Emergency Plan Manual

AHCA Form 3110-1022, Rev March 2013 Rule 59A-8.027, Florida Administrative Code http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Home_Care/HHA/index.shtml#other . Page 4 of 54 2. Person in Charge during Emergency (Key Staff ) Primary Name/Title (Safety Liaison) : ___________________________________________ Home Phone Number: ___________________________________________ Work Phone Number: ___________________________________________ HPDLO BBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Cell Phone Number: ____________________________________________ Alternate Name/Title: _____________________________________________________ Home Phone Number: ___________________________________________ Work Phone Number: ___________________________________________ HPDLO BBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Cell Phone Number: ____________________________________________ Agency Owner(s) Name/Title: _____________________________________________________________ Address: _______________________________________________________________ Work Phone Number: ______________________________________________________ Home Phone Number: ______________________________________________________ HPDLO BBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Cell Phone Number: _______________________________________________________ Person(s) Who Developed Plan Name/Title: _____________________________________________________________ Address: _______________________________________________________________ Work Phone Number: _______________________________________________________ Home Phone Number: ______________________________________________________ HPDLO BBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Insert additional planners as appropriate PN System (Consulting Services) Raul Camacho 2950 W 84 St. Bay 7. Hialeah, Fl 33018 HPDLO UFDPDFKR#SQV\VWHP FRP (305) 827-8678 Fax (305) 819-4064 II. CONCEPT OF OPERATIONS A. Direction and Control The chain of command for ensuring continuous leadership and authority in key positions: - Chain of Command: BBBBBBBBBBBBBBBBBBBBBBBBBB, maintains a chain of command for all operations. This list is a comprehensive list of all administrative and management resources, who can make management and leadership decisions in the event people in positions above them become unable to do so. Administrator __________ _____________ ____________________has the authority to declare that the Agency’s Emergency Plan is in effect. The chain of command ensures continuous leadership and authority in key position is as follows: _______________________________ ____________ Director of Nursing ________________________________ ___________ Nursing Supervisor ___________________________________________ Education Coordinator ____________________________ _______________ Medical Records NILA A. ALEGRE, ADMINISTRATOR 305-962-3847 (305) 220-4544 305-962-3847 CLAUDIO ALEGRE 786-303-1500 (305) 220-4544 786-303-1500 ANGEL ALEGRE & NILA A. ALEGRE, ADMINISTRATOR 1050 NW 128 CT. MIAMI, FL 33162 (305) 220-4544 305-962-2213 305-962-2213 / 305-962-3847 MARTHA CASCO, RN, DON, CLINICAL MANAGER 11003 SW 125 CT. MIAMI, FL 33186 (305) 220-4544 786-205-1540 NILA A. ALEGRE nalegre@angelhcs.com MARTHA CASCO, RN, DON, CLINICAL MANAGER martanica@aol.com MARTHA CASCO, RN, DON, CLINICAL MANAGER martanica@aol.com ANA PENANFIEL penafiellanamercedes@yahoo.com AINET RODRIGUEZ arodriguez@angelhcs.com Angel Home Care Services, Inc. nalegre@angelhcs.com calegre@angelhcs.com nalegre@angelhcs.com martanica@aol.com Angel Home Care Services, Inc.