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