WiFi / EMAR updates
Date Submitted
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
FACILITY:
*
Give as much info on name as possible - Several Facilities have similar names;
Contact at Facility for more Information:
Phone Number and Name or Extension
Does Facility Have WiFi
Yes
No
WiFi Identifier:
SSID / Router Name
WiFi Access:
Does Smartphone HotSpot work?
Yes
No
Is a Ethernet or CAT5/6 connection available
Yes
No
Does the Facility have an EMAR system
Yes
No
If YES please provide name of system
i.e. Point Click Care, Vision, etc
EMAR Identifier
EMAR Access
May you have Access to a Terminal/Computer at the Facility?
YES
NO
Additional Information:
Spelling is Important - First and Last names are required
To Validate that this is not a ROBOT
*
Email of Person Submitting
*
Send to Office
Clear Form
Print Form
Should be Empty: