WellSky Enhancement Request€¦ · Web viewWellSky 11300 Switzer Road Overland Park, KS 66210...
Transcript of WellSky Enhancement Request€¦ · Web viewWellSky 11300 Switzer Road Overland Park, KS 66210...
WellSky Enhancement Request Form
Behavioral Health & IDD Providers
WellSky Enhancement Request Form
WellSky11300 Switzer Road
Overland Park, KS 66210913.307.1000
FAX 913.307.1111www.wellsky.com
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WellSky11300 Switzer RoadOverland Park, KS 66210
913.307.1000FAX 913.307.1111Website: www.wellsky.com
WellSky Enhancement Request*Please create and attach this completed form to a Salesforce Case
Date of Request: Click here to enter a date. Salesforce Case #: Click here to
enter text.
MCO/Provider: Click here to enter text. Requesting Department: Click here to
enter text.
Staff Contact Name: Click here to enter text. Staff Contact Phone #: Click here to
enter text.
Area of Enhancement: Module: Click here to enter
text.
Tab: Click here to enter text. Tile: Click here to
enter text.
Please Explain the
Issue:
Click here to enter text.
Suggested
Enhancement:
Click here to enter text.
Enhancement Impact on
Other Modules:
Click here to enter text.
Requested Priority: ☐ Low ☐ Medium ☐ High
MCO/Provider
Approval:
Department: Click here to enter text.
IT Director: Click here to enter text.
UG Review Date: Click here to enter a date. WellSky Approval Date: Click here to enter a
date.
Target Due Date: Click here to enter a date. Build Number: Click here to enter
text.
Approved Priority: ☐ Low ☐ Medium ☐ High
Review Comments: Click here to enter text.