Medical Equipment and Staffing Requests

AzCHER may be able to assist your organization if it is encountering issues with securing key resources due to the COVID-19 pandemic, such as surgical masks, isolation gowns, or cleaning supplies. Please follow the steps below.

  1. Exhaust all other avenues of securing the needed resources (e.g. working within the healthcare system or your organization’s sister facilities; contacting all contracted vendors agencies).
  2. Complete ICS Form 213 RR.
    • First, submit the completed form to your local public health department through the contact methods provided here. Public health may have resources such as the Strategic National Stockpile from which to draw in emergencies, and/or may be able to work with county emergency management to meet your resource needs.
    • Then, submit a copy of the completed form to [email protected]Your requested item(s) will be placed on the AzCHER website’s PPE Request Log so that potential donors will have visibility into the healthcare delivery system’s needs. Your regional manager will reach out to you within 24 to 48 hours.

Instructions for Completing ICS 213 RR

Complete ONLY the following sections:

  • #1 – Incident Name = COVID-19
  • #2 – Date and Time you are completing the form
  • #4 – Your Order:
    • Quantity = the number of items needed
    • Kind of Resource = the general category of supply/equipment, such as “respirator”
    • Type of Resource = a more specific characterization of the kind of resource, such as “N95”
    • Detailed Item Description, such as brand or size
    • Do not complete the Arrival Time and Cost sections
  • #5 – Requested Delivery / Reporting Location = where resources should be sent open positions are located
  • #7 – Requested by Name and Position = person requesting and their contact information
  • #8 – Priority = Urgent, Routine, or Low

Apache County Public Health

Request form 213rr to be completed and sent to [email protected]

Cochise County Public Health

Requests to be submitted at https://crh.arizona.edu/ppe/cochise

Coconino County Public Health

Request form 213rr to be completed and sent to [email protected]

Gila  Public Health Department

Request form 213rr to be completed and sent to [email protected] or [email protected]

Graham County Public Health

Request form 213rr to be completed and sent to [email protected]

Greenlee County Public Health

Request form 213rr to be completed and sent to [email protected]

La Paz County Public Health and Emergency Management

Request form 213rr to be completed and sent to [email protected] and [email protected]

Maricopa Public Health Department

Resource requests to be submitted at https://www.maricopa.gov/5585/Request-Resources

Mohave County Public Health

Request form 213rr to be completed and sent to [email protected]

Navajo County Public Health

Request form 213rr to be completed and sent to [email protected]

Pima County Public Health

Requests to be submitted at https://webcms.pima.gov/cms/One.aspx?portalId=169&pageId=533608

Pinal Public Health Department

Request form 213rr to be completed and sent to [email protected]

Santa Cruz County Public Health

Request form 213rr to be completed and sent to [email protected]

Yavapai County Public Health

Request form 213rr to be completed and sent to [email protected]

Yuma County Public Health

Requests to be submitted at https://forms.gle/HkRtUM3yBdB2bihcA

The Arizona Coalition for Healthcare Emergency Response (AzCHER) and the Arizona Hospital and Healthcare Association (AzHHA) are not responsible for the quality or quantity of items donated, whether new or used, technical specifications, appropriateness for clinical use, damage in transport, malfunctions, or determining the value of an in-kind donation. AzCHER and AzHHA provide the Resource Request Log to connect potential in-kind donors with organizations that have submitted information regarding needs for specific supplies, equipment, or non-professional/non-clinical volunteers for COVID-19 response, so they can make all necessary examinations and arrangements directly.

Important Information for Donors:

  • Please contact the healthcare recipient before shipping or delivering any supplies or in-kind donations.
    • Each recipient may have different standards for donations of supplies. Some facilities may be able to sterilize homemade gowns and masks, while others may only be able to use protective gear in the original, sterile packaging; some may be able to accept used equipment, while other only can accept new.
    • Facilities may be able to take in-kind donations only at certain times or certain locations, or when certain personnel are available. Email ahead of time for delivery instructions.
    • Each recipient makes its own decision whether to accept certain types of in-kind donations as well as the specific supplies that a donor may offer.
  • Healthcare recipients may not be able to use in-kind donations for a specific area of the facility or program and may wish to use the gift for other needs, or to give the in-kind donation to other non-profit organizations. Contact the recipient to determine its designation rules.
  • Please understand that healthcare recipients may need to apply their own credentialing or vetting procedures before accepting any in-kind donation from a donor. AzCHER and AzHHA do not provide any vetting or evaluation of donors or proposed donations.
  • Both donors and healthcare recipients must notify AzCHER of an accepted and delivered donation, to ensure integrity of the PPE Request Log.

Important Information for Healthcare Recipients:

  • Once contacted by a donor, provide your delivery requirements and restrictions. Establish a mutually agreeable time and place for delivery. Best practices include receiving at least 24-hours advance notice.
  • AzCHER and AzHHA are facilitating non-professional/non-clinical volunteers, and are not responsible for any credentialing or background checks. AzCHER and AzHHA do not examine or evaluate either potential donors or potential in-kind donations.
  • Each healthcare recipient should apply its own credentialing or vetting procedures before accepting any in-kind donation from any donor.
  • Each healthcare recipient must evaluate whether the items meet the recipient’s requirements and policies (items, sizes, packaging, etc.), for confirming that the in-kind donations match what was promised, and for any examination or testing needed to confirm suitability for use in treating patients or residents.
  • The healthcare recipient is responsible for acknowledgment to the donor. Total non-cash contributions valued at more than $500 require the filing of IRS Form 8283, Non-Cash Charitable Contributions. Total non-cash contributions valued at more than $5,000 require the donor to obtain a qualified written appraisal.
  • Both donors and healthcare recipients must notify AzCHER of an accepted and delivered donation, to ensure integrity of the PPE Request Log.