Resources
Customer Service
Careers
RT FlexPool
(973) 244-2190
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Resources
Customer Service
Careers
RT FlexPool
(973) 244-2190
Customer Service
NJRA provides 24/7 service and support to our partners. Feel free to submit service or support requests via the forms below, call customer service at
(973) 244-2190
or email
Hello@NJRespiratory.com
.
Don"t have a contract with NJRA? We are happy to send over a contract and pricing for your consideration
upon request.
CPAP/BiPAP Service Request
BiPAP/CPAP Service Requests
Facility Information
Facility Name
*
Facility Contact
*
First Name
Last Name
Contact Number
*
(###)
###
####
Subject
New Admission/Readmission
Patient Sent to Hospital (holding bed)
Patient Returned from Hospital
Patient Discharged
Machine Discontinued
Other
Admission Information
Patient Name
*
First Name
Last Name
Room Number
Admission Date
MM
DD
YYYY
Sending Hospital
Settings
CPAP settings only have an EPAP setting.
IPAP
Inspiratory Pressure (4-25)
EPAP
Expiratory Pressure (4-25)
RR
Respiratory Rate (0-30)
Fi02 / 02 LPM
Oxygen Prescription
Mask
Nasal
Full-Face Mask Small
Full-Face Mask Medium
Full-Face Mask Large
Nasal Pillows
Additional Information/Requests
Thank you for your submission! NJRA will contract you within 30 minutes to confirm receipt.
Tracheostomy Service Request
Tracheostomy Admission
Facility Information
Facility Name
*
Facility Contact
*
First Name
Last Name
Contact Numer
*
(###)
###
####
Subject
New Admission/Readmission
Patient Sent to Hospital (holding bed)
Patient Returned from Hospital
Patient Discharged
Patient Decannulated
Other
Admission Information
Patient Name
*
First Name
Last Name
Room Number
Sending Hospital
Settings
Tracheostomy Size & Type
ie: Shiley 6 DCFS or Portex 6 Uncuffed
Fi02 / 02 LPM
Oxygen Prescription
DME Rentals Needed
Select all that apply
5 Liter Oxygen Concentrator
10 Liter Oxygen Concentrator
50 PSI Compressor
Suction Machine
Additional Information/Requests
Thank you for your submission! NJRA will contract you within 30 minutes to confirm receipt.
Respiratory Consult Request
Respiratory Consult
Facility Information
Facility Name
*
Facility Contact
*
First Name
Last Name
Contact Number
*
(###)
###
####
Consult Details
Patient Name
*
First Name
Last Name
Room Number
Consult Type
Select all that apply
Chest Physiotherapy
Incentive Spirometry
Pneumonia
Other (please note below)
Additional Information/Requests
Thank you for your submission! NJRA will contract you within 30 minutes to confirm receipt.
DME Rental/Service Request
DME Rental/Service Request
Facility Information
Facility Name
*
Facility Contact
*
First Name
Last Name
Contact Number
*
(###)
###
####
Subject
Rental Request
Rental Return
Repair Request
Preventative Maintenance
Other
DME Details
DME Type
5 Liter Oxygen Concentrator
10 Liter Oxygen Concentrator
50 PSI Compressor
Suction Machine
CPAP/BiPAP
Compressor Nebulizer
Cough Assist
Airvo
NiOV
Additional Information/Requests
For preventative maintenance, please provide us some service dates to choose from.
Thank you for your submission! NJRA will contract you within 30 minutes to confirm receipt.
Respiratory Inservice Request
Respiratory Inservice Request
Facility Information
Facility Name
*
Facility Contact
*
First Name
Last Name
Email Address
Phone
*
(###)
###
####
Inservice Details
Topics to Review
Select all that apply
Oxygen Administration
Nebulizer Treatments
BiPAP/CPAP Administration
Tracheostomy Care & Suctioning
Pulse Oximetry
Dates
Please provide us with a few dates/times for the inservice
Additional Information/Requests
Thank you for your submission! NJRA will contract you within 30 minutes to confirm receipt.
