Clinical System Change 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 requiredPractice Name*Practice Address*Practice Postcode*Practice NACS Code*Docman PINMain Contact Name*Main IT Contact Name*Contact Number*Contact Email*Payee 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 InformationWhich Clinical System do you currently use?Is your Clinical System hosted? e.g. SystmOne, INPS Aeros or local on site at your practiceWhich Clinical System are you migrating to?Will your Clinical System be hosted? e.g. SystmOne, INPS Aeros or local on site at your practiceWill the Docman server (PC that is always left on) keep the same IP address?Is the location of the clinical server/file server changing?Will all of the Docman documents and apps be changing to a new server?If you are having a new clinical server/file server, will this be stored locally or in a hosted environment?Do you intend on decommissioning/removing the old server?If you do intend on decommissioning/removing the old server, what is the intended date?How many PCs do you have at your practice?What is your new clinical system go live date?Are mapped drives available on all PCs for use with Docman?Branch Site InformationDo you have any branch sites, if so how many?What are the details of the branch site(s)?How many PCs do you have at your branch site(s)?Do you scan at the branch site(s)?Do you have a link between your main site and branch site(s)? e.g. NGA, BT N3What is the speed of the link between your main site and branch site(s)? e.g.1mbps, 10mbps, 100mbpsPlease add any additional comments here regarding the Reconfiguration you require and what other work is also taking place.If 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?