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First Name: *
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* Required Fields.
Note:
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Last Name: *
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Rank:
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Installation Name: *
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Site/MTF: *
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Department: *
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Your E-mail Address: *
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Commercial Phone: *
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DSN Phone:
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Fax Number:
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Do you currently have a ticket open for this request?
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Yes
No
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MHS Ticket # :
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CHCS Version:
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Are you a multi-divisional site?:
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Yes
No
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Is this CHCS Ad Hoc request a result of a directive requesting information from multiple MTFs?
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Yes
No
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If YES, please type and/or copy the directive in this box. You can also forward a copy of the directive to
or fax the directive to: (210) 767-0449
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Is this request to modify/troubleshoot an existing MHS Help Desk CHCS Ad Hoc?
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Yes
No
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If YES, what is the CHCS Ad Hoc # (i.e., MHS 58725 or A010815)?
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If the MHS Help Desk did not develop the CHCS Ad Hoc, be prepared to forward a copy of the CHCS Ad Hoc to
and/or fax the CHCS Ad Hoc to: (210) 767-0449.
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The next three sections are important. Specify the goal of the CHCS Ad Hoc, the selection/sort criterion, and describe the output.
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First, what is the goal of this CHCS Ad Hoc? Provide a brief description of what is required and how it will be utilized? *
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Next, what user prompted selection(s) will be entered (i.e., Appointment Date range, Clinic(s), etc.), is there any other selection criteria (i.e., Appointment Status=Kept,Walk-In,S-Call, or Tel-Con), and how do you want the resulting output grouped and/or sorted (i.e., grouped by Clinic & sorted by Terminal Digit)?
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Now, based on the selections described above, what information do you want to see on the report and in what order (i.e., Term Digit, Patient Name, FMP/SSN, Appt Date/Time)?
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If you want any Sub-totals or Totals identify the fields:
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Would you like your output in Report or ASCII-delimited (i.e., flat) file format?
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Report
Delimited
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Comments:
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with questions or support requests.