Question Title

* 1. What is the name of your facility?

Question Title

* 2. What is the address of your facility?

Question Title

* 3. How many residents need the first of a COVID-19 vaccine?

Question Title

* 4. How many residents at your facility are in need of the second dose of COVID-19 vaccine?

Question Title

* 5. Which booster/second dose is needed for your resident(s)?

Question Title

* 6. How many existing residents who previously declined COVID-19 vaccine would like to receive it now?

Question Title

* 7. Prior to this request from DOH, who have you reached out to for assistance?

Question Title

* 8. Who is your long term care pharmacy?

Question Title

* 9. Have you discussed vaccination needs with your long term care pharmacy?

0 of 9 answered
 

T