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Otsego County 9-1-1 Central Dispatch Special Health Care Needs Form Otsego county Central Dispatch is working to better improve our service to you, and we need your help! Please provide us with additional information specific to your location that will allow for better efficiency of emergency services in your time of need. Otsego County has adopted an address ordinance that requires you to have your address posted. For further information on this ordinance, have you property tax code or identification number available and contact the Otsego County Equalization Department at (989) 731-7410. ALL INFORMATION YOU PROVIDE IS CONFIDENTIAL Name: DOB: Street Address: APT City: Township: ZIP: Nearest Cross Street or Additional Directions: This Address is a: House Mobile Home Business Farm Apartment Duplex Foster Care Home Assisted Living Home Does this residence? Require “Buzz In” Entry Use of a “Knox Box” Does this residence have an Automatic/Intrusion Alarm? Yes No If Yes, Company Name & Phone Number: Key Holder Name & Phone Number: ____Hidden Key - indicate location below ---PAGE BREAK--- Special Conditions: Handicap Person Bedridden Person On Oxygen Alzheimer Patient Hearing Impaired Speech Impaired Cardiac Issues Sight Impaired Other Please Describe: Any weapons? Yes No Please Describe: Any Animals? Yes No Vicious? Yes No Hazardous Materials: Gasoline Diesel Propane Natural Gas Ammunition Explosives Pesticides Poisons Other Please Describe: This information will remain in our files for 1 year from date of entry. Please contact us to keep the information complete and up to date. If you require further assistance, please contact Otsego Co. Emergency Medical Services at (989) 732-9085 or Otsego County Central Dispatch at (989) 732-5141. RETURN THIS COMPLETED FORM TO: Otsego County Central Dispatch Attn: 911 Special Needs 225 W. Main St. Gaylord, MI. 49735 Location of weapons: (Type of animal ) ---PAGE BREAK---