2018 KISS Attestation 2018 KISS Attestation Survey Question Title * 1. Hospital Question Title * 2. Address Question Title * 3. City Question Title * 4. State Question Title * 5. Zip Code Question Title * 6. General Phone Number Question Title * 7. Attestation Date Date / Time Question Title * 8. CEO Name Question Title * 9. CEO Phone Question Title * 10. CEO Email Question Title * 11. Stroke Medical Provider Name Question Title * 12. Provider Phone Number Question Title * 13. Provider Email Question Title * 14. Marketing/PR Phone Question Title * 15. Marketing Contact Name Question Title * 16. Marketing/PR Email Question Title * 17. ED Nurse Manager Question Title * 18. ED Nurse Manager Phone Question Title * 19. ED Nurse Manager Email Question Title * 20. EMS Provider Question Title * 21. EMS Contact Name Question Title * 22. EMS Phone Question Title * 23. EMS Email Question Title * 24. EMS 2 Provider Question Title * 25. EMS 2 Contact Name Question Title * 26. EMS 2 Phone Question Title * 27. EMS 2 Email Question Title * 28. Alteplase Available for Stroke Yes No Question Title * 29. 24/7 CT Yes No Question Title * 30. CT Scanner Slice # Question Title * 31. 24/7 Blood Coag. Yes No Question Title * 32. Plan to Transfer to Appropriate Neurosurgical/Neuro-Interventional/Stroke Expertise: Yes No Question Title * 33. Where will these patients be transferred to, if needed? Question Title * 34. Implemented Emergent Stroke Care Protocol Yes No Question Title * 35. Hospital will submit HIPAA compliant data monthly on stroke patients Yes no Question Title * 36. Data Abstractor Name Question Title * 37. Data Abstractor Phone Question Title * 38. Data Abstractor Email Question Title * 39. Are you a part of the Heart and Stroke Collaborative? Yes No Question Title * 40. Willing to be listed on a statewide capability map Yes No Question Title * 41. Hospital will provide community stroke education Yes No Question Title * 42. Community Education Date Date / Time Question Title * 43. What Community Education Program Question Title * 44. 2018 # of Acute Ischemic Strokes Question Title * 45. 2018 # of Hemorrhagic Strokes Question Title * 46. 2018 # of Alteplase Treatments for Stroke Question Title * 47. 2018 # of transfers for intervention/care Done