Category Archives: Form
COVID-19 Testing Supplies Request
COVID-19 Testing Supplies Request
If your facility is in need of COVID-19 testing supplies please complete the following form and submit to the Region 3 Duty Officer. If your facility is in emergent need of testing supplies please note that in the email. If it is outside regular business hours and you are in emergent need please page the Duty Officer so we can move the request forward as an immediate need.
PPE Resource Request Form
PPE Resource Request Form
If you anticipate a supply shortage within the next 5 days to support emergency operations and are unable to source the material(s) through your normal supply chain or the vendor resources provided on the Commonwealth’s reopening webpage, then you may request PPE through your Health and Medical Coordinating Coalition (HMCC). Please submit to the Region 3 Duty Officer your PPE request form along with documentation of your inability to procure the needed PPE through other means by the needed date. This will be sent to and reviewed by DPH.
OPEM Exercise Request Form
OPEM Exercise Request Form
All requests must be submitted at a minimum of 45 days prior to exercise.
Discipline: Hospitals, Public Health
OPEM Request to Host Form
OPEM Request to Host Form
All requests must be submitted to the HMCC a minimum of 45 days prior to event.
Discipline: Hospitals, Public Health
OPEM Request to Attend Conference/Training
OPEM Request to Attend Conference/Training
Requests must be submitted to the HMCC a minimum of 45 days prior to event
Discipline: Hospitals, Public Health
Equipment- Supply-Service-Reimbursement
Equipment- Supply-Service-Reimbursement
All requests for reimbursement must be identified on the HMCC Region 3 Equipment, Supply, & Service Reimbursement Form and must be accompanied by backup documentation to include an itemized receipt, or invoice and proof of payment such as a credit card statement or a canceled check.
Discipline: Hospitals, Public Health
