Submitted by Pastor *Submitter's Full Name

First

Last

Submitting Pastor's Email*

Full Name of Patient ↓ *

First

Last

Proxy Care Patient / Inmate Location*

Hospitals - K I N G ST O N

Andrews Memorial

Bellevue Hospital

Bustamante Children's

Kingston Public (KPH)

Medical Associates

National Chest Hospital (NCH)

Nuttall Memorial Hospital (private)

St. Joseph's Hospital

University Hospital of the West Indies (UHWI)

Victoria Jubilee Hospital (VJH)

Sir John Golding Rehabilitation Center

Hospitals - ST. C A T H E R I N E

Linstead Hospital

Spanish Town Hospital

Hospitals - C L A R E N D O N

Chapelton Hospital

May Pen Hospital

Lionel Town Community Hospital

Hospitals - M A N C H E S T E R

Hargreaves Hospital (Private)

Mandeville Hospital

Percy Junor (Spalding Community) Hospital

OTHER INSTITUTIONS

Nursing Home

Children's Home

Infirmary

Juvenile Center

Jail/Police Lock-Up

Prison

General Penitentiary

St. Catherine Adult Correctional

Women's

Tamarind Farm

Ward (Number or Name) & Bed Number*

Date when Admitted*

mm/dd/yyyy

Patient's Phone Number

Any other info* single line note

Seventh-day Adventist® Church

CJC Ministerial Fraternity

Proxy Care - pastoral visits & co- care to CJC congregants by CJC Ministerial Fraternity.