• 1. General Information
  • 2. Contact Information
  • 3. Facility Description
  • 4. Local IT Support
  • 5. PC Hardware
  • 6. Computer Environment
  • 7. Server Hardware
  • 8. Network Environment
  • 9. Printers
  • 10. Digital Imaging
  • 11. Backups
  • 12. EHR Environment
  • 13. Version/Domain/Other
  • 14. Training
  • 15. Implementation Actions
  • 16. General Notes
  • 17. Implementation
  • 18. Upgrades
  • 19. Site Documents
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U.S. Department of Health and Human Services
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Indian Health Service The Federal Health Program for American Indians and Alaska Natives
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Document Type:
Description:
Submitted By:


Action Items:



EDR Upgrades
DXE Upgrade History: New Ugrade
Upgrading to DXE Version: 
Upgrade Completed


Item Date Prepared Send Date Received Signed
BAA
EULA
On Hold    
  • Assessment
  • Call Setup
  • Overview Call
  • Contract
  • Follow up
  • Test
  • Upgrade
  • Training
SE/SV form Submitted:

Unknown N/A
SE/SV form completed:
Site Engaged
Item Date Prepared Send Date Received Signed
  Upgrade Packet
Upgrade Authorization
Service Agreement

Assessment Comments:
Correspondence Date Send
  1st Request
    2nd Request
    3rd Request
 Phone Call to Clinic
 No response to Request
  Escalated to IHS Management

Call Setup Comments:
Upgrade Overview Call Date :
Assessment Completed: Unknown N/A
Assessment Completed

Tech Central supplied Hardware
Customer supplied new Hardware
Customer supplied existing Hardware

Site with signed BAA at UO call and only SQL needed or no SQL/HW needed
Site with BAA not signed at UO call and only SQL needed or no SQL/HW needed
Site with or without a signed BAA at UO call and Server, NAS and SQL needed
Unknown

Overview Call Comments:
Tech Central Contract On site Remote
DXE Training Contract On site Remote
Contract Actions Date Sent Date Signed
Tech Central Contract
DXE Training Contract
Contract Notes:
Due (Go/No-go) Completed
Action Items:  
Tech Central Contract: N/A
DXE Training Contract: N/A

Action Items Date Send
    1st Email
    2nd Email
    3rd Email
  Phone Call to Customer
 No response to Request
  Escalated to IHS Management


Follow Up Comments:
Tech Central Contract: N/A
DXE Training Contract: N/A
Test Scheduled:
N/A

Test Scheduled
Test Upgrade Completed:
Test Upgrade Completed
Test Comments:
Tech Central Contract: N/A
DXE Training Contract: N/A
Training Scheduled:
N/A

Training Scheduled
Training Completed:
Training Completed
Training Comments:
Tech Central Contract: N/A
DXE Training Contract: N/A
Upgrade Scheduled:
N/A

Upgrade Scheduled
Upgrade Complete:
Unknown N/A
Upgrade Comments:
Item Date Prepared Send Date Received Signed
Backup Addendum
General Comments: