Notification of CVI Access Exigent Circumstance Instrument Scope

Notification of CVI Access Exigent Circumstance Instrument

Name of Instrument

Notification of CVI Access Exigent Circumstance

Scope of Instrument

This instrument collects:

• Personally identifiable information from the individual reporting the exigent circumstance

• Relevant facility information

• Relevant details about the emergency or exigent circumstance

Example of DHS Forms used within the scope of this instrument

Attached is DHS Form 9024 that is used to standardize the collection of information within this instrument. DHS Form 9024 identifies most, but not all of the data routinely collected under this instrument.

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