Request To Activate Community Chart

Please fill out required information and click “Send” to request Community Chart activation.

MEDENT Account #*

Practice Name*

Your Name*

Title:

Preferred contact method*

Preferred phone # for call back*

- -

Practice phone #

- -


E-Mail Address*


  • Area of System *
    • Hardware
      • Backup
      • Card Scanning
      • Dragon
      • Faxing
      • Hardware Quote
      • Interface
      • Imaging
      • Lifebook
      • Medical Equipment
      • Medtrace
      • Medent mobile
      • Patient photo
      • Physical hardware issue
      • Printing
      • Remote cache
      • Scanning
      • Send
      • Server
      • VPN
      • Wireless
      • Other
    • ECS
      • ECS
      • Electronic Claims
      • Eligibility
      • Insurance Printing
      • PA Cost
      • SPARCS
      • Waystar
      • WEBECS
      • 5010
      • UB04
      • OTHER
    • Practice Management
      • Autopost
      • Billing Rules
      • Chart central
      • Charge entry
      • Client supplies
      • Collections
      • Daily Billing Summary
      • Daysheet
      • Date change
      • E-Superbill
      • HIPAA
      • Imm/Inj
      • Letters
      • Master files
      • Monthend
      • Office appointments
      • Modules
      • Patient info
      • Posting
      • Personal calendar
      • Quotes
      • Reports
      • Referral
      • Relink
      • Security
      • Statements
      • Superbill
      • Surgical scheduling
      • Workers comp
      • Other
    • Medical Records/EMR
      • Video Visits
      • Dragon templates
      • Documents
      • Electronic Prior Authentication
      • EMR Reports
      • ePrescribe of Controlled Substances
      • eRX
      • HIE
      • MCL
      • MIPS
      • MU 2015-2017
      • MU dashboard
      • Patient education
      • Prescriptions
      • Pharmacies
      • Portal
      • Kiosk
      • Pre-Check-in
      • Patient Online Scheduling
      • Read access violation progress note
      • SureScripts
      • Template by provider
      • Other
    • Lab
      • Lab
      • Diagnostic Imaging
      • General Orders
      • Therapy
      • Lab holding tank
      • Cross reference
      • Other
    • Disease Management
      • DM
      • Health maintenance
      • Medical home
      • NCQA
      • PQRS
      • Other
    • Portal
      • Patient Portal
    • Kiosk
    • Pre-Check-in
    • Patient Tablet App
    • Patient Online Scheduling
    • Online New Patient Request
    • Interfaces
      • Document Interface
      • HIE
      • Holding Tank
      • PACs System
      • Medical Equipment
      • N2N/Direct Messaging
      • Other
    • Carequality/Community Chart
      • Community Chart Activation
      • Community Chart Issues
    • Other


Subject*

Description of Support Inquiry*


Provider: *

Providers Affected:

Patients Affected: *

How many Patients?

Patient Examples (up to 5): (optional)