LET'S BREATHE Quick-Share Form

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Tell us how many masks you have delivered, and who has received them. Your team's results will become part of the nationwide LET'S BREATHE numbers.

Enter your results ONE HEALTH CENTER AT A TIME, submitting a separate completed form for each facility, each delivery.

2. Name of Healthcare Provider Receiving Your Team's Masks: *

3. State Where You Donated Masks *

4. Type of Healthcare Provider: *

5. Date You Delivered Your Masks *

YYYY

6. Number of Masks Donated To Them On This Date *

Submit

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