Phase II MaineCare PNMI Telehealth Project Question Title * 1. Would you like to participate in Phase II of the project and receive telehealth equipment for your PNMI site(s)? Yes No Question Title * 2. If not, would you mind sharing the primary reason? Our organization is no longer interested We have staffing capacity challenges Residents are not interested in using it Other (please specify) Question Title * 3. If you answered yes, please provide responses to the following:Are you still the correct contact for the PNMI telehealth project? If not, please provide the name and email for the person we should reach out to. Yes No Alternate contact name and email: Question Title * 4. We’d like to schedule an on-site visit to do a more in-depth technology assessment, and show you some of the telehealth solution options you can choose from. Please provide three dates/times that would work well for us to visit with you. We’ll follow up soon to confirm the date/time! (Note: We’d like to schedule site visits between October 23rd and December 1st if possible, but can be flexible if that timeframe doesn’t work for you.) First date/time Second date/time 3rd Date/time Question Title * 5. Questions: Please contact Phonse Allen-Laney at aralaney@mcd.org or 207-622-7566 ext. 252 Done