For your residents, care providers and managers, make a change for the better with a successful MDS 3.0 transition.

To learn more about GULF SOUTH MDS 3.0 Total Readiness and sign up for a FREE MDS-in-a-Day software webinar, simply complete and submit the form below. If you prefer, call us toll-free at 800-347-2456 x3353.



* Required Fields
   
 
Facility Data
 
Gulf South Account JDE # (If applicable) :
 
* Facility Name:
 
* Facility Address:
 
* Facility City:
 
* Facility State:
 
* Facility Zip:
 
Gulf South Sales Rep Name (If applicable) :
 
Facility Specialty:
 
# of Licensed Beds:
 
* Your First Name:
 
* Last Name:
 
* Email:
 
* Phone:
 
What is your role in the facility?
Owner
Administrator
Head Finance
DON
Ownership
1.
Is the facility independent or managed by a larger group?
Independent
Managed
 
If managed:
1.a
What is the name of that organization?
1.b
Who is the decision maker in that organization?
Technology and Systems
2.
Does the facility currently outsource the MDS and Billing/AR services or manage it in-house?

Outsourced Billing/AR MDS

In-House
3.
What system does the facility use?
MDS:
Billing/AR System:
4.
How long has the facility used its current MDS and
Billing/AR solution?
0 to 6 Months
7 to 12 Months
13 to 24 Months
24+ Months
5.
Which EHR vendor does the facility use?
Buying Timeframe
6.
What is the facility's timeline to purchase a new MDS 3.0  and Billing/AR solution?
0 to 6 Months
7 to 12 Months
13 to 24 Months
24+ Months
7.
Would you consider switching to a long term care software services partner of GSMS that could include a leading EHR, if they demonstrated value to your facility?
Likely
Neutral
Not Likely
 
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