Electronic Form:
Facility Room Details
Please use your written worksheet to complete this form for each of the rooms in your facility where emr
XL
is expected to be used with patients (examination rooms, treatment rooms, psychosocial support, pharmacy, reception, etc)
Your Details
Your Name (person completing this form)
(Required)
First
Last
Job Title
Email
(Required)
Rooms and Offices (primary emr
XL
usage rooms)
Enter details for each room in your facility where emr
XL
is primarily used. This is generally going to be rooms where patients are present, such as examination rooms, treatment rooms, reception, pharmacy, social work, subspecialties, etc.
Rooms List
(Required)
Click the + symbol each time to add additional rooms.
Room Name
Room ID (optional)
Phone Number or Extension
Add
Remove
Organization & Site Details
Name of Organization (Company, NGO, Foundation, etc)
(Required)
Name of Launch Site / Facility
(Required)
Country
(Required)
City
(Required)
Planning and Preparation Videos
Launch Team Resources
> Play
Watch first
Forming your Local Launch Team
> Play
Pharmacy & Prescriber Preparation
> Play
I.T. Infrastructure Requirements
> Play
Training & Certification Process
> Play
Launch Guidelines, Worksheets, and other Tools
emrXL Upgrade Guidelines
Download
Worksheet:
Launch Team Members
Download
Online Form:
Launch Team Members
Complete Online
Worksheet:
Drug Categorization
Download
Online Form:
Drug Categorization
Complete Online
Worksheet:
Room Details
Download
Online Form:
Room Details
Complete Online
Worksheet:
I.T. Infrastructure
Download
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