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  • Change in Facility Information

    Use for Personnel Name Changes, Report Distribution, Unit Name Changes, etc
  • DO NOT USE THIS FORM FOR WiFi / EMAR Information -> Take me to that form.

    DO NOT USE THIS FORM FOR FACILITY NAME CHANGE - PLEASE NOTIFY YOUR MANAGER OR THE CORPORATE OFFICE. IN MANY CASES A NEW CONTRACT MAY BE GENERATED BEFORE CHANGE NAME CAN TAKE PLACE.

    EFFECTIVE DECEMBER 1st - THE NOTIFICATION WILL
    ALSO BE SENT TO THE EPIC DEPARTMENT

  • Did you check the Facility Profile in HG+ to see what additional information may be missing? Someone else may have already requested a change.

    • Medical Director
    • Pharmacy Provider
    • Quarterly Meetings Period
    • Visiting Schedule Changes
    • PRIMARY FACILITY FAX NUMBER
  •  - - :
  • If providing a personnel change:

    • Is the person replacing someone else?
    • Is their Title Changing?
    • Check your Condensed Facility Profile Sheet.
    • Are they being added to the distribution list?
    • Email address if necessary
  • Browse Files
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