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An Official
Pennsylvania
Government Website
Department of Health
C. Auris Poster Order Form
E-mail
Name
Professional Role
Phone Number
Name of PA Healthcare Facility Requesting materials
Shipping Address
Type of PA Healthcare Facility
Acute Care Hospital
Long-term Acute Care Hospital
Skilled Nursing Facility
Personal Care Home
Other
Number of 11 x 17 Posters Desired:
(Note: Max of 5 per type available per facility)
General (Purple)
EVS (Green)
Providers (Red)
Any Other Comments/Questions?
