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An Official
Pennsylvania
Government Website
Department of Health
C. Auris Poster Order Form
E-mail
*
*
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Name
*
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Professional Role
*
Phone Number
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Name of PA Healthcare Facility Requesting materials
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Shipping Address
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*
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)
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EVS (Green)
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Providers (Red)
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*
Any Other Comments/Questions?
*
