Location/Site Onboarding - PRAXES Emergency Specialists

Location Information

In this section, we collect some important information about your location.

Location/Site Name *

Max # of people at this location/site? (Do not include Guests) *

Are Telemedicine services required for this location/site? *

Telemedicine Coverage Start *

Telemedicine Coverage End *

Primary Phone number *

Backup Phone number (OPTIONAL)

Photo of Location

It is optional, but if you can provide a photo then it provides some context for the PRAXES Doctors when answering Telemedicine calls.

Do you have a photo of the location that you can provide? *

Upload a Photo of your location (Optional, but preferred)

Click or drag a file to this area to upload.

Acceptable file formats are: .jpg, .jpeg, .gif, .bmp, .png

Company / Organization Information

In this section, we collect some important information about your company/organization and your main company representative. This is the person in your company that PRAXES will reach out to for any business renewals, ongoing operational concerns, and send incident reports to when your location/site calls in for Telemedicine assistance.

Company / Organization Name *

Name of company representative / main business contact *

First

Last

Job Title of company representative *

Email of Company Representative *

Phone of Company Representative *

Would the Company Representative like to receive incident reports? *

Incident reports are sent out anytime this site/location engages PRAXES Telemedicine service. An alert can be sent to the Company Representative.

Would you like to add a Backup Company Representative? *

You can optionally add a backup company representative

Name of Backup company representative

First

Last

Job Title of Backup company representative

Email of Backup company Representative

Phone of Backup company representative

Would the Backup company representative like to receive incident reports? *

Incident reports are sent out anytime this location/site is engaged PRAXES Telemedicine service. An alert can be sent to the Backup company representative as well.

Crew Members / Employees

In this section, you can upload a full list of all of the crew members / employees at this site/location. Ideally this is a spreadsheet and has First Name, Last Name, Sex, Role at Site/Location and Date of Birth.

Do you have a list of the crew/employees that will be at this location/site? *

Upload an Excel spreadsheet of the on-site employees

Click or drag files to this area to upload. You can upload up to 10 files.

Accepted file formats are: .xlsx, .pdf, .xls, .xlsm, .xlsb, .xltx, .xltm, .xlt, .xml, .xlw, .xlr, .xla, .xlam, .csv, .txt, .xps, .doc, .docx, .eps, .ppt, .pptx, .wpd,

Medical kit

In this section, you can upload a copy of your Medical Kit that is at the site/location.

Do you have a Medical Kit at this location/site? *

Please upload an Excel, Word or PDF copy of your Medical Kit at your location. (Optional but preferred)

Click or drag files to this area to upload. You can upload up to 10 files.

Acceptable file formats are: .xlsx, .pdf, .xls, .xlsm, .xlsb, .xltx, .xltm, .xlt, .xml, .xlw, .xlr, .xla, .xlam, .csv, .txt, .xps, .doc, .docx, .eps, .ppt, .pptx, .wpd,

Caller Information for Telemed Services

In this section, we ask you whom the Callers will be using the Telemedicine Service that are at the location/site. You can add up to 4 callers. It is important for us to gather these details, especially so that we can understand the skill level/training of the people onboard that will be calling us.

Name of Caller #1. This is the main/primary caller at your location/site. *

First

Last

Email of Caller #1 *

Role/Job of Caller #1 (Captain, Medic, Project Manager, Chef, 1st Mate, 2nd Mate, etc.) *

Medical Role of Caller #1 (First Aider, Registered Nurse, Primary Care Paramedic, etc.) *

Is there a 2nd caller that you'd like to add? *

Name of Caller #2 *

First

Last

Email of Caller #2 *

Role/Job of Caller #2 (Captain, Medic, Project Manager, Chef, 1st Mate, 2nd Mate, etc.) *

Medical Role of Caller #2 (First Aider, Registered Nurse, Primary Care Paramedic, etc.) *

Is there a 3rd caller you'd like to add? *

Name of Caller #3 *

First

Last

Email of Caller #3 *

Role/Job of Caller #3 (Captain, Medic, Project Manager, Chef, 1st Mate, 2nd Mate, etc.) *

Medical Role of Caller #3 (First Aider, Registered Nurse, Primary Care Paramedic, etc.) *

Is there a 4th caller you'd like to add? *

Name of Caller #4 *

First

Last

Email of Caller #4 *

Role/Job of Caller #4 (Captain, Medic, Project Manager, Chef, 1st Mate, 2nd Mate, etc.) *

Medical Role of Caller #4 (First Aider, Registered Nurse, Primary Care Paramedic, etc.) *

COVID Screening Services (Daily)

Are COVID screening services required for this location? This entails doing daily screening for COVID. *

Yes
No
Unsure

COVID Testing Services

Are COVID testing services required for this location? *

Yes
No
Unsure

Are rapid test units required to be provided by PRAXES? *

Yes
No
Unsure

Do COVID Test Result Certificates need to be sent to the employees after a COVID test is completed? *

Yes
No
Unsure

Medical Staffing On-Site

Are PRAXES employed contracts or medical staff personnel required on-site at this location? *

Yes
No
Unsure

Special instructions

Are there any special notes that you'd like to tell us? (Optional)

Terms and Conditions

Terms of Use *

Check this box to confirm you have read and agree with PRAXES Terms of Use.

View a copy of our Terms on our website here: https://praxes.ca/terms