Remote Patient Monitoring: Provider Request Form
The State of Wyoming has received permission to use CARES Act funds awarded to the state for a Remote Patient Monitoring (RPM) initiative. We will be providing telehealth equipment to patients who are screened by their providers, and who fit the inclusion/exclusion criteria in a separate letter sent to you from the Wyoming Department of Health.

The goals of the State of Wyoming RPM Initiative are to use this technology so that -- because of challenges related to the COVID-19 pandemic -- providers can monitor their patients’ overall health status, educate patients regarding their disease processes, engage patients in their overall plan of care, involve physicians and necessary support personnel, intervene when necessary, and guide patients through the healthcare arena, while caring for them in the comfort of their own homes. Through this process, our end goal is to reduce hospitalizations and emergency department visits, which further strain Wyoming's fragile healthcare system during a public health emergency.

Providers who want to participate in this initiative should fill out the form below for submission to the Wyoming Department of Health. Allocations of RPM equipment will be determined by the department.

For questions, please contact Dr. James Bush at: james.bush@wyo.gov
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Name of Provider Organization / Hospital *
Main Point of Contact (Name) *
Phone Number *
Email Address *
Provider Shipping Address *
Number of Patients Meeting Inclusion Criteria (based on document sent to providers) *
Number of RPM Monitors Being Requested *
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