ICAR Consultation
Please fill out the following information. Then, we can start the process to schedule a free ICAR assessment for your facility with one of our Washington State Department of Health infection preventionists.
1.
Please fill in the following facility demographic information:
What is the name of your facility?
First name:
Last name:
Title:
Executive Director phone number:
Executive Director email:
Facility bed count:
Current census:
Which county is your facility located in?
County
Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant
Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Okanogan
Pacific
Pend Oreille
Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Additional Comments:
2.
Please fill in the following scheduling preferences:
Preferred work week dates (example: October 19-23)
Preferred day of the week
Day of week
Monday
Tuesday
Wednesday
Thursday
Friday
Time of day
Time of day
AM
PM
Type of visit
Type of visit
On-site
Televisit