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Consulting Project Request Form
In order for us to provide you with a quote for our Contract Consulting Service, please complete the form below.
Please provide the following contact information:
Salutation
Please choose
Mr.
Ms.
Mrs.
First name
Last name
Title
Organization
Street Address
Street Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Mobile Phone
FAX
Email
Client/Institution Name
Cerner Client Mnemonic
Cerner Client Number
Cerner Site/Project Contact Name
Cerner Site/Project Contact Telephone
Cerner Site/Project Contact Mobile Phone
Cerner Site/Project Contact Email
Please check the Cerner Platform in use:
Millennium
Classic 3.06
Classic 3.05
Classic 3.04
Please check the Operating System in use:
Open VMS
AIX
Other
What name do you want to use for this project?
Please describe the program you need:
Are there any special or unusual considerations?
Yes
No
If yes, please describe:
Will this project include...:
An Interactive Program (requiring user-interaction)
A Program to Run Automatically (from operations, etc.)
Will A Custom or Extract Table Be Required?
Yes
No
Can you provide a sample of the desired output for this program?
Yes
No