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Apply to Become a CHAMP Site
CHAMP site application
Hospital Name
Your First Name
Your Last Name
Your Role
Email Address
Contact information for the Home Monitoring Program at your hospital
Contact information for other team members—name, email, phone
Does your program provide 24x7 interstage monitoring?
Yes
No
Does your program have the ability to receive instant alerts regarding changes in patients’ status?
Yes
No
Does your program have the ability to triage iPad connectivity issues involving the use of iPads used by your patients? (We will provide an Operation Manual and we will be available to provide support.)
Yes
No
Will you/your program be able to participate in at least 3 of 4 planned quarterly CHAMP conference calls per year?
Yes
No
Will you/your program be able to upload clinical information such as hospitalizations, readmissions, patient interventions, including feeding adjustments, medication adjustments, radiologic evaluation, blood work, oxygen need, or reassurance provided to families?
Yes
No
Will you/your program be able to upload clinical information pertaining to your response to instant alerts?
Yes
No
Once your site personnel have been trained on the use of the app, will you train the parent on the app?
Yes
No
Will your patients’ families have a pulse oximeter and weight scale in good working condition prior to discharge?
Yes
No
Does your home monitoring program currently follow only HLHS or all complex congenital heart babies?
How many patients are you following currently?
How many patients do you follow per year?
If you are only following HLHS patients currently, do you plan to expand the use to complex congenital heart disease once you have CHAMP?
Yes
No
If yes, how many more patients would you anticipate that would add to your numbers (both at any given time, and annually)?
Submit
Contact Us
(816) 234-3880
champapp@cmh.edu
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