5th District Medical Response Coalition
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PPE
Region 5 Healthcare Coalition
Personal Protective Equipment Order Form
*
Indicates required field
Facility Requesting
*
County
*
Allegan
Barry
Berrien
Branch
Cass
Calhoun
Kalamazoo
St. Joseph
Van Buren
Name of Person Requesting
*
First
Last
Contact Number
*
Email Of Person Requesting
*
Comments
*
LIST EQUIPMENT AND QUANTITIES BEING REQUESTED
*
Equipment available:
N95 masks - various makes and models
KN95 Masks
Surgical masks
Isolation gowns - various sizes and makes
Face shields
Gloves
Safety Glasses
Thermometers (No Touch)
Hand Sanitizer
Bleach Wipes
I agree to receiving marketing and promotional materials
SUBMIT
Resource Links
Johns Hopkins University of Medicine Coronavirus Resource Center
Centers for Disease Control and Prevention COVID-19
Michigan.gov Coronavirus
Home
About
Contact
News
Quarterly Newsletter
R5MCAN
Drug Bag CS Box Incident Report
Comments Form
Documents
R5 TRAUMA
COVID-19 PPE
COVID TESTING
Calendar
Links
5DMRC File Sharing
Media
Photos
Videos
Partners
Hospitals
Public Health
Emergency Management and Homeland Security
Emergency Medical Services
Federally Recognized Tribes
Ambulatory Care Clinics and Home Health Agencies
Social Service Organizations
New Page