FACILITY REGISTRATION

Welcome to Care Analytics. Please Fill out the following form as it will assist us in your setup process.

Main Contact Name

• First Name (required)
• Last Name (required)

Main Contact Email (required)

Facility Name (required)

Parent Organization

(Client - if Organization is Larger than One facility)

Required Dashboard User Logins (required)

Please provide a list that consists of FIRST NAME, LAST NAME, and EMAIL ADDRESS of each individual at the facility that will require access to the Care Analytics User Dashboard.

Assessment Email Notifications (required)

Please provide a list of emails that will receive the email notification every time an assessment or Real time comment is completed.

Assessments Settings (required)

Please check from the boxes below which assessments that this facility would like to assess on both the IPAD and Dashboard. (Assessments can be added and removed at any time based on request)

• Admissions Assessment (Recommended)
• Short Term Assessment
• Long Term Care Assessment (Recommended)
• Discharge Assessment Short (Recommended)
• Discharge Assessment
• 3 Day Follow-up Assessment
• Hospice Assessment
• Adult Day Health Survey
• Employee Assessment
• Oregon’s Quality Measurement Assessment
• Oregon’s Quality Measurement Family Assessment
• Real Time Comments

Medicare Provider Number

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