Vulnerable Populations Registry for Clay County

Introduction

Emergencies can occur at any time of the year, whether it is a house fire, tornado, flood, or hazardous chemical spill. Please take a moment to complete the Vulnerable Population Registry for yourself or for an individual who is considered at-risk and vulnerable especially during emergencies.

The information gathered through the Vulnerable Population Registry is protected under HIPAA and is only used during an emergency by Clay County Public Health and Clay County Emergency Management. By you completing this Registry, we have a better awareness to serve Clay County Residents who are at-risk and possibly need assistance during an emergency, i.e., safety and health check to an evacuation from residence.

Assistance to complete the Registry is provided by Clay County Public Health. Please do not hesitate to contact Public Health at 218-299-5220 between 8:00 am and 4:30 pm, Monday through Friday for assistance.

Question Title

* 1. Please give the name of the person who is considered vulnerable during emergencies.

Last Name

First Name

Question Title

* 2. Please read through the statements below and check one to begin the Vulnerable Population Registry.

I have completed the Registry and need to update my information.

My family member is entered in the Registry and I need to update their information.

My family member was entered in the Registry has passed away.

My client is entered in the Registry and I need to update their information.

My client was entered in the Registry has passed away.

I am considered at-risk and need to complete the Vulnerable Population Registry.

My family member is considered at-risk and I need to complete the Registry.

My client is considered at-risk and I need to complete the Registry for my client.

Other