Attestations of Compliance with 10 NYCRR 405.2 and 405.4, Sepsis Protocols

Attachment – C

Attestations of Compliance with 10 NYCRR §§405.2 and 405.4, Sepsis Protocols

CEO Attestation

My signature below indicates official attestation that (Insert facility name) will comply with the requirements in 10 NYCRR §§ 405.2 and 405.4 regarding Sepsis Protocols. (Insert facility name) will support all efforts and activities needed to implement severe sepsis and septic shock protocols and to comply with NYSDOH reporting requirements, as required by regulation and contained within the hospital’s approved protocols.

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Date Signature

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Print Name

Chief Medical Officer Attestation

The required components of severe sepsis and septic shock protocols, as outlined in regulations and in the guidance document distributed by NYSDOH, are contained within the hospital’s protocols submitted for approval herein.

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Date Signature

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Print Name