GE Healthcare

 

Custom Report Request Order Form

VAR customers please contact your VAR directly.  
* Indicates required field   Contact Information
*Organization name:  
*Your name:  
Phone number:  
*Email address:  
*Please check the box to confirm you are a direct customer.   Direct Customer
If you are a VAR (Value-added reseller) customer, please contact them directly for your report request.
 
*Centricity product and version:
(Please go to Help, About Centricity Practice Solution or Centricity EMR, and enter the exact version and build for which this report is to be built.
   
*Report type:    
Please separate each by a comma.
PROMO Code:
   
Please click Submit to complete the Custom Report Request.
* Indicates required field