Thank you for your interest in the Emergency General Surgery Verification Program (EGS-VP), and taking this important step in the surgical quality journey. This application begins the process for verification. There are 2 steps in the EGS-VP application process.

Step 1: Complete this application with demographic information about your hospital.

Step 2: A staff member will reach out with additional login information for you to complete a Hospital Profile, providing us information to better understand your hospital.

Completion of this application begins the process of becoming an EGS-VP site. Please make sure you have reviewed all program standards and requirements via the Optimal Resources for Emergency General Surgery prior to application submission.

Please Note:

Federal Employer Identification Number (FEIN): asks for your facility’s unique 9-digit number assigned by the Internal Revenue Service (IRS) to all businesses operating in the United States
Tax ID Number if Outside USA: should be completed by international facilities only, and asks for their facility’s national identification number

If you have any questions, reach out to ACS EGS Program Staff at egs@facs.org

Site Name:

Site Address:

Country:

City:

State:

ZIP:

Web Site:

Phone: (Country Code/Area Code/Number)

Ext:

Fax: (Area Code/Number)

Site Email:

FEIN:

NPI:

AHA Number: