If you would like to receive detailed information on PRN Plus reg;, or a copy of the software for testing, please complete this form and send it to OMS2.

 Required fields *


* Agency Name:

* Contact:

* Title:

* Street Address:

* City:

* State:

* Zip:

* Phone Number:

Fax Number:

* Email Address:

Medicare Certified?:
Yes
No

Private Duty?:
Yes
No

* Considering a software purchase for your agency:

Current System:

What is the best time to contact you?:

Comments:

To request  just additional information on PRN Plus at this time, click on the “Information Only" button below, and then click on 'Submit'.

To request a Demo,  you must agree to the following:

The Contact and Agency identified below (hereafter referred to as "Agency") agree that the PRN Plus reg; Test version software is being requested for the exclusive purpose of evaluation for possible lease or purchase of PRN Plus reg; by the Agency. The PRN Plus reg;  Demonstration version software will not be installed, copied, disclosed, distributed, or disseminated outside of the Agency’s physical address listed below and access to the software will be limited to Agency employees, agents and consultants.

If you agree, select either the ‘Software and Information’  option to receive a CD and   additional  information, or the 'Web Version and Information'  for Web Access and to receive the  additional Information.  

When completed, please click on 'Submit'.


 :
Information Only
Software and Information
Web Version and Information
   
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