May 10, 2016

Are you a Hospital Director or Staff Member?

areyouahospitalIf you own or operate a hospital that serves the underserved and would like to have a telemedicine project, please answer the following questions so we can contact you.

When you provide the information below, you can expect a response within a week, usually the next day. We will have some more questions based on what you tell us below. We will seek to connect with a nearby Rotary club that will work with Global Offsite Care.

Once the hospital is vetted, you will have access to telemedicine services by the international panel set up by Dr. Gude, Medical Director of the Heberden Telemedicine Foundation. We expect the hospital to screen the available specialists on the panel and approve all those it would like to authorize to provide remote consults. The hospital will also be able to participate in continuing doctor education through weekly grand rounds.

We will seek to establish a Wi-Fi network and provide tablets to enable easy access to remote consults and to enable the hospital to use electronic health records with software donated by the Heberden Telemedicine Foundation.

If interested in finding out more, please complete the following:

First Name (required)

Last Name (required)

Your Email (required)

Phone

Hospital Information

Name of Hospital

Location

How many beds?

Is there and Intensive Care Unit?
NoYes

If so, how many beds?

How many doctors work in the ICU or the hospital in general?

Do you have Internet connection?
NoYes

What type of Internet connection do you have?
SatelliteDSLISDNOther

How reliable?
MinimallyModeratelyHighly

Do you have a lead Doctor who is interested in a telemedicine project?
NoYes

Do you have a lead tech support person who is available to exchange information?
NoYes

Optional

Does the hospital have a connection to a Rotary club in the community?
NoYes

Club

District

Additional comments: