Please complete the following information for your facility.

  • Please report your facility's planned status leading up to the impact of the storm.
  • Please submit an individual survey for each facility.

 
The Network will be sending a follow-up survey after the storm to evaluate your operational status and identify needs to assist you with returning to normal operations.
          

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* 2. Who is the Primary Emergency Point of Contact for this unit for the duration of this event?

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* 3. What is your facility planned operational status for the following days?

  Open Closed Altered (Open Late / Close Early) Unknown
Thursday 10/11
Friday 10/12
Saturday 10/13

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* 4. Provide a brief summary of alternate treatment locations and what has been communicated to dialysis patients at your facility.

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* 5. Have you provided the following information to patients in preparation for the event? (Check all that Apply)

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* 6. Has all patients at this unit been contacted and accounted for?

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