Epic Request
Full Name:
E-mail:
Supervisor's email
Department:
Please Select
Admin
Back Office
Front Office
Marketing
Physicians
Research
Surgery
Office Location
Sacramento
Lincoln
Other
Request Type
New IT issue
IT Request
Epic Ticket
Other
Category:
Billing Workflow
Clinical Workflow
New User Request
Scheduling Workflow
User Account Update
Other
Service Level:
Critical (< 1 HR) - Any issue that completely prevents the business or employee from providing services. Prioritized over all issues until resolved.
Urgent (< 24HR) - Any issue that results in loss of primary job functionality for an employee.
Essential (< 1 WEEK) - Any issue that does not result in loss of primary job functionality for an employee but is necessary to address for business operations.
Standard (AS NEEDED)- Any issue present that does not fall into the above categories.
Other
Please describe the issue/request:
What troubleshooting have you tried:
Upload Screenshot, File, or specific example, if applicable
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: