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Click ‘Get Form’ to open the emergency crisis plan in the editor.
Begin by entering your Agency/Business Name in the designated field. This identifies where you practice.
Select the applicable block that describes your agency type: Public/Govt. Agency, Private-Non-profit, Private-For profit, or Other. If you select 'Other', provide a brief explanation.
Fill in your Agency/Business Address and Phone number to ensure accurate contact information is available.
In the provided space, describe your practice setting comprehensively. Include details such as whether you work from home, an office, solo, or with other practitioners.
Outline the hierarchy of initial contact persons and their locations (onsite/offsite) along with estimated response times for emergencies.
List emergency backup contacts and their locations, including estimated response times if your clinical supervisor is unavailable.
Detail your plan for follow-up consultation with your clinical supervisor after contacting an alternate emergency contact.
Finally, ensure all required signatures are included at the bottom of the form along with license numbers and dates.
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