Get Ms 255e 2018-2025

This guide provides clear instructions for completing the MS 255E form online. It is essential for facilities to properly enroll in the Strategic National Stockpile and Pandemic Influenza Program to receive necessary resources and support.

Follow the steps to successfully complete the MS 255E online.

1. Click ‘Get Form’ button to obtain the MS 255E form and open it in your selected editor.
2. Fill in the facility name and type of facility, ensuring to include the county for accurate identification.
3. Provide the physical address of your facility, including street, city, state, and zip code.
4. If your mailing address differs from your physical address, fill out that section with the appropriate details.
5. Enter the telephone and fax numbers for your facility to ensure reliable communication.
6. Complete the primary 24-hour facility contact details, including the contact's name, title, phone number, and email address.
7. Fill in the secondary 24-hour facility contact details in the same manner as the primary contact.
8. Input the number of staff, employees, faculty, and students at your facility. Calculate the total family members as line 1 multiplied by three.
9. Indicate the number of patient beds available in your facility.
10. Provide the total number of persons needing medications and vaccinations at your facility.
11. Confirm agreement to administer vaccines to the entire designated population and document the responsibilities detailed in the agreement section.
12. Ensure the administrative representative and medical consultant sign the form, including their titles and dates.
13. Review all entries for accuracy before saving, and then choose to download, print, or share the form as needed.

Complete your MS 255E enrollment online today to ensure your facility is prepared for public health needs.