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401 Grand St. Paterson, NJ 07505 | (973) 881-4000
"Rich History, Bright Future"

Nursing Home/Assisted Living Center Surveillance Form

(973) 881-4000

1. Surveillance Date*


2. Name of Facility*


3. City*


4. County*
 Passaic           Morris

5. Total Number of Residents*


6. Number with respiratory illness on surveillance date*

(please elaborate, if necessary, in comments below)

7. Comments:



Reply Email Address:*

Enter your Email Address here for follow-up if necessary