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Sick, Shut-In & Hospital Notification
1.
Your Name
2.
Your Phone Number
3.
Name of Person Needing Care
4.
This person is a:
Church member
Visitor
Family member
Friend
5.
Type of Care needed: (check all that apply)
Intercessory prayer
1st Sunday Communion
hospital visit
home/nursing home visit
phone call
6.
Hospital or Facility Name and location
7.
Home Address (if applicable)
8.
Best contact person
9.
Contact Phone number
10.
Brief description of situation: