- This form should only be used to request supplies and resources other than Personal Protective Equipment (PPE) or Ventilators
- Requests for PPE through the NYC PPE Stockpile should be directed to Medline
- Requests for Ventilators through the NYC Ventilator Stockpile Program should be directed to Agiliti Health
- For more general information regarding requests for PPE or Ventilators, please visit www.gnyha.org/news/information-on-new-york-city-ppe-and-ventilator-stockpiles/
- All requests for supplies other than PPE or ventilators should be made by submitting this form to GNYHA at: email@example.com. Please note Organization Name and ‘Supply Request’ in email subject.
- ALL sections of this form MUST be completed for request to be submitted.
- As a reminder, there may be costs associated with any supplies provided pursuant to this supply request.
- Please limit request size to ONE (1) WEEK of anticipated demand for the product(s).
Emergency Supply Request Form for NYC Facilities
October 23, 2020