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Birlamedisoft Pvt. Ltd.
                                           XENON/Quanta HIMS
                              (Hospital Information Management Software)
                                   Brief Information Gathering Form

Sr. Particular
No.                                                                Details
 1 Name, Address, Tel no, details of Hospital




 2   Number of beds in the Hospital
 3   Provide the approximate number of users who will be using
     the application
 4   Provide the total number of computer Nodes where the
     application needs to be installed?
 5   Average number of laboratory and Radiological tests done
     per day
 6   Number of Doctors working in the hospital
 7   Number of OPD consulting clinics associated with the
     hospital. Please list the OPD specialties
 8   Average number of Registrations done per day (both OP
     and IP)- OP registrations, IP registrations and approximate
     (average) Emergency admissions
 9   What are the total number of employees in the hospital?
10 Indicate and details of the individuals in charge of
   administration and decision making at the hospital
11 Who is the deciding Authority for HMS/HIS purchase in the
   hospital
12 Any indicative time frame for the decisions to be taken on
   purchase of software
13 Does your hospital have an IT Dept? How many people are
   working in this department
14 Is your Organization using any software currently? If so
   which and since how long they are using the software?
15 Will there be any data migration involved?
16 How many days training required on the software. (Specify
   No of days)
17 Does the hospital work with TPA’s, Sponsor companies,
   Corporate, Insurance
   Companies, Referral Third party clinics and medical
   centers? Please specify.
18 Do you have good internet connection available (Preferably
   1- 2 MBPS) broadband connection?




                                                                             Page 1 of 3
Birlamedisoft Pvt. Ltd.
                                          XENON/Quanta HIMS
                             (Hospital Information Management Software)
                                  Brief Information Gathering Form

19 Do you want HIS in any particular language? Ex.
   French, Arabic, Spanish, Hindi, Marathi, in your local
   language, kindly specify your language.
20 Select the functional Modules required at your
    hospital:

       1. Patient Registration
       2. Appointment Scheduling
       3. Admission Discharge Transfer (ADT)
       4. IPD Clinical
       5. Wards & Bed Management Module
       6. Patient Relations (Complains and feedback module)
       7. Doctors Workbench
       8. Nursing Workbench
       9. Operation Theater Management Module
       10. Electronic Medical Record & Clinic Specialties
       11. Laboratory Information System (LIS)
       12. Radiology Information System (RIS)
       13. Microbiology Dept
       14. Histopathology & Cytology Dept
       15. Pharmacy Management
       16. Inventory & fixed asset Management
       17. Procurement DEPT
       18. Central Sterilized Supply Department (CSSD)
       19. Blood Bank Management
       20. Dietary (F&B)
       21. Housekeeping/Laundry
       22. Equipment Maintenance System (EMS)
       23. Healthcare Packages
       24. Patient Billing
       25. Insurance and Contracts Management
       26. Management Information System (MIS)
       27. Hospital Administration (Master Setup and
           Maintenance)
       28. Roster Management (Duty Rosters)
       29. HRMS (Human Resource)
       30. Payroll
       31. Financial Accounting (A/C Receivable and Payable,
           Budget, Cost centre )


                                                                          Page 2 of 3
Birlamedisoft Pvt. Ltd.
                                          XENON/Quanta HIMS
                             (Hospital Information Management Software)
                                  Brief Information Gathering Form

        32. Help Desk
        33. Patient Module
        34. Facility Management
        35. Waste management
        36. Energy Audit
        37. Communication module
        38. PACS & Tele Radiology
        39. User management & Authority System
        40. Emergency/ Casualty
        41. Ambulatory Services
        42. Library management
        43. Medical College Management
21 Are you looking for Online/Web based HIS software or
   Desktop based Client Server (Offline) HIS software
22 Do you have multiple branches of the hospital, If yes, How
   many
23 Are you looking for main hospital computerization or do you
   want to computerize all branches
24 Any Budget you have decided for computerization
25 Any other information you want to share with us.
26 Any other modules required. If so list them below




                                                                          Page 3 of 3

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Hims brief questionnaire

  • 1. Birlamedisoft Pvt. Ltd. XENON/Quanta HIMS (Hospital Information Management Software) Brief Information Gathering Form Sr. Particular No. Details 1 Name, Address, Tel no, details of Hospital 2 Number of beds in the Hospital 3 Provide the approximate number of users who will be using the application 4 Provide the total number of computer Nodes where the application needs to be installed? 5 Average number of laboratory and Radiological tests done per day 6 Number of Doctors working in the hospital 7 Number of OPD consulting clinics associated with the hospital. Please list the OPD specialties 8 Average number of Registrations done per day (both OP and IP)- OP registrations, IP registrations and approximate (average) Emergency admissions 9 What are the total number of employees in the hospital? 10 Indicate and details of the individuals in charge of administration and decision making at the hospital 11 Who is the deciding Authority for HMS/HIS purchase in the hospital 12 Any indicative time frame for the decisions to be taken on purchase of software 13 Does your hospital have an IT Dept? How many people are working in this department 14 Is your Organization using any software currently? If so which and since how long they are using the software? 15 Will there be any data migration involved? 16 How many days training required on the software. (Specify No of days) 17 Does the hospital work with TPA’s, Sponsor companies, Corporate, Insurance Companies, Referral Third party clinics and medical centers? Please specify. 18 Do you have good internet connection available (Preferably 1- 2 MBPS) broadband connection? Page 1 of 3
  • 2. Birlamedisoft Pvt. Ltd. XENON/Quanta HIMS (Hospital Information Management Software) Brief Information Gathering Form 19 Do you want HIS in any particular language? Ex. French, Arabic, Spanish, Hindi, Marathi, in your local language, kindly specify your language. 20 Select the functional Modules required at your hospital: 1. Patient Registration 2. Appointment Scheduling 3. Admission Discharge Transfer (ADT) 4. IPD Clinical 5. Wards & Bed Management Module 6. Patient Relations (Complains and feedback module) 7. Doctors Workbench 8. Nursing Workbench 9. Operation Theater Management Module 10. Electronic Medical Record & Clinic Specialties 11. Laboratory Information System (LIS) 12. Radiology Information System (RIS) 13. Microbiology Dept 14. Histopathology & Cytology Dept 15. Pharmacy Management 16. Inventory & fixed asset Management 17. Procurement DEPT 18. Central Sterilized Supply Department (CSSD) 19. Blood Bank Management 20. Dietary (F&B) 21. Housekeeping/Laundry 22. Equipment Maintenance System (EMS) 23. Healthcare Packages 24. Patient Billing 25. Insurance and Contracts Management 26. Management Information System (MIS) 27. Hospital Administration (Master Setup and Maintenance) 28. Roster Management (Duty Rosters) 29. HRMS (Human Resource) 30. Payroll 31. Financial Accounting (A/C Receivable and Payable, Budget, Cost centre ) Page 2 of 3
  • 3. Birlamedisoft Pvt. Ltd. XENON/Quanta HIMS (Hospital Information Management Software) Brief Information Gathering Form 32. Help Desk 33. Patient Module 34. Facility Management 35. Waste management 36. Energy Audit 37. Communication module 38. PACS & Tele Radiology 39. User management & Authority System 40. Emergency/ Casualty 41. Ambulatory Services 42. Library management 43. Medical College Management 21 Are you looking for Online/Web based HIS software or Desktop based Client Server (Offline) HIS software 22 Do you have multiple branches of the hospital, If yes, How many 23 Are you looking for main hospital computerization or do you want to computerize all branches 24 Any Budget you have decided for computerization 25 Any other information you want to share with us. 26 Any other modules required. If so list them below Page 3 of 3