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Product End-of-Life Information Integration Services Education and Training Services Continuing Education User Groups   Anesthesia Providers Materials Managers Nurses Pharmacists Media Investors Careers   Use the form below for all routine technical support issues. Our support staff replies to all web based requests as quickly as possible with an assigned service request ticket number returned to the e-mail address you provide. For urgent issues please dial 800-910-2220, toll free, for immediate assistance. *= Required Field Request Date: Submitted By: (If different from Customer Contact) Note: Omnicell employees submitting this request must provide a customer contact. Account Information Contact Information Site Name*: Customer Contact*: City, State*: , Contact Phone*:   Extension      Mobile Phone: Omnicell CSN#   : Contact E-mail*:     Contact me by*: E-mail Phone Mobile Phone Product Information Product Line*: Select a Product Product Area*:                                       Model*:                                       Is the problem with the main product (cabinet, server, interface) or a module (see list)? Main Product     Module Select a Module Unit Serial#: Unit Name: Location: O/S Version:                              Software Version:                              Problem Description Problem Severity* (select one) Frequency* (select one) Impact* (select highest impact) Down Limited Functionality Functioning - Minor Problem User Question Continuous Intermittent Infrequent Patient Safety Patient Care Narcotic Security Billing Impact Productivity Reporting None Describe Problem in Detail *: Was this problem previously reported? Yes   No If so, do you have the ticket #? Yes   No    Ticket Number:

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