Purpose
The purpose of the Polk
County Special Needs
Registry
is to allow
individuals with
critical health and
medical conditions that
may require assistance
during an emergency or
disaster, such as a
power outage, tornado,
flood or infectious
disease outbreak, an
opportunity to
voluntarily register
with the program and get
their name on a
database. If an
emergency or disaster
occurs, the Registry
will provide emergency
responders important
information about your
health and medical
needs. This is
important so that
emergency responders
know about you and can
develop a more effective
response.
The Registry is a
voluntary program and in
no way ensures that the
individual enrolling in
the program will receive
immediate or
preferential treatment
in an emergency. This program will
merely provide the
emergency response
community with
information that is
pertinent to developing
an effective response,
whether
sheltering-in-place or
evacuation.
The
Polk County Special
Needs Registry in no way
replaces the
responsibility of
individuals to have
their own emergency plan.
Click here for
information on
developing an individual
or family emergency
response plan for people
with disabilities or
other special needs.
The Registry is a
voluntary program that
should be considered by
individuals who have NO
Alternative or have no
family or friend support
structure in their
community. Emergency
Management recommends
using this program only
as a Last Resort and
individuals with special
needs should consider
sheltering or evacuating
with relatives or
friends first.
Program Eligibility
The
Registry is for those
individuals who are not
in a care facility, such
as a hospital, nursing
home or congregate
living facility. These
facilities are required
to have an evacuation
plan in place for their
residents and patients
to be transported to
another healthcare
facility. The Registry is for
individuals who are not
part of a group facility
and have no other
alternative but to seek
assistance from the
County.
-
Must be a Polk
County resident.
-
Individuals require assistance
with ostomy and
indwelling catheter
management.
-
Activities of daily
living are so
restricted by
immobility that
others provide
assistance to meet
their basic needs
and those people may
be unavailable
during and emergency
or disaster.
-
They have a
respiratory
condition requiring
special equipment
such as monitors or
oxygen.
-
There may be other
conditions which
would render an
individual eligible
for special needs
emergency sheltering
and these will be
considered by the
review of the
registration form by
a Review
Team.
Downloads
Polk County Special
Needs Registry ON-LINE
Application
Polk County Special
Needs Registry Information Packet and
Application 
Polk County Special
Populations Plan for
Disasters and
Emergencies
Polk County Special
Needs Registry Poster
Frequently Asked
Questions about the Polk County Special
Needs Registry
1. What is the process for
determining whether
someone meets the
program eligibility?
Once an individual
submits their
application, they are
automatically placed in
Special Needs Registry
database. A Review Team
consisting of emergency
response and health and
medical partners will
meet regularly to review
the applications and
make a determination.
2. How
do I register?
Individuals can submit
applications to the
program by printing,
completing and
submitting the Special Needs
Registry Application
Form to Polk County Emergency
Management or by
completing the Special Needs Registry
On-Line Application Form.
3. How
will I be notified if I
am enrolled in the
program?
After the Review Team
looks at the
application, they will
either accept the
application, deny the
application or will
contact the individual
for more information
before making a
decision. Individuals
will be notified via
letter of the status of
their application.
4. Can
I register a family
member or friend?
Yes. The application
provides a section
acknowledging that a
person other than the
applicants name is
completing the form.
5. Will
the database be sold or
given to non-emergency
responders?
No. The database will
only be distributed to
emergency responders
within the geographical
area at the time that
emergency or disaster is
occurring. Polk County
Emergency Management
will house the database
and will determine who
will receive database
information. All
records will be
protected by Security
Software.
6. What
is the process for
updating individual’s
information?
It is critical that
participant’s
information stay current
including addresses,
contact information, and
health status.
Individuals enrolled in
the Registry will be
sent a renewal notice in
March of each year
asking the individual to
complete the
re-application via paper
or through the on-line
registration process.
7. The
application form
indicates that emergency
responders can enter my
home during an emergency
or disaster. Is this
true?
Yes. Depending the
nature of the incident,
and as a last resort, if
you are not responding
to multiple attempts to
contact you whether via
phone calls or visits to
your home or we can not
reach your emergency
contact listed on your
application, emergency
responders may enter
your home to check on
you.
8. What
does it cost for me to
be enrolled in the
program?
Nothing. Polk County values our
residents and we
understand the
importance of taking
care of our own.
Therefore, the costs
incurred for developing,
operating and
maintaining this program
come from a partnership
of government agencies.
9. What
can I expect if I am
asked to evacuate my
home and I have no place
to go?
If no other alternatives
are available,
individuals apart of the
Special Needs Registry
may be transported to a
Special Needs Emergency
Shelter. This shelter
will be staffed by
individuals from the
American Red Cross,
Human Services, Public
Health and others.
10. What
if I am asked to
shelter-in-place?
The nature of the
Special Needs Registry
allows emergency
responders to check in
on those individuals who
have serious health and
medical needs especially
those that rely on
medical equipment and
medication for
survival.
