home :: join MUSE :: facility members
Facility Membership Form

Facility:
Address:
City:
State/Province
Country
Zip/Postal Code:
Website:
Key Contact:    Title:
Phone:    Email:
Membership Level: (check one)
  0 - 150 beds $550 US or $550 CDN
  151 - 500 beds $750 US or $750 CDN
  501 - 1000 beds $950 US or $950 CDN
  1001 - 2000 beds $1,150 US or $1,150 CDN
  Over 2,000 beds Determined on an individual basis - please contact MUSE
A 'bed' is defined as an acute care bed. Any other bed, such as rehab, extended care, long-term care, etc. can be counted at a 2 to 1 ratio - that is, these other beds are considered ½ of an acute care bed. This is for counting purposes only, not clinically speaking - we don't want to offend anyone!

So, for a hospital that has 100 acute care beds, 50 rehab beds, and 60 extended care beds, the number of 'total beds' is 100 + ½ (50) + ½ (60), or 155. This hospital would pay $750 US for their MUSE annual membership dues.

Mail your check payable to MUSE.

If applicable:
CIO Name: (if not the key contact)
Address: (if different than above)
City:
State/Province
Country
Zip/Postal Code:
Phone:    Email:

If applicable:
CFO Name: (if not the key contact)
Address: (if different than above)
City:
State/Province
Country
Zip/Postal Code:
Phone:    Email:

Facility Profile:
Configuration?
Facility platform:   Magic   Client/Server   Both Magic and C/S
Approximate number of MEDITECH modules contracted:
Size?
If this membership is for a Health Region, Partnership, or Corporation, how many acute care hospitals are covered by this membership:   
Approximate number of acute care beds:   
Approximate number of 'other' beds:
(i.e. Rehab; Psych; Long Term Care; Extended Care; etc)		   
Approximate number of employees:   
Approximate number of IS employees:   
How did you hear about MUSE? (MUSE offers incentives to those who assist with the recruiting of new members):


  Copyright © Medical Users Software Exchange. 1996-2002.
 Web Design by Acro Media Inc.