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Immediate Response Required

LeadingAge Wisconsin, WHCA/WiCAL, and WALA have been approached by Dr. L. Silvia Munoz-Price, M.D., Ph.D., Froedtert & Medical College of Wisconsin, with a strategy to provide Personal Protective Equipment for post-acute providers, including nursing homes and assisted living facilities.  Dr. Munoz-Price is working to secure a PPE grant from Advancing a Healthier Wisconsin to fund the purchase of disposable masks and reusable face shields. Please note that the face shields are re-usable after disinfection with standard disinfectants.
 
If your organization is interested in potentially receiving masks and face shields, at no cost, you need to complete this survey.

We need your survey response before 3:00 p.m. on Monday, March 23rd.

Thank you.

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* 1. Name

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* 2. Organization

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* 3. City

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* 4. County

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* 5. Telephone Number

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* 6. Email Address

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* 7. What is your best estimate of the number of DISPOSABLE MASKS that each of the entity types within your organization will need over the next 4 months? Indicate your estimate for each entity type in your organization.

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* 8. What is your best estimate of the number of REUSABLE FACE SHIELDS that each of the entity types within your organization will need over the next 4 months? Indicate your estimate for each entity type in your organization.

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* 9. Comments

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