Alameda County Medical Health Situational Status Report Form (COVID-19)
Please fill out this form to provide situational awareness of what is currently happening within your facility.
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Facility Name *
Facility Address *
Originator Name *
Title *
Department *
Phone # *
Email Address *
Facility Type *
Is your EOC/HCC activated? *
EOC/HCC Phone # *
EOC/HCC Email (if applicable)
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