If you will take a few moments to complete the following questionnaire, we will be happy to provide you with a preliminary quote for your system configuration.

Product(s):

AACS (Financials and Clinicals)

Csswin  

Cssxray 

Enterprise Scheduling

Nursing

Pharmacy

Inventory/Materials Management

Medical Necessity

Document Scanning/Management

Toxicology

Type of Facility:

Clinic  Hospital Group Practice

Daily Samples Accessioned:

Number of Techs during busiest time of Day:

Hematology Analyzer:

Chemistry Analyzer:

Special Chemistry Analyzer:

Urinalysis Analyzer:

Coag Analyzer:

Other Analyzer(s):

Remote Print to Network Printers

Remote Print to Off-Site Printers

Remote Fax Capability

Automatically Print/Fax Patient Reports to distributed locations.

Number of Faxes sent per day:

Barcode Sample Labels

Multiple Label Printers Required  Number?:

Remote Order Entry

ASTM or HL7 Interface with Patient Info System

Receive Patient Demographics from Patient Info System

Transmit Billing/Charge Information to Billing or HIS System

Transmit Patient Results to Electronic Medical Records/Chart System

Name of HIS/Billing System to be interfaced with:

Advanced Laboratory Management Reporting

Total number of workstation seat licenses 

Please indicate any special considerations or requirements that you feel apply to your facility or items that are of particular importance to your implementation.

Please Provide Hardware Recommendations.

Please Provide Quote for Hardware.  Note: We do not REQUIRE you to purchase your computer hardware from us.

We are budgeted for this project.

Amount budgeted is:

Minimum:

Maximum:

We are in the Planning Stage for this project.

We are currently evaluating Vendors.

We are currently scheduling demonstrations.

We expect to select a vendor by

(Date)

We would like to be operational by

(Date)

Your Name:

Your Facility:

Your Email Address:

Your Phone Number:

Your Fax Number:

Your Mailing Address: