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Encompass - Maintenance Request
Use this form to request changes to the EnCompass audits for your customers.
You may make multiple changes, but only for
ONE account at a time
.
What type of EnCompass maintenance would you like to perform?
*
Make Changes to EVS Technican(s)
Make Changes to Auditor(s)
Make Changes to Audit Target
Make Changes to Unit(s)
Make Changes to HTO (High Touch Object)
Close Baseline
Request Additional License(s)
Account Details
Your Email Address:
*
Select Account Number Type:
*
Surgical
Infection Prevention
Do you know the customer's Account Number?
*
Yes
No
Customer Name:
*
Customer Account Number:
*
Customer Street Address:
*
🛈
How many additional license(s) are you requesting?
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Baseline End Date:
*
+
Change EVS Technician(s)
Select the change you would like to make:
*
Add EVS Technican(s)
Edit Existing EVS Technician(s)
Remove EVS Technicians(s)
Add EVS Technician(s)
Select Module(s):
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
CCL/IR
Enter the EVS Tech(s) to be added to the Account (one EVS Tech per line)
*
🛈
Clinic/Exam Room
Enter the EVS Tech(s) to be added to the Account (one EVS Tech per line)
*
🛈
Emergency Room
Enter the EVS Tech(s) to be added to the Account (one EVS Tech per line)
*
🛈
ICU
Enter the EVS Tech(s) to be added to the Account (one EVS Tech per line)
*
🛈
Operating Room
Enter the EVS Tech(s) to be added to the Account (one EVS Tech per line)
*
🛈
Patient Room
Enter the EVS Tech(s) to be added to the Account (one EVS Tech per line)
*
🛈
Other
Enter the EVS Tech(s) to be added to the Account (one EVS Tech per line)
*
🛈
Edit EVS Technician(s)
Select 1 Module:
*
🛈
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
On the left, enter the existing name of the EVS Technician
On the right, enter in the new name of the same EVS Technician
Existing EVS Technician Name
Updated EVS Technician Name
User 1
Existing EVS Technician Name
Updated EVS Technician Name
User 2
Existing EVS Technician Name
Updated EVS Technician Name
User 3
Existing EVS Technician Name
Updated EVS Technician Name
User 4
Existing EVS Technician Name
Updated EVS Technician Name
User 5
Existing EVS Technician Name
Updated EVS Technician Name
Edit More Existing EVS Technicians?
Yes
On the left, enter the existing name of the EVS Technician
On the right, enter in the new name of the same EVS Technician
Existing EVS Technician Name
Updated EVS Technician Name
User 6
Existing EVS Technician Name
Updated EVS Technician Name
User 7
Existing EVS Technician Name
Updated EVS Technician Name
User 8
Existing EVS Technician Name
Updated EVS Technician Name
User 9
Existing EVS Technician Name
Updated EVS Technician Name
User 10
Existing EVS Technician Name
Updated EVS Technician Name
Remove EVS Technician(s)
Select Module(s):
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
CCL/IR
Enter the EVS Tech(s) to be removed (one EVS Tech per line)
*
🛈
Clinic/Exam Room
Enter the EVS Tech(s) to be removed (one EVS Tech per line)
*
🛈
Emergency Room
Enter the EVS Tech(s) to be removed (one EVS Tech per line)
*
🛈
ICU
Enter the EVS Tech(s) to be removed (one EVS Tech per line)
*
🛈
Operating Room
Enter the EVS Tech(s) to be removed (one EVS Tech per line)
*
🛈
Patient Room
Enter the EVS Tech(s) to be removed (one EVS Tech per line)
*
🛈
Other
Enter the EVS Tech(s) to be removed (one EVS Tech per line)
*
🛈
Change Auditor(s)
Select the change you would like to make:
*
Add Auditor(s)
Edit Existing Auditor(s)
Remove Auditor(s)
Add Auditor(s)
Select Module(s):
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
CCL/IR
Enter the Auditor(s) to be added to the Account (one Auditor per line)
*
🛈
Clinic/Exam Room
Enter the Auditor(s) to be added to the Account (one Auditor per line)
*
🛈
Emergency Room
Enter the Auditor(s) to be added to the Account (one Auditor per line)
*
🛈
ICU
Enter the Auditor(s) to be added to the Account (one Auditor per line)
*
🛈
Operating Room
Enter the Auditor(s) to be added to the Account (one Auditor per line)
*
🛈
Patient Room
Enter the Auditor(s) to be added to the Account (one Auditor per line)
*
🛈
Other
Enter the Auditor(s) to be added to the Account (one Auditor per line)
*
🛈
Edit Existing Auditor(s)
Select 1 Module:
*
🛈
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
On the left, enter the existing name of the Auditor
On the right, enter in the new name of the same Auditor
Existing Auditor
Updated Auditor
User 1
Existing Auditor
Updated Auditor
User 2
Existing Auditor
Updated Auditor
User 3
Existing Auditor
Updated Auditor
User 4
Existing Auditor
Updated Auditor
User 5
Existing Auditor
Updated Auditor
Edit More Existing Auditors?
Yes
On the left, enter the existing name of the Auditor
On the right, enter in the new name of the same Auditor
Existing Auditor
Updated Auditor
User 6
Existing Auditor
Updated Auditor
User 7
Existing Auditor
Updated Auditor
User 8
Existing Auditor
Updated Auditor
User 9
Existing Auditor
Updated Auditor
User 10
Existing Auditor
Updated Auditor
Remove Existing Auditor(s)
Select Module(s):
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
CCL/IR
Enter the Auditor(s) to be removed to the Account (one Auditor per line)
*
🛈
Clinic/Exam Room
Enter the Auditor(s) to be removed to the Account (one Auditor per line)
*
🛈
Emergency Room
Enter the Auditor(s) to be removed to the Account (one Auditor per line)
*
🛈
ICU
Enter the Auditor(s) to be removed to the Account (one Auditor per line)
*
🛈
Operating Room
Enter the Auditor(s) to be removed to the Account (one Auditor per line)
*
🛈
Patient Room
Enter the Auditor(s) to be removed to the Account (one Auditor per line)
*
🛈
Other
Enter the Auditor(s) to be removed to the Account (one Auditor per line)
*
🛈
Change Unit(s)
Select the change you would like to make:
*
Add Unit(s)
Edit Unit(s)
Remove Unit(s)
Add Unit(s)
Select Module(s):
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
CCL/IR
Enter the Unit Name to be added to the Account (one Unit Name per line)
*
Clinic/Exam Room
Enter the Unit Name to be added to the Account (one Unit Name per line)
*
Emergency Room
Enter the Unit Name to be added to the Account (one Unit Name per line)
*
ICU
Enter the Unit Name to be added to the Account (one Unit Name per line)
*
Operating Room
Enter the Unit Name to be added to the Account (one Unit Name per line)
*
Patient Room
Enter the Unit Name to be added to the Account (one Unit Name per line)
*
Other
Enter the Unit Name to be added to the Account (one Unit Name per line)
*
Edit Unit(s)
Select 1 Module:
*
🛈
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
BE ADVISED
When editing a Unit Name, your customer will only see the Updated Unit Name in their reports once this request has been completed.
Please make sure the customer syncs their device after this request has been completed.
On the left, enter the existing name of the Unit
On the right, enter in the new name of the same Unit
Existing Unit Name
Updated Unit Name
Unit 1
Existing Unit Name
Updated Unit Name
Unit 2
Existing Unit Name
Updated Unit Name
Unit 3
Existing Unit Name
Updated Unit Name
Unit 4
Existing Unit Name
Updated Unit Name
Unit 5
Existing Unit Name
Updated Unit Name
Edit More Unit Names?
Yes
On the left, enter the existing name of the Unit
On the right, enter in the new name of the same Unit
Existing Unit Name
Updated Unit Name
Unit 6
Existing Unit Name
Updated Unit Name
Unit 7
Existing Unit Name
Updated Unit Name
Unit 8
Existing Unit Name
Updated Unit Name
Unit 9
Existing Unit Name
Updated Unit Name
Unit 10
Existing Unit Name
Updated Unit Name
Remove Unit(s)
Select Module(s)
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
BE ADVISED
By removing a Unit Name, you will no longer see any data for that specific Unit Name going forward.
The Unit Name will remain on the reports but will not have any data associated with it.
CCL/IR
Enter the Unit Names to be removed from the Account (one Unit Name per line)
*
Clinic/Exam Room
Enter the Unit Names to be removed from the Account (one Unit Name per line)
*
Emergency Room
Enter the Unit Names to be removed from the Account (one Unit Name per line)
*
ICU
Enter the Unit Names to be removed from the Account (one Unit Name per line)
*
Operating Room
Enter the Unit Names to be removed from the Account (one Unit Name per line)
*
Patient Room
Enter the Unit Names to be removed from the Account (one Unit Name per line)
*
Other
Enter the Unit Names to be removed from the Account (one Unit Name per line)
*
Change HTO (High Touch Objects)
Select the change you would like to make:
*
Add HTO(s)
Remove HTO(s)
Add HTO(s)
Select Module(s):
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
List out the HTOs to add to the
CCL/IR
Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to add to the
Clinic/Exam Room
Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to add to the
Emergency Room
Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to add to the
ICU
Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to add to
Operating Room
LIMIT 5
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
HTO 4
HTO Name
HTO 5
HTO Name
Select Category under the
Patient Room
to add the HTO to:
*
Bathroom
Patient Room
List out the HTOs to add to
Bathroom
Category under the Patient Room Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to add to
Patient Room
Category under the Patient Room Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to add to the
Other
Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
Remove HTO(s)
Select Module(s):
*
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
List out the HTOs to remove from the CCL/IR Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to remove from the Clinic/Exam Room Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to remove from the Emergency Room Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to remove from the ICU Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to remove from the Operating Room
LIMIT 5
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
HTO 4
HTO Name
HTO 5
HTO Name
Select Category under the Patient Room to remove the HTO from:
*
Bathroom
Patient Room
List out the HTOs to remove from the Bathroom Category under the Patient Room Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to remove from the Patient Room Category under the Patient Room Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
List out the HTOs to remove from the Other Module
LIMIT 3
HTO Name
HTO 1
HTO Name
HTO 2
HTO Name
HTO 3
HTO Name
Change Audit Target
Select Module:
*
🛈
CCL/IR
Clinic/Exam Room
Emergency Room
ICU
Operating Room
Patient Room
Other
Other
New Audit Target:
*
Notes About Audit Target Changes:
.
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