Facility Onboarding Form

Please complete the information below so EMA Telemed can prepare onboarding, training, shipping, and go-live planning for Vitals Sent for RPM.

Facility legal name

Facility address

Shipping address

Main administrator contact

Director of Nursing contact

DON contact

IT contact, if available

PCC administrator contact

Billing/admin contact, if RPM reimbursement is involved

Number of residents

Number of RPM-eligible residents

Number of units or wings

Number of daily vitals rounds

Vitals being captured:

Blood pressure Pulse SpO₂ Temperature Weight, if applicable Glucose, if applicable

Preferred training dates

Preferred go-live date

Wi-Fi availability