CMS Emergency Preparedness Consultation

These nine questions will help us prepare for your free phone consultation.

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* 1. How many total patients/residents do you regularly care for?

fewer than 40

40 to 99

100 or more

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* 2. About how many Medicare/Medicaid patients or residents are you usually serving?

zero - we do not accept Medicare/Medicaid

between 1 and 40

40-99

100 or more

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* 3. Are you currently accredited by The Joint Commission or any similar agency?

Yes (please indicate which, if known, in the comments below)

No

Which agencies accredit your facility?

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* 4. What type of facility is this?

Other/more than one (please specify)

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* 5. Is your facility part of a network that will develop an integrated compliance plan?

Yes

No

What other facilities will be included?

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* 6. Have you conducted your Risk Assessment yet?

Yes

No

Other (please specify)

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* 7. Does your facility require a backup power generator?

Yes

No

Other (please specify)

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* 8. How many facilities (different locations) need to be incorporated into your emergency plan?

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* 9. Your contact information

Your name

Your facility name

Facility address

Address line 2 (if needed)

City

State

ZIP

Your title

Your email address

Best phone number to reach you