Supply Shortage Reporting Form

Ongoing healthcare system pharmaceutical and supply chain shortage issues pose serious risks to the quality and safety of patient care, as well as the availability of essential medicines and medical devices. To address these challenges, MHA is asking that healthcare providers and stakeholders report any problems or disruptions they encounter to help improve situational awareness and facilitate technical support and coordination among local, state, and federal entities when needed. Reporting can also help identify the root cause of issues and inform policy decisions and interventions to mitigate them.

 

To report an existing or anticipated supply chain issue or supply shortage, please complete this form in its entirety. 
There are three sections to complete. Begin by providing contact information to identify the reporting facility and reporting individual. Next, complete the table to provide specific detail on up to five supply shortages or supply chain issues you may be experiencing. Finally, complete the mitigation section to identify which, if any, mitigation efforts have been implemented as a result of the supply chain issue or shortage.

 

Please note: The information submitted will be maintained on record for up to 90 days. After 90 days, the information will be automatically removed from the reported shortage list. If you are still experiencing the shortage, information will need to be re-submitted. To make earlier updates or report resolutions to any previously reported shortages, please contact Keri Barclay or Kara Amann-Kale by phone at 573-893-3700, or email kbarclay@mhanet.com or kamann-kale@mhanet.com.