Sick & Shut-In Form

This Sick & Shut-In Form allows a family member or friend (persons without Realm access) to report on a CPBC member's significant health situation when the member is unable to report for themselves on Realm in the Sick & Shut-In Members Group. The completed form will land on a spreadsheet that is monitored by one member of the ministerial staff and one member of the Diaconate, who will relay the report to the Pastor and the other ministers and Diaconate members. Also, please don't forget to come back as needed to report updates concerning the member's progress or to alert us to any additional concerns. 

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Date *
MM
/
DD
/
YYYY
Name of Sick/Shut-in Member *
Name of Person Reporting *
Contact Number of Person Reporting *
Relationship to the Sick/Shut-in Member *
Is this a first instance or an update? *
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