Information
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Document No.
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Conducted on
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Client / Site
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Easter Seals Tristate: Rossplain Road
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Easter Seals Tristate: Gilbert
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Easter seals Tristate: Morgan
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Easter Seals Tristate: West Seventh Street
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Easter Seals Tristate: East Central Parkway
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Easter Seals Tristate: Walnut Street
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Easter Seals Tristate: Symmes Road
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Easter Seals Tristate: Harrison Ave
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Easter Seals Tristate: Spring Grove Ave
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Prepared By:
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End User first and last name
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Computer Name
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Login username
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Operating System
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Special Programs
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Microsoft Dynamics
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TACS-CIS
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Paycor
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Quickbooks
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Advisor
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Other
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Other?
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Additional Special Program/LOB information
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Printers
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Administrator-8000
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Xerox-administrator
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Local printer
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Model?
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Additional printer information
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Mapped Drives
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H
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O
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M
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P
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S
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T
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W
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Z
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Other
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Power
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Anti-virus status
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Sales Note
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Pain/Note #1
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Intervention:
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Pain/Note #2
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Intervention:
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Pain/Note #3
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Intervention:
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Pain/Note #4
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Intervention:
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Pain/Note #5
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Intervention:
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Pain/Note #6
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Intervention:
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Pain/Note #7
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Intervention:
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Pain/Note #8
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Intervention:
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Pain/Note #9
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Intervention:
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Pain/Note #10
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Intervention:
