This form is designed to help our support team gather detailed information about issues you are experiencing with our clinical communication application. The more information you provide, the faster and more effectively we can assist you.
Please Note: This form is for technical support issues only. For any medical or clinical questions, please contact your healthcare provider or organization directly.
Full Name:
Email Address:
Associated Healthcare Organization:
Your Role:
Unique User ID:
App Name:
App Version Number:
Operating System:
Device Model:
Is the device managed by your organization?
Severity of Issue:
Critical: The app is completely unusable, preventing all clinical communication or patient care activities.
High: The app is severely impaired, affecting critical workflows and causing significant disruption.
Medium: The app is partially functional, but a key feature is not working as expected, causing inconvenience.
Low: A minor issue or bug that does not significantly impact daily use.
Type of Problem: (select all that apply]
Login/Authentication: Cannot log in, forgot password, authentication errors.
Messaging: Messages not sending, not receiving, messages delayed, disappearing, or incorrect formatting.
Notifications: Push notifications not working, inconsistent, or incorrect.
Calls (Voice/Video): Cannot initiate/receive calls, call quality issues, audio/video problems.
Directory/Contacts: Cannot find contacts, contact list is incorrect or outdated.
Integration with EMR/EHR: Data sync issues, inability to access patient information.
Attachments/Media: Cannot send/receive files, images, or documents.
General Performance: The app is slow, crashes, or freezes.
User Interface (UI): Display issues, buttons not working, incorrect layout.
Data Security/Privacy: Concern about patient data security or a potential breach.
Other:
Please describe the issue in as much detail as possible. What were you trying to do, and what happened instead?
Is this issue affecting patient care?
If yes, how is it affecting patient care? (e.g., delayed response to an urgent message, inability to view critical lab results).
This is the most critical section for our technical team. Please provide a clear, step-by-step guide to recreating the issue.
Step-by-Step Instructions:
Example: "1. Open the app. 2. Tap on the patient's chart. 3. Select 'Send Message'. 4. App crashes."
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Frequency of the Problem:
Always: Happens every time I try.
Often: Happens frequently, but not every time.
Sometimes: Happens sporadically, difficult to reproduce.
Only Once: Happened a single time.
When did the problem first occur?
Any recent changes to your device, network, or the app before this happened? (e.g., a new app update, a new hospital network).
Connectivity Details:
Are you connected via Wi-Fi or cellular data?
Wi-Fi
cellular data
If Wi-Fi, are you on a public, private, or hospital network?
public network
private network
hospital network
Have you tried switching between Wi-Fi and cellular data to see if the problem persists?
What have you already tried to resolve the issue?
Restarting the app.
Restarting the device.
Reinstalling the app.
Clearing the app cache.
Checking for app and OS updates.
Checking network connectivity.
Other:
Attachments (Optional but highly recommended):
Please attach screenshots or screen recordings that show the problem. This can be extremely helpful for our team.
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I confirm that I have read and understand that this form is for technical support only, and I will not include any Protected Health Information (PHI) or confidential patient data in this form or its attachments.
App Support Form Insights
Important Note:
This analysis provides strategic insights to help you get the most from your form's submission data for powerful follow-up actions and better outcomes.
AI-Generated Content: This template and its accompanying guidance are AI-generated to provide a practical starting point for your form-building needs. Please review and customise the content to ensure it is accurate, appropriate and suitable for your intended use.
This guide is provided for general informational and planning purposes only. It does not constitute professional, legal, financial, medical, employment, privacy, regulatory, or advice of any other kind, nor does it certify that this template is suitable or compliant for any particular jurisdiction or purpose.
Laws, regulations, industry practices and business requirements vary. You are responsible for reviewing and customising the template to suit your intended use and obtaining advice from appropriately qualified professionals where necessary.
Please delete this section before publishing your form. See our Terms of Service for further information.
Based on the clinical communication app support form you provided, here are detailed insights into its structure, effectiveness, and key considerations for a support team.
The form is highly effective for initial triage. By breaking down the problem into different categories and a severity rating, it allows a support team to:
The "Steps to Reproduce the Problem" section is arguably the most valuable part of the form. A support ticket that says "The app crashes" is nearly useless. A ticket that says "The app crashes when I tap on a patient's chart after logging in from a public Wi-Fi network" provides the key variables needed for a developer to replicate the issue in a test environment.
The form collects data that goes beyond a simple bug report, providing a holistic view of the user's environment.
The form is designed not just to collect data, but to guide the user toward a solution or a better report.
While the form is excellent, a few minor refinements could make it even better:
Mandatory Questions Recommendation
Important Note:
This section explains why certain fields in this form are marked as required and provides general guidance on how these requirements may support the collection of complete, accurate and relevant information.
Required fields and information-collection obligations may vary depending on your industry, jurisdiction, business operations and intended use of the form. A field marked as required in this template does not necessarily mean that collecting the information is legally mandatory.
Please review each required field to determine whether it is necessary, appropriate and lawful for your particular purpose. Consider applicable privacy, data protection, consent and industry-specific requirements, and consult an appropriately qualified legal, privacy or compliance professional where necessary.
Please delete this section before publishing your form. See our Terms of Service for further information.
Based on the provided form, here are the mandatory questions and the reasoning behind their necessity for effective support.
1. Full Name & Email Address
2. App Name & App Version Number
3. Operating System (e.g., iOS, Android) & Device Model
4. Detailed Problem Description
5. Steps to Reproduce the Problem
6. I confirm that I have read and understand that this form is for technical support only, and I will not include any Protected Health Information (PHI) or confidential patient data in this form or its attachments. (I Agree checkbox)
To configure an element, select it on the form.