Health Care Facility Emergency Management Portal
Health Care Facility Emergency Management Portal
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Facility Registration
Facility Name:
*
Facility Type:
*
Adult Day Care Center
Ambulatory Surgical Center
Assisted Living Facility
Hospital
Intermediate Care Facility
Nursing Home
Fire Jurisdiction:
*
City of Kissimmee
City of Saint Cloud
Osceola County
Location Address:
*
City:
*
Zip Code:
*
Mailing Address (if different than Location Address)
Mailing Address
*
City:
*
Zip Code:
*
Facility Phone:
*
Emergency Phone:
*
Administrator/Owner Contact:
Contact Name:
*
Office Phone:
*
Cell Phone:
*
Office E-Mail:
*
Create Portal Account
Alternate Administrator Contact:
Contact Name:
*
Office Phone:
*
Cell Phone:
*
Office E-Mail:
*
Create Portal Account
Safety Liaison Officer Contact:
Contact Name:
*
Office Phone:
*
Cell Phone:
*
Office E-Mail:
*
Create Portal Account
Portal Account Contact:
Contact Name:
Office Phone:
Cell Phone:
Office E-Mail:
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