L&C H1N1 Information and Forms

Approval for Health Care Facility Use of Surge Tents

This following document provides guidance for hospitals and other health care facilities and local health departments on regulatory requirements from the State Fire Marshal and the Office of Statewide Health Planning and Development for tents used to accommodate a surge in demand for health care.

Surge Tent Guidance (PDF)

Facility Requests

In an effort to assist acute care hospitals to more promply respond to H1N1 related emergencies, the following link provides a standardized form necessary to:

• Provide notification to the L&C District Office of specific response actions taken,
• Request authorization from the L&C District Office for specific H1N1 response activities, or
• Request Program Flexibility from the L&C District Office for specific H1N1 response activities.
H1N1 Facility Request Form(PDF)

H1N1 Surveillance Tool

Surveillance tool used by L&C surveyors to monitor implementation of infection control practices related to H1N1 in General Acute Care Hospitals (GACH's).

H1N1 Surveillance Tool  (PDF)