STARS Inquiry

Hospital *

Name *

Email *

Phone *

Additional Information *

STARS Referral Request

Children who qualify would include at least one of the following when going home:

Tracheostomy
Ventilator
Severe cardiac abnormalities (cyanotic heart lesions, placement of cardiac shunts, LVAD patients, heart transplant candidates)
Hemophilia or other bleeding disorder necessitating administration of clotting factors
Status epilepticus-prone patient (VNS, Ketogenic Diet, multiple rescue meds)
VP/VA Shunt
Central Line/PICC Line/Dialysis shunt
Metabolic or Mitochondrial syndrome
Adrenal Insufficiency/Crisis with prescribed emergency medications
Advanced Directive/DNR
Child with a Medical Complexity who require alteration to emergency EMS treatment algorithms (Case-by-case enrollment)

My child meets this criteria

STARS Plan Update Request

Pediatric Hospital *

Name *

Email

Phone

Child's name *

Child's date of birth *

Relationship to Child *

STARS number *

I do not know the STARS number

Change Reason *

Additional information

info

Important: Due to HIPAA laws, please do not include any sensitive health information, like diagnosis or medication information.

Request STARS Training

STARS Team Site

Your Information

Name *

Agency name *

Email *

Phone *

Training Information

Training topic *

Additional information *

STARS Website Assistance

Name *

Email *

Phone *

Type of Assistance *

Please include any additional details to help us address your issue more quickly *

STARS Inquiry

STARS Referral Request

STARS Plan Update Request

Request STARS Training

STARS Team Site

Your Information

Training Information

STARS Website Assistance

How can we assist?

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Enroll / Refer a Patient

Update Care Plans

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