Georgia Hospital
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Healthcare Facility Emergency
Contact & Cooperative Planning Form

General Information 24 Hour Emergency Contact Numbers Facility Type
Facility Name:Demo General Phone:770-000-1111 ACUTE CARE: Yes
Address:1 Test Road Fax:770-111-2222 REHAB: No
City:Testville, GA Security:770-000-0111 NURSING: No
Main Phone:770-000-1112 ED:770-000-1113 COMM. CLINIC: No
Emergency Planning Personnel
Title: Name: Phone: Cell: Email:
Safety Officer Joe Smith 770-000-1114 770-000-1115 joesecurity@demo.com
Security Director Jack Smith 770-000-1116 770-000-1117 jacksecurity@demo.co
ED Director Jane Smith 770-000-1118 770-000-1119 janesmith@demo.com
Infection Control Jess Smith 703 591-2846 703 449-9308 jesssmith@demo.com
Pharmacy Director Jody Smith 770-000-1120 770-000-1121 jodysmith@demo.com
Laboratory Director Jose Smith 703 777-7777 703 777-7777 josesmith@demo.com
Disaster Contact Information
Incident Command Center Phone Numbers: Radio Information:
Primary Location:Helipad 800 MHz radio link to EMS:Yes
Alternate Location:Starbucks HAM Radio Frequency(if applicable):999.012
Facility Information
# of Acute Care Beds 12
# of Emergency Dept. Beds 18
# of Intensive Care Beds 12
# of Coronary Beds 10
# of Newborn Intensive Care Beds 5
# of Post Anesthesia Care Beds 12
# of Burn Unit Beds 10
# of Negative Pressure Rooms 2
# of Negative Pressure Rooms in ED 1
# of Ventilators/Respirators 30
% of Ventilators in use on a daily basis 40
Permanent Internal Decon Facility? Yes
Outdoor Permanent Decon Facilities? Yes
Outdoor Temporary Decon Facilities? Yes
Anticipated Hourly Capacity of ALL Decon. Facilities 20
What is your Surge Capacity (% of Total Number of Beds) 25
Information
Last Updated:
Sat Mar 09,2013 06:41:41
(information should be updated quarterly and as needed)
Trauma Center Designation
               (I - II - III - IV - n/a):   
I
NDMS Facility?   Yes
 
 

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