Physicians Available On-Call for Consultation (Must be capable of responding to the emergency 3. department within 20 minutes) □ Pediatrician or Family Practice Physician with expertise and experience in the care of children or guideline for □ □ E Yes No obtaining consultation with regional pediatric referral center. □ D □ □ General Surgeon Yes No □ □ □ D Anesthesiologist Yes No □ □ □ D Gynecologist Yes No □ □ □ D Orthopedic Surgeon Yes No □ □ □ D Radiologist Yes No □ □ 4. Licensed Pharmacist On-Call D Yes No 5. Nursing □ □ Director of Nursing/Chief Nursing Officer E Yes No □ □ Director of Emergency Nursing/ED Manager E Yes No
3. Physicians Available On-Call for Consultation (Must be capable of responding to the emergency department within 20 minutes) □ Pediatrician or Family Practice Physician with expertise and experience in the care of children or guideline for obtaining consultation with regional pediatric referral center. E □ Yes □ No □ General Surgeon D □ Yes □ No □ Anesthesiologist D □ Yes □ No □ Gynecologist D □ Yes □ No □ Orthopedic Surgeon D □ Yes □ No □ Radiologist D □ Yes □ No 4. Licensed Pharmacist On-Call D □ Yes □ No 5. Nursing Director of Nursing/Chief Nursing Officer E □ Yes □ No Director of Emergency Nursing/ED Manager E □ Yes □ No