Hartford HealthCare Epic On-Site Assessment Form Please fill out the following Hartford HealthCare Epic On-Site Assessment Form: Company DemographicsLegal Practice Name:Specialty:Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeNumber of Midlevels or Other Providers:Number of Physicians:First NameLast NamePractice Contact Role:Contact Phone Number:Contact Email Address:General InventoryNumber of Desktops:If any of these are "backup desktops," how many?Number of Laptops:If any of these are "backup laptops" how many?Number of PCs:Number of Macs:Number of Tablets (iPads, Chromebooks, Microsoft Surfaces, etc.)::Number of Printers:Number of Scanners:Number of Multifunction Printers (MFPs):Does the office fax/scan from the MFPs?Fax OnlyFax and ScanScan OnlyDoes the practice fax via telephone lines?YesNoHow many fax numbers does the practice employ?IT EnvironmentDoes the practice have their own IT staff?YesNoIf Yes, Number of IT staff:IT Manager Name:If No, Name of IT firm:Firm Contact Name:IT Phone Number:IT Email:Name of Current Practice Management/Billing System:Name of Current EMR:Name of Other System in Use:Will Stay After Epic?YesNoName of Other System in Use:Will Stay After Epic?YesNoName of Other System in Use:Will Stay After Epic?YesNoName of Other System in Use:Will Stay After Epic?YesNoIs there broadband internet access at each site?YesNoNetwork Type:WiredWirelessBothAre all locations networked?YesNoAre there any networked medical devices?YesNoIf Yes, what are the devices?Are there any mobile devices used in the practice (i.e. smartphone, tablet):YesNoIf Yes, what are the devices?Do you plan on using this application on a laptop?YesNoDo you plan on using the laptops on your wireless network?YesNoDo you have adequate chargers and spare batteries for laptops and portable devices?YesNoInternal InfrastructureAre all rooms hard-wired for network access?YesNoPartialIf partial, please explain:Are there any workgroup switches in use in the office?YesNoIf yes, please describe location and indicate make(s), model(s), and speed here:Verify Network InfrastructureExternal IP Address:Primary ISP download/upload speed (e.g., 100 Mbps down/35 up, etc.):Connection type?CableDSLFiberSatellite4G/5GSecondary/Backup ISP:Connection type?CableDSLFiberSatellite4G/5GInternal (LAN) subnet used (CIDR):Location of network equipment: Router make and model:Firewall(s) make and model:Switch(es) make and model:Does the office have an Uninterruptable Power Supply (UPS) attached to the network infrastructure?YesNoMake and model of UPS:Additional Information:Wireless InformationTotal Number of Wireless Access Points (WAPs):Make, model, and location(s) WAP(s):Office/Private WiFi:YesNoN/ASSID(s):Encryption type:RadiusWPA2 PersonalWPA2 EnterpriseWPAWEPOpenGuest/Patient WiFi:YesNoN/AGuest SSID(s):Encryption type:RadiusWPA2 PersonalWPA2 EnterpriseWPAWEPOpenNumber of visible SSIDs:Demarcation AreaLocation of demarcation point:Is this a secure area?YesNoDo you see any potential environmental hazards?YesNoDetails:Phone SystemSystem Type:VOIPAnalogDigitalAre computers connected to the network via the phones?YesNoMalware ProtectionAntivirus software:Is A/V software managed?YesNoWorkstation SummaryDo any computers NOT have at least 4 GB RAM?YesNoIndicate machine name(s) here of any that do not:Do any desktop computers NOT have a 24” monitor?YesNoIndicate machine name(s) here of any that do not:Do any computers NOT have at least a 7th generation Intel i5 processor?YesNoIndicate machine name(s) here of any that do not:Do any computers NOT have GPU with resolution of 1920x1080?YesNoIndicate machine name(s) here of any that do not:Are there any all-in-one desktops?YesNoHow many?What version of Citrix Workspace is installed?Printer/MFP ListPrinter Information Needed for Each DeviceScanner ListScanner Information Needed for Each DeviceMiscellaneousHow does the group take pictures of the patients?Device Count:Make:Model:Does the practice schedule telemed sessions?YesNoTelemed Application:Are there historically any issues with power or Internet connectivity in the building?YesNoAdditional details:Any concerns/sensitivities the office has that should be noted?Submit
