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Hospital: First Name: Last Name: Email Address: Number: Alternate Number: Preferred Contact Method:

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Where are you having the issue?: * In What Area?: * Brief Description of the Issue: Note: This will be the support ticket title Detailed Description: Priority:

Priority Levels:

Minor Issue: Defined as Low Priority in our SLAs, and means no major impact, eg, enhancements, new notifications, etc.
Moderate Impact: Defined as Normal Priority in our SLAs, indicates work can continue.
Major Impact: Defined as High Priority in our SLAs & indicates significant disruption to operations.
Severe/System Down: Defined as Critical Priority in our SLAs

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