PPE Resource Request Form

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

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.