Health
Division of Emergency Preparedness and Community Support
Bureau of Emergency Medical Oversight
Trauma Section
4052 Bald Cypress Way, Bin A-22
Tallahassee, FL 32399-1701

2 DH Form 1840, January 2010