MED PASS - PRODUCT PREVIEW REQUEST

OASIS-C / Home Health Online Charting Demo Request

To learn more about MED-PASS OASIS-C/Home Health Online Charting and arrange an online demo, please provide your contact information below. We will reply promptly to provide details about demo opportunities (dates/times) from which to choose.

Agency Name:

Contact Name:
City:
State:
Zip:

Phone Number:

Days/hours you wish to be contacted:

Contact Email Address:

Enter Email Address again:

Optional: Answers to the following questions will help us understand your agency and better prepare to discuss MED-PASS OASIS-C/Home Health Online Charting and your business when we contact you.

Is your agency a "start-up" or new agency? Yes No
Is your agency Medicare Certified? Yes No
Do you currently use MED-PASS OASIS-C forms? Yes No
Do you currently use an electronic billing system? Yes No
If yes, which vendor?
How many sites does your agency have?
Approximately how many skilled nursing visits does your agency or agencies make per month?

Thank you for your interest in MED-PASS OASIS-C/Home Health Online Charting. A MED-PASS Home Care representative will contact you. Sincerely, Lisa Hanauer President and Owner