This is a generic Bed Report Form.
It is for reporting available beds at a facility. You enter your Jurisdiction, Group, or entity name at the top right. Example: Basset County RACES or San Bernardino County Health. This form will total the available bed counts for you.
Based on W2SRP original Marion County Florida form.
{var IsExercise}
Hospital Name: {var Hospital}
Addtional Comments: {var Comments}
FAX COMPLETED FORM TO THE MEDICAL ALERT CENTER AT (562) 906-4300 OR SEND TO LAC-MAC VIA WINLINK WITHIN 60 MINUTES OF REQUEST