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Directory/Contacts: Cannot find contacts, contact list is incorrect or outdated.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?
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
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
Please remove this app support form insights section before publishing.
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
Please remove this mandatory questions recommendation before publishing.
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)