Cortex User Group

CORTEX Medical Management Systems

Support Request

Date: ______________

Customer Name: _________________________Submitter Name:__________________________

Submitter’s Phone Number:___________________ Submitter’s Fax Number:____________________

Cortex Version: ___________

Menu/Screen/Report Name:__________________________________________________________

Urgency:               1              2              3              4              5              (1 most urgent – 5 least urgent)

Request Details:

Attach any necessary print screens or documentation.   Attachments:   YES________   NO___________

Rec’d by User Group President on: ____________

Sent to:   Windows Billing   Gold Standard   CUG esite   on : _____________ (30 days to return to president)

Returned to CUG President on:____________________

Committee Response: Approved,  Denied, Site Specific (Custom), Bug, Need add’l info, Provided Solution

Committee Notes:

Forwarded to Cortex Representative on: ____________  (30 days to respond to President of CUG)

Submitter Notified of Decision on: __________________  

Cortex Estimate of Time to Complete__________

Fax your request to CUG President Trish Schoepflin call 888-447-2450 for fax number.

Email to trish@ihsi.com