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Health Care Coalition (HCC) for Santa Cruz County

Various agencies across Santa Cruz County are a part of the county’s Health Care Coalition (HCC). HCC member organizations work together during an emergency to support the medical health needs of the county.

See a full list of HCC participating organizations

Respond to a Disaster

During a Department Operations Center (DOC) activation, complete the relevant forms and e-mail them to: HSADoc@santacruzcounty.us

If you have trouble emailing, fax to (831) 454-5068 or (831) 454-4488. Call the DOC with any questions at (831) 454-4444.

Situation Status Forms

Situation Status Form (PHDOC-01)
Report general facility status to Emergency Preparedness and Response.

Download

Resource Request Forms

Resource Request Form - Supplies and Equipment (PHDOC-02)
Submit a request for additional supplies in the event of an emergency.

Download

Resource Request Form - Personnel (PHDOC-03)
Submit a request for additional staffing support with this form. See a list of all available MRC volunteer categories.

Download

Capacity Assistance Forms

Assistance Capacity Report for Clinics (PHDOC-04)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.

Download

Assistance Capacity Report for Surgery Centers (PHDOC-05)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.

Download

Assistance Capacity Report for Skilled Nursing Facilities (SNFs) and Long-term Care Facilities (LTCFs) (PHDOC-06)
Report facility hours, service expansion capabilities, or your organization’s ability to support additional services, if requested.

Download

Patient Tracking Forms

HICS 255 Master Patient Evacuation Tracking Form

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HICS 260 Patient Evacuation Tracking Form

Download

Instructions & Exercise Forms

Instructions for use of PH DOC 01, 02, and 03:

Instructions

ICS 214 Unit Log
Document all of your facility’s response activities in the event of a disaster.

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Participant Critique Sheet
Complete this sheet after a drill or emergency preparedness exercise.

Download

HCC Member Preparation

Utilize these templates and resources to ensure your organization has a plan in place to be a contributing member of the HCC in a disaster or major emergency in Santa Cruz County. Click the download button for the relevant template, save it to your computer, and modify it to formulate your organization’s plan.

Hazards Vulnerability Analysis

The Hazards Vulnerability Analysis (HVA) provides a tool to identify hazards that may affect demand for the health care facility’s services or its ability to provide those services. A HVA is often the foundation to develop an Emergency Operations Plan (EOP).

HVA Template

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HVA Template Instructions

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HVA Definitions

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Use California Office of Emergency Services webpage to find specific hazards by address. Type in your facility address to learn the risks at that address and what you can do to mitigate those risks.

Get familiar with the Hazard Mitigation Plans for the City of Santa Cruz and for the County of Santa Cruz County.

Emergency Operations Plan

California Primary Care Association provides this template to develop your clinic’s Emergency Operation Plan (EOP).

Clinic

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Continuity of Operations Planning

A Continuity of Operations Plan (COOP) helps prepare organizations to maintain mission critical operations after any emergency or disaster.

Behavioral Health

Download

Clinic

Download

Public Laboratory

Download

Public Health

Download

Long Term Care/Skilled Nursing Facility

Download

Pharmacy

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CMS Rule

The purpose of the Centers for Medicaid and Medicare Emergency Services (CMS) Preparedness Rule is to establish national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters, and coordination with federal, state, tribal, regional and local emergency preparedness systems.

Presentation about the Rule

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Resources

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The CMS webpage provides resources for compliance with the Centers for Medicare & Medicaid Emergency Preparedness Rule.

The Health and Humans Services webpage provides links to resources that can help provider and suppliers comply.

Additional Links & Resources

HHS.gov - Get an overview of the national Hospital Preparedness Program, from which the HCC is modeled.