Practice Merge Form Please note that Docman require 60 days’ notice from receipt of the signed order and purchase order to book the work requested on this formPlease provide a brief description of the work requiredMain Practice Name and AddressNACS codeDocman PINMain Contact NameMain IT Contact NameDirect Telephone NumberEmail AddressPayee Name at the ICB, Email Address and Job Title*What ICB are you part of?Who is the contact at your ICB managing this project?*Main Site InformationAre you using PATCHS?YesNoUnsureWhich Clinical System do you use?Is your Clinical System located locally or hosted?What is the date of your clinical merge? The Docman merge will be the next day following the merge.If you have a local clinical/file server, will this be replaced with a new sever when you merge?How much data is in the PCTI folder? This folder is normally found on the shared drive. Right click the folder and select properties. The size in GB to be recorded.How many PCs will use Docman at your practice?How many PCs scan into Docman?Branch Site InfomationDo you have branch sites and if so, how many?What are the details of the branch site(s)?How many PCs are at each site?Branch site 1: Branch site 2: Branch site 3:Do you scan at the branch sites?Branch site 1: Branch site 2: Branch site 3:Do you have a link between your main site and branch site? e.g. NGA, BT N3Branch site 1: Branch site 2: Branch site 3:What is the Network Link Speed at each Branch Site? e.g. 1mbps, 10mbps, 100mbpsBranch site 1: Branch site 2: Branch site 3:Merging Practices into the Main SiteWhat are the details of the site(s)?Which Clinical System do you use?Is your Clinical System located locally or hosted?How much data is in the PCTI folder? This folder is normally found on the shared drive. Right click the folder and select properties. The size in GB to be recorded.Will your site become a branch site of the main site or will it close down?How many PCs will use Docman at your practice?How many PCs scan into Docman?Do you have branch sites and if yes, how many?What are the details of the branch site(s)?How many PCs are at each site?Branch site 1: Branch site 2: Branch site 3:Do you scan at the branch site(s)?Branch site 1: Branch site 2: Branch site 3:How many PCs scan into Docman at the branch site(s)?Branch site 1: Branch site 2: Branch site 3:Do you have a link between your main site and branch site? e.g. NGA, BT N3Branch site 1: Branch site 2: Branch site 3: What is the Network Link Speed at each Branch Site? e.g. 1mbps, 10mbps, 100mbpsBranch site 1: Branch site 2: Branch site 3:Additional CommentsIf we have any questions about this form who would be the best contact?Name: Email: Telephone:Who should we contact to plan dates for this work?