2017 Donate Life Hospital Challenge

The Hospital & Healthsystem Association of Pennsylvania (HAP) has partnered with the Pennsylvania Department of Health and the two organ procurement organizations serving Pennsylvania—the Center for Organ Recovery & Education and the Gift of Life Donor Program—to support the 2017 Pennsylvania Donate Life Hospital Challenge, which begins April 1, 2017, as part of National Donate Life Month. The Pennsylvania Donate Life Hospital Challenge encourages Pennsylvania hospitals to increase organ donation awareness and designations within their hospital and community. 

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* 1. Hospital Name:

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* 2. Address:

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* 3. Name of PRIMARY Hospital Liaison:

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* 4. Title of PRIMARY Hospital Liaison:

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* 5. Email for PRIMARY Hospital Liaison:

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* 6. Telephone number for PRIMARY Hospital Liaison:

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* 7. Name of SECONDARY Hospital Liaison:

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* 8. Title of SECONDARY Hospital Liaison:

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* 9. Email of SECONDARY Hospital Liaison:

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* 10. Telephone number of SECONDARY Hospital Liaison:

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