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Alzheimer's Alert

Steps

  1. 1. Introduction & Instructions
  2. 2. Part I: Personal Information on Individual Living with Alzheimer's Disease
  3. 3. Part II: Reporting Person
  4. 4. Part III: Primary Care Physician (For Individual Living with Alzheimer's Disease)
  5. 5. Person Completing Form
  6. 6. Submit

  • Introduction & Instructions

    2. Prescott Valley Police Badge
    4. Alzheimer's Aware: Recognize, React, Respond
    6. Prescott Valley Police Department
    8. Alzheimer's Alert
      Alzheimer's and Related Illnesses
    10. 1. This address advisory form is designed to relay pertinent information regarding a resident within the jurisdiction of the Town of Prescott Valley to the Prescott Regional Communications Center (PRCC). All information received will be placed electronically into the Computer Aided Dispatch (CAD) system; linking it to the provided address.
    12. 2. The information received will be available to first responders dispatched to the address listed in Part I. The information may be helpful to the first responders in their initial response and contact at the specified location.
    14. 3. The information provided will stay attached to the provided address until the Primary Caregiver in Part II asks that it be removed or the current situation is no longer applicable.
    16. 4. Any information submitted will be used for the purposes of emergency response only with the goal of providing the best services possible to our community residents.
    18. 5. Please complete Part I through II and mail to:
    20. Prescott Regional Communications Center Alzheimer's Alert
      216 S. Cortez Street, Prescott, AZ 86303