ChartCapture - Data Migration Discovery

Aesto Health | athena DirectPay

The purpose of this form is to compile information about your prospective practice's current EHR to plan for their clinical data migration.

You will be asked questions regarding their EHR and what type of access will be available.

This information will remain confidential and will not be shared with any other parties.
athenahealth Account Executive Name
N/A

Required First Required Last

Enter the name of the person completing this form.
athenahealth Account Executive Email Address *
N/A
athenahealth Account Executive Phone Number *
N/A
athenahealth Sales Segment *
N/A
Practice Name *
N/A
Practice Specialty *
N/A
Practice Address
N/A

Required
Street Address
Address Line 2 Required City Required State/Region/Province Required
Postal / Zip Code

Country
Practice Contact
N/A

Required First Name Required Last Name
Practice Contact Role *
N/A

i.e., Office Manager, Owner, Provider
Practice Contact Email Address *
N/A
Practice Contact Phone Number *
N/A
Estimated athenahealth Go-Live Date
N/A
Number of Physicians
N/A
Number of Mid-Levels
N/A
Project Information
Does your practice use the same system for Practice Management and Clinical data? *
N/A
Practice PM System *
N/A
Do Patient IDs (MRNs) match in the PM and clinical systems? *
N/A

Whether or not these IDs match will determine how Aesto Health approaches these data migration projects.
Current EHR *
N/A
Other EHR Name
N/A
Where is the EHR hosted? *
N/A
****IMPORTANT****
Please ensure your client is starting conversations with ___ or their 3rd Party Vendor about the timeframe and cost to get a backup/export of their data to prevent project timeline delays.

Some vendors require a long lead time (2-8 weeks) to provide a database backup/export to the practice.

The backup/export should be delivered to Aesto Health 8-10 weeks ahead of the athena Go-Live Date. The assigned Aesto Project Manager will collaborate with athena and the practice to determine the appropriate date on which this backup/export should be pulled to ensure the shortest gap management period possible.
Is there additional information about this opportunity that you'd like to share with Aesto Health?
N/A
Does the practice document any clinical data on paper charts?
N/A
Imports to athenahealth
Will this practice utilize Aesto Health's Standard or Premium Import File Preparation offerings? (Select One)
N/A

Standard imports can include Demographics, Future Appts, Appt Ticklers, Chart Alerts, Allergies, Immunizations, Family Hx, Gynecology Hx, Medications, Obstetric Hx, Past Medical Hx, Past Pregnancy, Problems, Social Hx, Surgical Hx, & Vitals
Stage *
N/A
Pipeline *
N/A
Practice Specialty - Other
N/A

Aesto Health | athena DirectPay

Project Information

Imports to athenahealth

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