2018 Hospital Bed Survey Facility name Name of person submitting this form Please enter your phone number in case there are responses that need clarification # Intensive Care Unit (ICU) Beds # Intermediate Care (IMC) Beds # Medical/Surgical Beds # Pediatric ICU Beds # Pediatric Med/Surg Beds # Neonatal ICU Beds # Labor and Delivery Capacity (Count Moms only) # Psychiatric Beds # Emergency Department Beds Name of your facility's PRIMARY emergency preparedness/management (EP/EM) coordinator Primary EP/EM coordinator's office phone number Primary EP/EM Coordinator's 24/7 emergency phone number Name of your facility's SECONDARY EP/EM contact Secondary EP/EM contact's office phone number Secondary EP/EM contact's 24/7 emergency phone number Please use this space to clarify or comment on any of the above fields