Facility Personnel Update Form

Please Complete this Mandatory Facility Personnel Update Form by 11/27/20, to provide the ESRD Network of Texas with the most updated contact information for your facility. We understand that COVID-19 has brought about many changes, and it is important for the Network to have the most updated contact information for all the facilities within the Network's service area to ensure information is being disseminated and received by the appropriate party. We appreciate your communication and support!

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If your Medical Director is part of a physician group, please provide the information below:



If your facility has a team member for the below positions, provide their contact information below: