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2023-06-17T17:46:09+00:00
Customer Acquisition Information
Site:
*
Hospital
Poly-clinic
Radiology Center
Other
Multi-Site configuration:
Yes
No
Number Of Sites
Type
*
Domestic
International
Expected Date of Execution:
*
Less than 3 Months
More than 3 months
More than 6 months
Is the site network-ready
Yes
No, Network infrastructure is needed
Type of Project:
*
Public/Governmental
Private
Military/Defense
PPP
Contact Name
*
Cell Phone
*
Reported By
*
Address
*
Fax
*
Address
*
E-Mail
*
Basic System Configuration
How many sites to be connected?
Central reporting repository or distributed/cross reporting?
*
What is the average cases/studies per year per site?
*
Is HMIS required? Or Integration with existing one?
*
Does the HIS /EHR supports HL7 Standard?
*
Do you need HL7 integration between PACS and HIS or EHR?
*
Do you need RIS be integrated financially with your HIS?
*
PACS User Licenses
How many concurrent user is required?
*
Do you need report dictation?
*
Is web booking is required?
*
HMIS | RIS User Licenses
How many concurrent users for patient registration/retrieval?
*
Is Inventory module is required? How many concurrent inventory users are needed? Pharmacy? Human Resources?
*
Span of long term archiving is ........ Months/Years?
*
How many Mammography Workstations?
*
Medical Imaging Setup
Equipment
*
Vendor
*
Model
*
Digital/DICOM Interface
Store
Q/R
Print
WL MPPS
Analog/Non-DICOM
Video
Department/Floor
Qty
Total Studies /Year
Do You have more data to be added
Please check Yes to have another data form
Yes
No
Equipment
*
Vendor
*
Model
*
Digital/DICOM Interface
Store
Q/R
Print
WL MPPS
Analog/Non-DICOM
Video
Department/Floor
Qty
Total Studies /Year
Do You have more data to be added
Please check Yes to have another data form
Yes
No
Equipment
*
Vendor
*
Model
*
Digital/DICOM Interface
Store
Q/R
Print
WL MPPS
Analog/Non-DICOM
Video
Department/Floor
Qty
Total Studies /Year
Do You have more data to be added
Please check Yes to have another data form
Yes
No
Equipment
*
Vendor
*
Model
*
Digital/DICOM Interface
Store
Q/R
Print
WL MPPS
Analog/Non-DICOM
Video
Department/Floor
Qty
Total Studies /Year
Do You have more data to be added
Please check Yes to have another data form
Yes
No
Equipment
*
Vendor
*
Model
*
Digital/DICOM Interface
Store
Q/R
Print
WL MPPS
Analog/Non-DICOM
Video
Department/Floor
Qty
Total Studies /Year
Do You have more data to be added
Please check Yes to have another data form
Yes
No
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