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Urgent Request-Hurricane Irma
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1.
What is your first and last name?
(Required.)
*
2.
Are you currently in Florida?
(Required.)
Yes
No
If yes, which county:
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3.
Are you willing to work in a medical needs shelter for Hurricane Irma?
(Required.)
Yes
No
*
4.
Do you have any training or experience in providing patient care?
(Required.)
Yes
No
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5.
When are you available to begin work in a shelter?
(Required.)
Immediately
After landfall of the hurricane
Next week
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6.
Are you a licensed healthcare provider?
(Required.)
Yes
No
If yes, what type:
Current Progress,
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