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NW4 - Facility Status Reporting Tool

1.Select your facility provider number and name.(Required.)
2.Date when facility operations were interrupted. (Required.)
3.What caused this interruption of operations?(Required.)
4.Facility operational status.(Required.)
5.Have all of your patients been notified of the changes to their treatment schedule?
* If not please call Network 4 Patient Services at: 610-265-2418 ext 2831 or 2830.(Required.)
6.When do you expect normal operations to resume?(Required.)