Mountain Shadows is a one hundred eight bed campus residential facility for the developmentally disabled. Five nurses oversee unlicensed caregivers. The nurses are on the campus during normal business hours, but are on 24/7/365 call. The Medical Director is on campus one-half day per week, but receives between eight and twelve calls per day from the nurses or residential caregivers for medical direction. Mountain Shadows sends an average of one resident to the Emergency Room (ER) each week. The cost of transport to and from the ER as well as the ER visit is charged to the Mountain Shadows fixed operating budget. The charge caregiver at Mountain Shadows has an iPod® Touch® with the telmedx application installed. The Medical Director has an iPad® with the telmedx application installed. When caregivers contact the Medical Director he has the ability to see the patient and any wound or condition, enabling him to better evaluate the patient and give medical direction. The availability of the telmedx telemedicine platform reduces the number of ER visits.