Georgia Hospital

Healthcare Facility Emergency
Contact & Cooperative Planning Form

General Information 24 Hour Emergency Contact Numbers Facility Type
Facility Name:Tanner Medical Center Villa Rica Phone: ACUTE CARE:
Address: Fax: REHAB:
City:, GA Security: NURSING:
Main Phone: ED: COMM. CLINIC:
Emergency Planning Personnel
Title: Name: Phone: Cell: Email:
Safety Officer
Security Director
ED Director
Infection Control
Pharmacy Director
Laboratory Director
Disaster Contact Information
Incident Command Center Phone Numbers: Radio Information:
Primary Location: 800 MHz radio link to EMS:
Alternate Location: HAM Radio Frequency(if applicable):
Facility Information
# of Acute Care Beds
# of Emergency Dept. Beds
# of Intensive Care Beds
# of Coronary Beds
# of Newborn Intensive Care Beds
# of Post Anesthesia Care Beds
# of Burn Unit Beds
# of Negative Pressure Rooms
# of Negative Pressure Rooms in ED
# of Ventilators/Respirators
% of Ventilators in use on a daily basis
Permanent Internal Decon Facility?
Outdoor Permanent Decon Facilities?
Outdoor Temporary Decon Facilities?
Anticipated Hourly Capacity of ALL Decon. Facilities
What is your Surge Capacity (% of Total Number of Beds)
Last Updated:
(information should be updated quarterly and as needed)
Trauma Center Designation
               (I - II - III - IV - n/a):   
NDMS Facility?   

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