Hale Makua Discontinuation of Service
Location
Kahului
Wailuku
Hale Makua Representative (include name, phone number, and email)
Melani Campos, 808-357-2109, melani.campos@halemakua.org
Erllie Cabacungan, 808-357-2271, erllie.cabacungan@halemakua.org
Sharron Joseph, 808-281-6438, sharronj@halemakua.org
Mark Souza, 808-357-2266, mark.souza@halemakua.org
Other
Resident Last Name
*
Neighborhood and Room Number
*
Reason for Discontinuation
*
Deceased
Discharged from Hale Makua Services
Admitted to Facility
Other
Pick Up at:
*
Resident's Room
Nurses Station
Maintenance Department
Purchasing Department
Administrative Offices
Other
Item(s) Requested to be Picked Up
*
Last 4 Serial Number of Item(s) being Picked Up
*
Insert "N/A" for None
Comments
*
Submit
Should be Empty: