Low-Priority/Generic Request Submission Form

Have a question or a request from the RAPC IT Team?

Submit this form to request a non-emergent need to RAPC IT Support Team.

Do not submit this form for merges, addenda requests, or exam on wrong patient as there are other forms specific for those requests.
Thank you.

Submitter Name: Submitter Name: First Last
Submitter's Organization:
Submitter's Phone Number: Submitter's Phone Number: - ### - ### ####
Submitter's email:
Describe the Request

Please include details about the exam, accession, MRN, Pt. Name, DOB, steps to reproduce, device/modality ID, and any other valuable information.
Upload a File or Screen Shot:

Attach Files

Save a log file or screen shot and attach it.