The file's text, extracted by GovTribe without its formatting.
ATTACHMENT C
Vendor Information Sheet – Core Features EHR/Case Management General
Name
| Click here to enter text. |
| Address (Headquarters) |
| Click here to enter text. |
| Address Continued |
| Click here to enter text. |
| Main Telephone Number |
| Click here to enter text. |
| Website |
| Click here to enter text. |
| Publicly Traded or Privately Held |
| Click here to enter text. |
| Statement of Vendor Qualifications |
| Click here to enter text. |
| Descriptions of similar implementations at the local level serving large populations (Example 1) |
| Click here to enter text. |
| Descriptions of similar implementations at the local level serving large populations with high level of complexity (Example 2) |
| Click here to enter text. |
| Description of Proposed Vendor collaboration(s) that the selected vendor will manage for the implementation of a solution |
Click here to enter text.
Describe 2 successful integrations and collaborations you have had with other vendors as part of your implementation.
Click here to enter text.
List and describe any successful implementations within Florida and note any that are specific to Florida state or local government.
Click here to enter text.
| Has the proposer recently files for bankruptcy or filed for bankruptcy within the previous five (5) years? (explain) |
| Click here to enter text. |
| Please provide information on any outstanding lawsuits or legal judgements within the previous five (5) years. Please indicate any cases that you cannot respond to as they were settled with a non-disclosure clause. |
| Click here to enter text. |
| Proposer certifies that they are not under suspension or disbarment by any government entity (local, state, federal) and that they are eligible to participate in procurement which may include federal grant funding. |
| Click here to enter text. |
Parent Company (if applicable)
Name
| Click here to enter text. |
| Address |
| Click here to enter text. |
| Address Continued |
| Click here to enter text. |
| Telephone Number |
| Click here to enter text. |
| Main Contact |
Name
| Click here to enter text. |
| Title |
| Click here to enter text. |
| Address |
| Click here to enter text. |
| Address Continued |
| Click here to enter text. |
| Telephone Number |
| Click here to enter text. |
| Fax Number |
| Click here to enter text. |
| Email Address |
| Click here to enter text. |
| Names, Description, and Roles of planned project team |
| Click here to enter text. |
| EMR Market Data |
Number of years as an EMR vendor
| Click here to enter text. |
| Number of live sites |
| Click here to enter text. |
| Breakdown of sites by provider # (1-5, 6-9, >10) |
| Click here to enter text. |
| Number of new EMR installations over the last 3 years? |
| Click here to enter text. |
| Breakdown of sites by specialty |
| Click here to enter text. |
| Size of existing user base |
| Click here to enter text. |
| Does the product have a Florida presence? |
If so, # of install sites by specialty and size; list of Florida reference sites.
| Click here to enter text. |
| What is the current implementation timeframe when using only vendor-supplied resources? |
| Click here to enter text. |
| How many organizations have de-installed any vendor systems over the past two (2) years? Please specify which systems and why? |
| Click here to enter text. |
| Total FTEs Last Year |
| Click here to enter text. |
| Case Management Market Data (Social Service Systems) |
Number of years as Case Management vendor
| Click here to enter text. |
| Number of live sites |
| Click here to enter text. |
| Breakdown of sites by provider # (1-5, 6-9, >10) |
| Click here to enter text. |
| Number of new installations over the last 3 years? |
| Click here to enter text. |
| Breakdown of sites by type |
| Click here to enter text. |
| Size of existing user base |
| Click here to enter text. |
| Does the product have a Florida presence? |
If so, # of install sites by specialty and size; list of Florida reference sites.
| Click here to enter text. |
| What is the current implementation timeframe when using only vendor-supplied resources? |
| Click here to enter text. |
| How many organizations have de-installed any vendor systems over the past two (2) years? Please specify which systems and why? |
| Click here to enter text. |
| Total FTEs Last Year |
| Click here to enter text. |
| Product Information |
Proposed Product name(s) and version#(s)
Click here to enter text.