SuiteMed Solutions

SuiteMed Solutions Quote Calculator

Private Medical Practices
Please provide the following information

County Name*

State*

 

Practice Information:

Practice Name*

Street Address*
Primary Location

City, State, Zip*

 

Primary Contact Information:
This should be the person we should contact for information or questions regarding your practice.

Primary Contact Name*

Contact Phone Number*
Example format: xxx-xxx-xxxx

Contact Email Address*

 

SuiteMed Solutions Quote Calculator

Operational Details

Practice/Department Details

Clearinghouse*

ENS

 

 

Do you use an outside billing service?*

Yes
No

 

 

Would you prefer a Web-hosted system or a server-based system?*
We recommend server-based systems to avoid Internet interruptions, but either system is reliable and cost-effective.

Web-Hosted
Server-Based

 

 

Practice Specialty Description*
Health Dept, Family Medicine, Pediatric, etc., select all that apply.

Number of Specialty Training Factor*
Family=2; Health Department=3; Other=1 (i.e. Peds, OB, Allergy, etc.)

How many days is your practice open during the typical work week?*

Number of Office Locations*

Number of computers (total for all offices)*
Count all PCs, Tablets, Servers, Faxes, Etc.

Number of full time physicians (total for all offices)*

Number of PAs and MAs (total for all offices)*

Number of NPs (total for all offices)*

Number of DC/DPM - Podiatrists/PT (total for all offices)*

Number of Chiro/PT/Psychologists/SW (total for all offices)*

Number in your practice who can sign prescriptions (total for all offices)*

Is yours a multilingual practice (other than English and Spanish)?*
If so please select the language(s), select all that apply.

Does your practice offer dental Services?*

Yes
No
Plan to

 

 

 

What Lab Service(s) do you use?*

None
LabCorp
Quest
LabCorp & Quest
Other

 

 

 

 

 

 

SuiteMed Solutions Quote Calculator

Health Department Information
Please provide the following information

County Name*

State*

Street Address*
Primary Location

City, State, Zip*

 

Primary Contact Information:
This should be the person we should contact for information or questions regarding your practice.

Director's Name*

Phone Number*
Example format: xxx-xxx-xxxx

Email Address*

 

SuiteMed Solutions Quote Calculator

Primary Hospital Affiliation*

Does your patient base consist of at least 30% Medicaid or 20% Medicare OR do you not qualify stimulus funding?*

Medicaid
Medicare
No Stimulus

 

 

 

Is your practice 20% Pediatric?*

Yes
No

 

 

What is the dollar amount of your Medicare Billing?*
Confirms ARRA stimulus funds.

Is your practice in a Federal Class Rural Area?*

Yes
No

 

 

Do you participate in the NC Immunization Registry?*

Yes
No

 

 

What is your estimated number of patients per day (total for all offices)?*

What is the estimated number of prescription refill requests per day (total for all offices)*

What is the estimated number of Patient Files that get pulled daily that are not seen?*

What is the dollar amount of your annual Malpractice Insurance premiums?*

Do you currently use a Transcription Service?*

No
Yes - In House
Yes - Out Source

 

 

 

Current System Information

Do you have an EMR system now?*
If yes, please enter the Brand.

No
Yes

 

 

Do you have an appointment system now?*
If yes, please enter the Brand.

No
Yes


 

Will there need to be Data Conversion from your old system to SuiteMed IMS?*
If you are not sure, select "Yes".

Yes
No

 

 

Will there be an Immunotherapy Utilization?*
If you are not sure, select :No".

Yes
No

 

 

 

Comments:

 


Thank you for supplying this information!!
 Please click "Submit" to complete the Quote Calculator.