Pages - ExampleInfoRqst

NOTE: THIS INFORMATION REQUEST IS A SAMPLE VERSION AND IS PROVIDED ONLY AS AN EXAMPLE FOR REFERENCE

The table below represents data gathered from a sample information request. For more information on how to submit an information request, contact alerts@rxresponse.org.

Title:	Request for Open Pharmacies Near Shelters
Requester Name:	John Doe
Requester Phone:	555-555-5555
Requester Email Address:	john.doe@state_ema.gov
Requester Agency Affiliation:	State Emergency Management Agency
Requester Title:	ESF8
Requester Tracking Number:	ST_32510186209
Secondary Requester Name:	Jane Smith
Secondary Requester Phone:	555-555-0000
Secondary Requester Email Address:	jane.doe@redcross.org
Secondary Requester Agency Affiliation:	American Red Cross
Secondary Requester Title:	Shelter Lead
Request:	Given the devastation caused by Hurricane Omar, our state has opened 8 shelters (and counting) to address evacuee needs. A number of shelter residents have seen medical staff onsite or at nearby temporary medical facilities and require prescriptions to be filled. The shelters are at: Johnson-Wenton High School 1481 Park Ave Springfield, ST 01010 Bally's Gym 36181 Juniper Dr Springfield, ST 01014 Winwood Elementary School 8171 Genesis St Farris, ST 01021 Blackwell Middle School 176951 Lampost Dr Farris, ST 01022 24-Hour Fitness 18571 West 9th St Bourain, ST 01017 Oakwood High School 32519 Oakwood Lane Bourain, ST 01019 Fenton Middle School 32110 Maplewood Ave Cuttler, ST 01024 St. Vincent's 8710 Blessed Park Cuttler, ST 01024 Please let us know of the nearest pharmacy(ies) to these locations, in particular if any of the pharmacies are 24-hour sites. If you need further information, don't hesitate to ask. Thank you.
Information Request Status:	Pending
Owner:	Rx Response Support Team InfoCenter Administrator
Interested Parties:	State Representatives
Target Completion Date:	07/01/2010
Request Comments: