WebEOC Facility Account Request
Please enter the information below if you would like your facility to be added to WebEOC. We will create your facility's account and notify you via email once it is complete.
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1.
Facility Name
(Required.)
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2.
Please select your Healthcare Coalition Region
(Required.)
Region A - Catoosa, Dade, Fannin, Gilmer, Gordon, Murray, Pickens, Walker, Whitfield
Region B - Banks, Dawson, Habersham, Hall, Lumpkin, Rabun, Stephens, Towns, Union, White
Region C - Bartow, Carroll, Chattoga, Coweta, Floyd, Haralson, Heard, Polk
Region D - Clayton, Fayette, Forsyth, Fulton, Gwinnett, Newton, Rockdale
Region E - Barrow, Clarke, Elbert, Franklin, Greene, Hart, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton
Region F - Bibb, Butts, Crawford, Henry, Houston, Jones, Lamar, Monroe, Peach, Pike, Spalding, Upson
Region G - Burke, Columbia, Emanuel, Glascock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Taliaferro, Warren, Wilkes
Region H - Baldwin, Bleckley, Dodge, Handcock, Jasper, Johnson, Laurens, Montgomery, Pulaski, Putnam, Telfair, Treutlen, Twiggs, Washington, Wheeler, Wilcox, Wilkinson
Region I - Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Meriwether, Muscogee, Quitman, Schley, Stewart, Talbot, Taylor, Troup, Webster
Region J - Bryan, Bulloch, Camden, Candler, Chatham, Effingham, Evans, Glynn, Liberty, Long, McIntosh, Screven, Tattnall, Toombs
Region K - Baker, Brooks, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Randolph, Seminole, Sumter, Terrell, Thomas, Worth
Region L - Ben Hill, Berrien, Cook, Echols, Irwin, Lanier, Lowndes, Tift, Turner
Region M - Appling, Atkinson, Bacon, Brantley, Charlton, Clinch, Coffee, Jeff Davis, Pierce, Ware, Wayne
Region N - Cherokee, Cobb, Douglas, Paulding
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3.
Facility Type
(Required.)
Assisted Living Facility
Community Health Center
Dialysis Services
EMS
Home Care
Hospice
Hospital
Outpatient/Clinic
Personal Care Home
Public Health
Skilled Nursing Facility
Support Agency/ Organization
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4.
Your Name
(Required.)
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5.
Your Email
(Required.)
Current Progress,
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