PathWest Direct Setup for Medical Sites

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	PathWest Direct

PATHWEST DIRECT SET UP
FOR MEDICAL SITES

STEP 2.
You have 2 options in how you choose to get your information to us:
OPTION 1: You can choose to either download the Medical Practice Questionnaire (PDF Format), print it out, complete it and fax it back to us on (08) 9381 1704
PDF Format (100 Kb )	Click here if you do not have the Abode Reader, to download it.

OPTION 2:
For a more rapid system deployment, simply complete the on-line form below and submit it directly to our IT Department's helpdesk

COMPLETE THE ON-LINE FORM BELOW AND CLICK ON 'SUBMIT '

Practice Name:	Practice Address:
Contact name:	Phone Number:
Email Address:	Fax Number:

IT Support person:	Phone Number:
IT Support email:	Mobile Number:

DOCTOR'S NAME(S)	DOCTOR'S PROVIDER NUMBER(S)	RESULT FORMAT
Use preferred name format for results	Include any use leading zeros
		PIT HL7
		PIT HL7
		PIT HL7
		PIT HL7
		PIT HL7

If more than five doctors practice at your surgery, please contact our marketing staff on (08) 9346 2142 or email them on marketing@pathwest.com.au so that we can setup a PathWest Direct system that meets your surgery's needs.

COMPUTING ENVIRONMENT DETAILS

Please select your Clinical Practice Software Sytem:
Please specify your system if not listed above:
Please select your computer's operating system:
Please type your operating system if not listed above:
Please select your type of internet connection:

RETROSPECTIVE ELECTRONIC REPORTS

Would you like retrospective reports for all of the above doctors ? No Yes NB: If No is selected, reports will commence being processed from the date of system setup
If Yes, please specify starting date:
Form Completed by:

PATHWEST DIRECT SET UP
FOR MEDICAL SITES

STEP 2.

MEDICAL PRACTICE DETAILS

IT SUPPORT STAFF DEATILS

REFERRING DOCTOR DETAILS

COMPUTING ENVIRONMENT DETAILS

RETROSPECTIVE ELECTRONIC REPORTS

PATHWEST DIRECT SET UP FOR MEDICAL SITES

STEP 2.

MEDICAL PRACTICE DETAILS

IT SUPPORT STAFF DEATILS

REFERRING DOCTOR DETAILS

COMPUTING ENVIRONMENT DETAILS

RETROSPECTIVE ELECTRONIC REPORTS

PATHWEST DIRECT SET UP
FOR MEDICAL SITES