ICU Bed Creation Documentation

ICU Bed Creation Documentation

Documentation portal for items related to the creation of ICU beds for the COVID-19 Expanded Capacity Hospital Program. Use separate submissions for multiple invoices/receipts.

Name of Hospital*

Hospital Contact Name*

For any questions related to invoice

Hospital Contact Phone Number*

For any questions related to invoice

Hospital Contact Email Address*

For any questions related to invoice

Life Safety Code Inspection*

Are the ICU beds ready for inspection by MSDH HFLC Life Safety Code inspection?

Yes

Life Safety Inspection Date*

If bed(s) are not currently ready for inspection, choose an anticipated inspection date.

Vendor Name*

Vendor name from invoice

Invoice Number*

If applicable, insert the invoice number. If not, type "N/A".

Invoice Date

Amount of Invoice*

File Upload*

Upload invoice/receipt/documentation related to the creation of ICU beds at your facility. Multiple submissions may be necessary.

Drag and drop files here or

Send me a copy of my responses

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