PedsCCM.org: PICU Jobs Database Form

PedsCCM: PICU Jobs Database Entry Form

Instructions:

Complete all required fields

Please provide a valid email address as a contact
(you may choose to have this omitted from what appears in the database, but we need this to contact you...). Your job will not be posted unless you provide us a valid email address.

We will review your submission and post it promptly if appropriate. We will contact you by the email address you provided for confirmation of accuracy.

Please read the PedsCCM Job Notice Policy and consider participating!

Questions? E-mail Barry Markovitz (markovitz@pedsccm.org)

PedsCCM: PICU Jobs Database Entry Form

*Hospital Name (Required)**	Affiliated Medical School	*Hospital City (Required)**
Hospital State (two letter abbreviation please)	USA Region	*Hospital Country (Required)**
Affiliated Health Care System	Hospital name 2	Hospital name 3
*PICU Type (Required)**	Practice model	Requirements?
*Number of PICU beds (Required)**	Number of PICU admits/year	Number of intermediate care beds
Number of intermediate care admits/year	Number of intensivists	Number of positions open
Rank Available
Additional information(feel free to include several text paragraphs for a full description as needed)
Does the program have ... residents?	Resident number
Fellows?	Fellow number
Nurse practitioners?	Nurse practitioners number
Clinical Nurse Specialists?	Clinical Nurse Specialists number
Physician assistants?	Physician assistant number
Director First Name	Director MI	Director Last Name
Director Degree
Other Contact First Name	Other Contact MI	Other Contact Last Name
Other Contact Degree
Street address 1	Street address 2	Contact City
Contact State (two letter abbreviation please)	Zip	Contact Country
Phone	Fax	*email address (Required)**
URL? (enter as www.yoursite.com)
Any additional instructions for PedsCCM, e.g., do not post email address, etc.