Membership Overview

The Southwest Colorado Healthcare Coalition (SWCHCC) serves the 5 counties and 2 Indian Tribes of Southwest Colorado: Archuleta, Dolores, La Plata, Montezuma, and San Juan Counties, and the Ute Mountain Ute and Southern Ute Indian Tribes.  The SWCHCC exists to develop, enhance, and promote the region’s healthcare emergency preparedness and response capabilities through communication, planning, training, coordination and collaboration with coalition partners for the delivery of safe and high-quality patient care during emergency events. The coalition also works to ensure Healthcare organizations are in compliance with CMS standards for Emergency Management. 

By completing this application, you are agreeing to represent your organization as a member of the Southwest Colorado Healthcare Coalition. We would like for each organization to have at least 2 representatives (Primary and Secondary) but you can have additional representatives as well. You will receive information from the coalition about meetings (dates/time, locations, agendas, and minutes), educational/training opportunities, exercises, and grant funding opportunities.  As a member of the coalition at least 1 representative from each organization is required to attend, at a minimum, 2 quarterly meetings each year in order to be considered an active member in "Good Standing". The information provided will also be used to aid in the response to a real event.  We will only share this information for the purposes of a response and with authorized agencies.

We look forward to your agency joining our coalition as we work together to ensure our Healthcare community is prepareded and capable to respond effectively during a disaster.

If you have any questions prior to joining the Southwest Colorado Healthcare Coalition please send them to swchcc@gmail.com. Thank you. 

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* 1. First Name

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* 2. Last Name

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* 3. Title

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* 4. Organization Name

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* 5. Email Address

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* 6. Office Phone Number

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* 7. Cell Phone Number (Recommended for Emergency Contact)

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* 8. Organization Mailing Address

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* 9. Organization Physical Address (If same as mailing, enter SAME in the first line)

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* 10. Organization Type.  Choose all that apply for your organization's services.

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* 11. Which county is your agency in?  If your agency serves more than one county, please select all that apply.

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* 12. Does your agency have more than one location / office?  If so, please list additional addresses below.

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* 13. 24/7 Contact Information

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* 14. Does your agency have access to an 800 MHz radio?

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* 15. Does your agency have access to WebEOC?

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* 16. Does your agency have access to EMResource?

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* 17. Do you have any other comments for the SWCHCC?

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* 18. Can we share your contact information publicly?  If yes, your contact information may be posted on the Coalition website.  If no, it will be only shared with the Steering Committee for coordination and response purposes only.  

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