HCA - Service Request Form

Repair Services for HCA Healthcare

Welcome! To request repair services, please complete the form below.

Please send repairs to 9635 Philadelphia Road, Baltimore, MD 21237.

For assistance, please e-mail helpdesk@rmsomega.com.

HCA Service Request Form

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Request Service or Repair
Action Required*
- Open New Onsite Service Call
- Open New Phone Support Call
- Obtain a Return Merchandise Authorization (RMA) #
Select a Device*
Items to Service or Repair*
Model/Part Number Serial Number Problem Description
Contact Information
HCA Division*
Please select your HCA Healthcare division.
Capital Division - Hospital Name
Please select your hospital.
Central West TX Division - Hospital Name
Please select your hospital.
Continental Division - Hospital Name
Please select your hospital.
East FL Division - Hospital Name
Please select your hospital.
Far West Division - Hospital Name
Please select your hospital.
Gulf Coast Division - Hospital Name
Please select your hospital.
Mid America Division - Hospital Name
Please select your hospital.
Mountain Division - Hospital Name
Please select your hospital.
North Carolina Division - Hospital Name
Please select your hospital.
North FL Division - Hospital Name
Please select your hospital.
North Texas Division - Hospital Name
Please select your hospital.
San Antonio Division - Hospital Name
Please select your hospital.
South Atlantic Division - Hospital Name
Please select your hospital.
TriStar Division - Hospital Name
Please select your hospital.
West FL Division - Hospital Name
Please select your hospital.
Hospital Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Contact*
First Last
Phone*
Extension
Alternate Phone*
Email*
Secondary Contact*
First Last
Message
Additional Equipment Needed?
Would you like to request a quote for additional items?*
- Yes
- No thank you
Equipment Needed
- MobiLab Devices
- Labels
- Batteries
- Other Accessories
Other Description
Quantity
Email
This field is for validation purposes and should be left unchanged.

Model/Part Number	Serial Number	Problem Description

HCA – Service Request Form

Repair Services for HCA Healthcare

HCA Service Request Form

Request Service or Repair

Contact Information

Additional Equipment Needed?