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Healthcare Resource Assessment- Hospital
This survey is designed to collect information on those disaster-related assets within your agency
Email address *
1. Hospital Name *
Your answer
2. Hospital Type *
Required
3. Hospital Fiscal Type
4. Location of Facility (County) *
Required
3. 24/7 Primary Hospital Contact: Name *
Your answer
4. 24/7 Primary Hospital Contact: E-mail *
Your answer
5. 24/7 Primary Hospital Contact: Phone *
Your answer
6. 24/7 Alternate Hospital Contact: Name
Your answer
7. 24/7 Alternate Hospital Contact: E-mail
Your answer
8. 24/7 Alternate Hospital Contact: Phone
Your answer
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