COVID-19 VAYU bCPAP Request Form
Please complete this form to the best of your ability in order to request VAYU bubble CPAPs. This data will be used to inform resource allocation and will not be shared with parties outside of VAYU. Please do not hesitate to contact covidresponse@vayughi.com with any questions.
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FACILITY INFORMATION
Facility Name *
Facility mailing address *
Number of deliveries per month in your facility *
Number of beds in NICU and special care nursery *
Number of admissions into NICU and special care nursery per month (inborn infants) *
Number of admissions into NICU and special care nursery per month (outborn infants) *
Current number of working CPAP devices in your NICU and special care nursery *
What brand or model are the CPAP machines that you have in the NICU and special care nursery?
Current number of working ventilators in your NICU and special care nursery *
What brand or model are the ventilators that you have in the NICU and special care nursery?
Our bCPAP device comes with brackets to attach it to the infant's bed (as pictured below). Please select the configuration that would work best in your NICU.
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Does your facility have an adult intensive care unit? *
If yes to question above, how many beds are in the adult intensive care unit?
If yes to question above, how many working ventilators are available in your adult intensive care unit?
COVID-19 RESPONSE
Would the addition of VAYU bCPAP help to move ventilators from the NICU to other areas of the hospital? *
Have there been COVID-19 cases in your region? *
Have there been COVID-19 cases in your facility? *
Would VAYU bCPAP help your facility during this global pandemic? *
VAYU bCPAP devices come with an online app and website for training materials. Does your facility and staff have access to a reliable WiFi or cellular connection? *
How many VAYU bCPAP devices are you requesting? *
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