SystmOne Service Requirements Questionnaire – GW Attempt at designing Service Requirements Questionnaire Call Reference(Required) Basic InformationName of service(Required) Number of sites(Required)Number of SystmOne units(Required)Business hours(Required)Current system(Required) What service are patients referred for?(Required) Parent organisation/commissioner(Required) Total number of users(Required)Project manager for deployment(Required) First Name Last Name Number of patients registered with the service(Required)Type of organisation(Required) Private NHS Are you commissioned to see patients from NHS services?(Required) Yes No Do you have an HSCN/N3 Connection?(Required) Yes No ExtractsDo you require any of the below extracts?(Required)ECDSNQRCSDSMHSDSPalliativeNone/UnknownIs the service an A&E/ED unit?(Required) Yes No Does the service have a call centre?(Required) Yes No How is the service classified?(Required) Primary Care Secondary Care Does the service use Sectioning functionality or Progress notes?(Required) Yes No Does the service require bed management?(Required) Yes No Does the service have in-Patients?(Required) Yes No Do you require a HUB unit for PCN/Federated working?(Required) Yes No Is the organisation a social care service, who assertain required patient needs?(Required) Yes No Does the service find & schedule childhood immunisations?(Required) Yes No Is the organisation a Palliative service?(Required) Yes No Are services offered within the community?(Required)e.g District Nursing, Rehab, Physio, Wellbeing support, Occupational therapy etc. (these contacts can occur either at the patient’s home or within clinics) Yes No Please provide further information about your requirements(Required)Does the service currently have, or will it ever have, in-Patients?(Required) Yes No Will the unit need to use EPMA?(Required)(Electronic Prescribing & Medicines Administration) Yes No Please provide a description of the service you provideHiddenModule RequiredHidden Hidden Hidden Hidden Hidden Hidden Hidden Hidden Hidden Hidden Hidden Hidden Δ
