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Crisis Standards of Care Activation
Please fill out this form when your facility or agency has activated Crisis Standards of Care. When you submit your response, you will receive an email with a copy of your responses and a link to edit these responses. Please save that email and use the link in it to edit responses when needed.
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Email *
Hospital, Agency or Health Care Provider Name *
County *
Required
What part of the Crisis Standards of Care are you implementing? *
Required
What date did you activate Crisis Standards of Care? *
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A copy of your responses will be emailed to the address you provided.
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