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Check-In: Telehealth Cart Sites

Telehealth Coordinators will be using this form to do monthly check-in's at all Telehealth Cart locations

MM slash DD slash YYYY
Have they had any telehealth visits on the telehealth cart?(Required)
Who was telehealth cart used for?
Telehealth cart availability schedule(Required)
What barriers are preventing the use of the telehealth cart(Required)
Are there any staff members who need to be trained or re-trained on how to use the cart?(Required)
Would your site like us to come do a telehealth demonstration with the equipment?(Required)
Does your cart require additional supplies?(Required)