Administration/General Interior
Date: ____________ Location: _______________________ Team member: __________________________
General Facility (Overall facility, including condition of the interior, space, number of rooms, licenses, current uses and age.)
Observations:
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Current approved uses:
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Location: |
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Hours: |
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Current licensing/accreditation (if any): |
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Estimated interior square footage: |
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Original patient capacity: |
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Number of rooms
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Patient: |
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Emergency: |
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OR: |
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ICU: |
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