Customization Request Form – Internal This form allows Compulink staff to submit customization requests received from and on behalf of clients to the Customization Team.Name* First Last Date request received from client* MM slash DD slash YYYY Your CBS Email* CBS ID of staff member taking client's request* Unique number of Users issue sheet containing your notes after speaking to client* Client Name* First Last Client Acct #* Contact Name* Contact Email* Phone Number*Address* City State / Province / Region ZIP / Postal Code What existing product functionalities, if any, did you consider or propose before submitting this request? If existing functionality is available, help us understand the client's goals in submitting the request. (If this can be done without customizing, a non-response here may result in the request being returned with suggestions for training client.)*Type of Customization Request(s) Check all that apply. Customize screen in product. Includes add/delete fields, change field order ("workflow changes"), change tabs or tab order, or anything possible using Screen Builder. Screens include: Appointment, Claim, CL Rx, EHR, Patient, Spec Rx (Available in Master version only) Smart Script SQL, includes: data mining query, worklist, SQL grid, etc. Open Office document, e.g. add letter or patient summary Crystal Report (like items in product's Report menu) Customizing database table, e.g. adding fields (Available in Master version only) "Form Editor" document Custom routine. Routines modify data in the database, e.g. reassign appointments for provider that is leaving to another provider Customize Web Registration Custom claim edit Accelerated (ASAP) development of a request for functionality multiple clients would want. Please enter Request # below, under Other. Custom software development of functionality specific to a particular client Other, describe below If you selected Other, explain here:* What screen is to be customized? If new, please indicate. If EHR, be specific about which tab(s). E.g. Complaint and ROS tabs in EHR.What is the client's expectation of how soon this project should be completed? Note lead times to complete and deliver customizations vary based on complexity of the request and our workload. It could take anywhere from 2 days to several weeks or months. The quote we send the client will include the estimated time of completion so the client can see if it will meet their needs.) * As soon as possible Client has no particular expectation Other, describe in box below If you selected Other, explain here:* In your opinion, how soon does the client ACTUALLY need the project completed?* Additional Notes*PhoneThis field is for validation purposes and should be left unchanged.