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  E+Arogya Inquiry Deposition Form
 
Name:*
Designation*:
Organisation: Hospital Company
Address1:*
Address2:
City:*
Zip Code:
Country:*
Phone:* Ext :
Mobile:
Email:*
Best Time to Call? From : To :
   Hospital Information:
 
Number of Beds :
less than 50 50-100 100-200 200-500 500 above
Number of Nodes :(Computers) * Unknown
Number of Users :* Unknown
Approx. Budget for procuring HMS:
  I would like more information about the following modules:
 
Front Desk/Help Desk Hostpital-Administration
Electronic Medical Record(EMR) Laboratory
Radiology Billing
Financial Accounting Fixed Assets/Equipment Management
Nursing & Ward Management Blood Bank
MIS & Dashboard House Keeping Module
HR & Payroll Store
OT Psychiatry
Pharmacy  
   
 
 Does your Hospital Use computers?  Yes No
 If yes then indicate the PC types used:
Uses IBM / PC Uses MAC Uses both Does not use a computer
 Would Doctors, at the hospital, be personally entering data? Yes No
  Indicate the software(s) currently being used?
 
1.
2.
3.
4.
5.
Would you want to integrate the above into the HMS that you wish to procure?
Yes  No
Please list below details of further information/clarification you require:
   How did you hear about MediNous Hospital Management System ?
 
Internet Advertisement Referral Mailer Conference
 
   
 
 
   
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