COVID Relief Facility Capacity Change Form

Please complete this form if you are already a designated COVID Relief Facility that would like to notify MDHHS of any recent capacity changes you would like to implement. You must complete this form each time you wish to increase or decrease the number of COVID-designated beds in your facility, or if there are additional changes that need to be made since your application was reviewed (e.g. staffing changes). 

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* 1. Facility Information

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* 2. Point of Contact Information

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* 3. Is a change in your capacity relative to an increase or decrease in unit size?

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* 4. Which designation does your facility currently maintain as it relates to the CRF Status?

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