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Ascension Health
Ascension Health Change Order Form (Module and Layer Removal Only)
To
remove
any/all of the following American Heart Association/American Stroke Association programs, please complete and submit the change order form.
Program and Module Deactivation Request
Program and Module Deactivation Request
1
Please select the site whose participation you would like to change.
Please select the program(s) you would like to remove.
Get With The Guidelines®-Stroke
Get With The Guidelines®-Heart Failure
Get With The Guidelines®-Resuscitation
Get With The Guidelines®-AFIB
Get With The Guidelines®-CAD
Cardiogenic Shock Registry
Outpatient Quality Registry
Please select the layer(s) you would like to remove.
GWTG-CAD with direct data entry into GWTG
GWTG-CAD with authorized vendor data submission
GWTG-CAD AHAR layer
GWTG-CAD CHAC layer
GWTG-CAD PHAC layer
GWTG-Heart Failure with Advanced Certification in Heart Failure
Report Writer - Resuscitation
GWTG-Stroke STK layer
GWTG-Stroke CSTK layer
GWTG-Stroke TSC layer
GWTG-Stroke ASR layer
GWTG-Stroke ePCR integration
CMS OP-23
Report Writer - Stroke
Coverdell Layer - for Coverdell State Hospitals (No Additional Cost)
Coverdell Layer - for Non-Coverdell State Hospitals (cost)
Massachusetts PSS with GWTG-Stroke Contract
Massachusetts PSS without GWTG-Stroke Contract
New Jersey DOH Data Reporting Fee
New York State Reporting Fee
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Submit
Submission Records
Submission Records
1
Submission Date
Please select the site whose participation you would like to change.
Please select the program(s) you would like to remove.
Please select the layer(s) you would like to remove.
Submission Date
Please select the site whose participation you would like to change.
Please select the program(s) you would like to remove.
Please select the layer(s) you would like to remove.
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