Request a Reemo Smartwatch

For Care Coordinators Making a Request for a Medica DUAL Solution Member

Member Information

Member details are required to set up the smartwatch.

First name

Last name

Date of birth

Phone number

Member Sex

Male

Female

Member ID

Medica authorization number

Covered by

Elderly waiver

Supplemental benefit

Primary language

Other language

Does the member agree to be contacted by Reemo Health in the future for feedback about the device?

Yes

Shipping Address

Street address

City

State

ZIP Code

Care Coordinator Information

First name

Last name

Organization

Member Health and Activity Level

What is the main reason the member wants to use Reemo Health?

How often does the member wear their current Personal Emergency Response System (PERS) device?

Daily

3-4 times a week

1-2 times a week

Less than once a week

How often does the member interact with other people?

Daily

3-4 times a week

1-2 times a week

Less than once a week

Emergency Contact

When the member makes an emergency call on their smartwatch, the call center operator will alert an emergency contact, if necessary. Members can have up to two contacts.

First name

Last name

Phone number

Do you want to add a second emergency contact?

Yes

Additional Emergency Contact

First name

Last name

Phone number

Reemo Health^TM is an independent company providing connected technology and services.

Request a Reemo Smartwatch

For Care Coordinators Making a Request for a Medica DUAL Solution Member

Member Information

Shipping Address

Care Coordinator Information

Member Health and Activity Level

Emergency Contact

Additional Emergency Contact

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