Scout RMS Change Form - RescueStat

CHANGE FORM

Please complete this form prior to moving the ScoutRMS unit to ensure the smoothest transition of your unit.

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Business Name *

Contact Name *

First

Last

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Contact Email *

Select which best applies: *

Moving the AED associated with ScoutRMS
Relocating ScoutRMS to a new AED
Removing a ScoutRMS unit

Contact Phone

Why are you making this change? *

No cellular connection
Site location is closing
Other

Removed Site/Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Removed/Moved AED Make/Model *

ScoutRMS IMEI number *

Placement Description *

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If the ScoutRMS has been relocated, you will need to perform a power cycle to connect it to the new AED. Please watch the video on how to perform a power cycle.