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Antibiotic Stewardship Letter of Intent

Our facility is interested in joining the Antibiotic Stewardship initiative. The following form contains introductory information about our team.

1. Name of Facility: *This question is required.

2. Name of Contact Person: *This question is required.

3. Work Phone Number for Contact Person: *This question is required.

4. Work Email for Contact Person: *This question is required.

5. Our unit has a QI team. *This question is required.

6. Our team has an active family member. *This question is required.

7. Our team has a member of senior leadership. *This question is required.

8. How many deliveries does your unit do a month?

9. What level NICU does your facility have?