DR Applications Site Report Site NameDates of ApplicationsPO#Applications SpecialistApps Specialist Email Apps Type*Install/Turn overF/UDemoContact InformationSite Contact Name Contact TitleSite Contact Number:Site Contact Email Address Address Dealer GroupSelect GroupSamsung HMERPS ImagingRadsource ImagingCommonwealthMid-SouthTexas ImagingSeidel ImagingAXIParkerExcelDealer/Sales ContactFSE ContactEquipmentSystem TypeSelect TypeGM85GM85 FiTGC85AGF85GR40NF50GU60System ID:Number of SystemsGeneratorSelect GeneratorDR GEM 40DR GEM 32Neusoft 40Neusoft 32SpellmanSoftware VersionPACS VendorQuick Link app setup?Select answerYNSite Specific# of TechsNames of Super UsersRadiologist Involved?Radiologist feedback on IQ?Applications Summary and Site FeedbackVoCTech List Notes Δ