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MS D-74 Atlanta GA 30333 ATTN PRA 0920-0666. CDC 57. 101 Front Rev. 10 v8. 6 Valid email account required for enrollment Dialysis Facility Primary Contact Person if different from Facility Administrator CDC 57. Please see NHSN enrollment guidance and surveillance protocols to determine which component s your facility should use within NHSN. Components may be added at any time after enrollment. Form Approved OMB No. 0920-0666 Exp. Date 11/30/2019 www. cdc.gov/nhsn Facility Contact Information...
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Create a form or document with fields for each piece of contact information.
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Who needs facility contact information?

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Businesses and organizations that have a physical location or facility.
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Facility managers or administrators responsible for overseeing and maintaining the facility.
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Facility contact information includes the name, address, phone number, and email address of the person or entity responsible for overseeing the facility's operations.
Any facility owner or operator is required to file facility contact information.
Facility contact information can be filled out online through a secure portal provided by the regulatory agency.
The purpose of facility contact information is to ensure that there is a designated point of contact for regulatory agencies in case of emergencies or for routine communication.
The required information includes the name, address, phone number, and email address of the facility contact person.
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