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Healthcare Resource Assessment: Coroners
This survey is designed to collect information on those assets that your agency may access, activate, deploy, etc. during an emergency.
Email address *
1. Agency Name: *
Your answer
2. Jurisdiction(s) covered - select all that apply *
Required
3. 24/7 primary agency contact - Name: *
Your answer
4. 24/7 primary agency contact - Phone: *
Your answer
5. 24/7 primary agency contact - E-mail: *
Your answer
6. 24/7 alternate agency contact - Name:
Your answer
7. 24/7 alternate agency contact - Phone:
Your answer
8. 24/7 alternate agency contact - E-mail:
Your answer
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