Get Ms 255e 2020-2025

Filling out the MS 255E form online is an essential step for facilities participating in the Strategic National Stockpile and Pandemic Influenza Program. This guide will walk you through each section of the form to ensure accurate completion.

Follow the steps to complete the MS 255E online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the facility name in the designated field. Ensure the name is accurate as it will be used for official documentation.
3. Identify and specify the type of facility in the provided space. This section will help categorize your institution appropriately.
4. Provide the physical address of the facility, including street, city, state, and zip code. Double-check for correctness to avoid miscommunication.
5. If the mailing address differs from the physical address, complete that section as well, including street or P.O. Box, city, state, and zip code.
6. Enter the primary telephone and fax numbers in the respective fields. Include area codes to ensure clarity.
7. Input the primary 24-hour facility contact details, including name, title, phone number, and email address, to establish a point of communication.
8. Repeat the previous step for the secondary 24-hour facility contact. This provides an additional line of communication.
9. Record the number of staff, employees, faculty, or students in the first line of the staff section. This information is crucial for resource allocation.
10. Multiply the number of staff by three to determine the number of family members related to the staff, and document it in the next line.
11. Indicate the number of patient beds available within the facility to inform resource needs during emergencies.
12. Calculate and enter the total number of persons needing medications or vaccinations based on the information provided.
13. Indicate whether the facility has the capacity and assumes responsibility for administering vaccinations to the entire community population by selecting 'YES' or 'NO.'
14. Read the agreement section carefully and ensure that all necessary commitments are understood before signing.
15. Sign and date the form as the administrative representative and provide the title. Ensure that the medical consultant also signs, includes their printed name and title, and their license number, if applicable.
16. If applicable, complete the shipping address section for facilities that require direct shipping, including GPS coordinates.
17. Review all entered information for any errors or omissions before finalizing your submission.
18. Once everything is complete, save your changes. You can also download, print, or share the form as needed.

Complete and submit your MS 255E form online today to ensure your facility is prepared for public health emergencies.