-------------------------------------> Advancing Health Care Through Telecommunications

 

Missouri Telehealth Network
2401 Lemone Industrial Boulevard, DC345.00
Columbia, Missouri 65212

Phone - Main: 573.884.7958 

Technical Hotline: 573.882.3060

Fax: 573.882.5666

Email MTN:
mtn@health.missouri.edu

 

© University of Missouri, Columbia
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::::: general information :::::

telehealth - staff - links - forms - policies ____________________________________

Video Request Form

(return to forms)

What we need YOU to do:

  • Complete the form below and click "submit". MTN requires a notice of a minimum of 5 working days prior to the conference. (If you prefer, you may download the paper copy. Complete the form, and mail or fax it to MTN, using the address on the left.)

  • Make room and additional equipment arrangements, both locally and with remote facility.

  • Contact attendees.

  • If using a Power Point presentation: Bring laptop, projector and provide paper copies to each site.

  • Use good video etiquette. (Let MTN know if you need advice.)

What WE will do:

  • Arrange and perform a test call with the remote facility's videoconferencing contact.
  • Contact you if the video conference is not technically possible.
  • Have an MTN Staff member available for assistance, if needed.
________________________________________________________

For Questions Contact:

Shanda Cash
Administrative Assistant
573.884.7958
cashs@health.missouri.edu

Aaron Woolridge
User Support Analyst
573.882.2322
woolridgea@health.missouri.edu


_______________________________________________________

Video Conference Request Form:

Today's Date:

Name of Requestor/Contact Person:

Phone:

E-mail Address:

Department:

Description of Video Conference:

Date of Video Conference:

Start Time (Central Time):  am  pm

Duration:

Will you need MTN Staff assistance with the video conference?       yes  no

Will this be a regularly scheduled conference?     yes  no

If yes, please explain:


________________________________________________________

Video Conference Location Information:

#1 Location:

Site Contact:

Site Contact E-mail:

Site Contact Phone:

Participant Contact:

Participant Contact E-mail

Participant Contact Phone

Presenters:

Type of Presentation:

Number of Participants:

#2 Location:

Site Contact:

Site Contact E-mail:

Site Contact Phone:

Participant Contact:

Participant Contact E-mail

Participant Contact Phone

Presenters:

Type of Presentation:

Number of Participants:

#3 Location:

Site Contact:

Site Contact E-mail:

Site Contact Phone:

Participant Contact:

Participant Contact E-mail

Participant Contact Phone

Presenters:

Type of Presentation:

Number of Participants:

#4 Location:

Site Contact:

Site Contact E-mail:

Site Contact Phone:

Participant Contact:

Participant Contact E-mail

Participant Contact Phone

Presenters:

Type of Presentation:

Number of Participants:

#5 Location:

Site Contact:

Site Contact E-mail:

Site Contact Phone:

Participant Contact:

Participant Contact E-mail

Participant Contact Phone

Presenters:

Type of Presentation:

Number of Participants:

#6 Location:

Site Contact:

Site Contact E-mail:

Site Contact Phone:

Participant Contact:

Participant Contact E-mail

Participant Contact Phone

Presenters:

Type of Presentation:

Number of Participants:


________________________________________________________

Screen Formats:

A few things to remember regarding the different formats:

  1. Each square in the screen format represents a different site. This does not include the near site (your site). You would only be seen in the picture-in-picture.
  2. The format chosen is the screen format that each site will see.
  3. The number of sites you choose is not limited to the screen format you choose. For example: If you choose format #3, you could have more than 4 sites connected or you could have less than 4.
  4. If you choose format #1, only the speaker will be shown on the screen.
  5. Formats 1 & 2 are conducive to Power Point presentations and formats 3 & 4 are not.

Below are several screen formats to choose for your conference. Based on the criteria above please check the one that best suits your needs.



 1.  


 2. 


 3. 


 4.