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Lodi Dialysis <br />1610 West Kettleman Lane, Suite D <br />Lodi, CA 96242 <br />Phone: 209-334-9888 <br />Fax: 209-333-0888 <br />DaVita.com <br />Communication Checklist <br />Emergency Management Agency <br />Instruction: Complete at least annually and place with Facility Emergency Management Plan <br />Date of communication: 8/12/21 <br />Facility name / number: Lodi Community Dialysis / 00277 <br />Apency information <br />Provider name: San Joaquin County Office of Environmental Safety <br />Business Phone number: 209 468 3420 <br />Secondary Phone number: <br />Contact person: Sandi) Singh <br />After hours contact person: <br />Phone number: 209 468 3526 <br />Emerpency preparedness <br />Is dialysis facility noted as critical care provider within Agency plan? Yes No <br />If no, explain: <br />Communication process <br />Explain how Agency will communicate with the facility regarding emergency situations: <br />Community emergency drills and exercises <br />Explain if community drill and exercises are available and how facility will participate: <br />Additional information: <br />Teammate completing form: Stormee King, RN <br />Date: 8/12/21 <br />