1. Identification of the siteHospital Name: Address of the hospital: Total Number of beds in the ICU(s) & CCU(s): * Contact PhysicianName: * Mobile: * Email * 2. Cath lab informationNumber of cath labs Number of interventional cardiologist Cathlabs working (24/7) YesNo 3. Coronary interventional activity per yearNumber of coronary angiographies Number of coronary interventions 4. Interventional Activity in AMI per yearNumber of total procedures/interventionsNumber of thrombolysis Number of Primary PCI Number of stents used# BMS # DES 5. Facilities in the hospital:Computer available for electronic form submission of cases: *YesNo Internet available: YesNo Do you wish that your center participates in SSL project? *YesNo Do you wish to participate in the ACS registry? *YesNo VerificationPlease enter any two digitsExample: 12This box is for spam protection - please leave it blank
