Please use the form below to submit data for your institution. Questions and comments may be directed to Stowe Teti at stowe.teti@inova.org. Thank you for your participation in this project.

CECS Data Submission

HOSPITAL INFORMATION

Address

Top 3 served zip codes as reported
Zip 1
Zip 2
Zip 3
Population Density

Level of Service
Academic Medical Center denotes a facility affiliated with one or more medical schools. Acute Care General Hospitals may offer services comparable to Academic Medical Centers, but are not medical school affiliates. Specialty hospitals include cancer-specific, psychiatric, or an otherwise narrowed-scope of practice provider. Critical access hospitals refer to institutions with a CMS-certified CAH designation indicating the facility is a provider type with its own iMedicare Conditions of Participation (CoP).
Patient Population
Refers to ages of patients treated in the facility.
Hospital Ownership
Affiliation
Please select "religious" for hospitals that consider themselves to be faith-based institutions (does not include hospitals solely for having a religious name).

ETHICS CONSULTATION

Overall consults is the number of consults the service performs at the location named in a calendar year (if your program counts "curbside consults," please note that in the notes section at the end of this submission). ICU Consults represent the number of consults requested for a patient while the patient is in an ICU (not all services may collect this data). FTEs includes salaried, hourly, or consulting hours dedicated to clinical ethics and the services needed to support it. This is intended to represent the hospital's investment in clinical ethics consulting and thus may count administrative time in service of that goal, preventative ethics, and research ethics activities, but should not include both parts of split appointments if partial salary comes from a non-hospital source.
Primary Consultation Model
Consult Volume Self-Assessment
Please provide any additional information needed to understand your data.
Point of Contact

Consent
This field is for validation purposes and should be left unchanged.

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