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[Hospital Name] E-notifications Requestor Portal

[Hospital Name] has chosen PatientPing to facilitate the delivery of real-time event notifications for care events occurring at its facilities, as required by CMS’ electronic event notifications Condition of Participation (e-notifications CoP)*.

To request e-notifications for your patient’s care events at [Hospital Name], please fill in the required information.

Once you have submitted your information, a PatientPing representative will contact you directly to assist you in enabling real-time, e-notifications from [Hospital Name].

*Event notifications are provided in accordance with 42 CFR 482.14(d), 482.61(f), and 485.638(d)

[hubspot type=form portal=2459619 id=99ecf04d-c8a2-4ef8-a7b4-e946f120b6d9]