fasten-onprem/.github/ISSUE_TEMPLATE/provider-request.yml

67 lines
2.4 KiB
YAML

name: Provider Request
description: Request a new institution/clinic/insurance provider to be added to Fasten
title: "[Provider Request]: "
labels: ["provider", "enhancement"]
projects: ["fastenhealth/fasten-onprem"]
assignees:
- AnalogJ
body:
- type: markdown
attributes:
value: |
Thanks for taking the time to request a new Provider.
Before you submit this request, please make sure that you've searched the existing issues to see if your provider has already been requested.
- type: input
id: contact
attributes:
label: Contact Details
description: How can we get in touch with you if we need more info?
placeholder: ex. email@example.com
validations:
required: false
- type: input
id: provider-name
attributes:
label: Provider/Institution Name
description: What is the name of this Institution?
placeholder: ex. Humana/Kaiser/John Hopkins
validations:
required: true
- type: input
id: provider-website
attributes:
label: Provider/Institution Website
description: Please share a link to the provider's homepage.
placeholder: ex. https://www.humana.com/
validations:
required: true
- type: input
id: provider-portal
attributes:
label: Patient Portal Login Website
description: Please share a link to the provider's login page, where you can access your health records.
placeholder: ex. https://ucsfmychart.ucsfmedicalcenter.org/ucsfmychart/Authentication/Login?
validations:
required: false
- type: input
id: provider-ehr
attributes:
label: Provider EHR Platform
description: If you know the name of the EHR platform that this provider uses, please share it.
placeholder: ex. Epic MyChart, Cerner, Allscripts, etc
validations:
required: false
- type: textarea
id: additional-info
attributes:
label: Anything else we should know?
description: Please share any additional information or links that you think would be helpful.
validations:
required: false
- type: markdown
attributes:
value: |
If you haven't already, please consider filling out our [Personal Health Record Research Survey](https://forms.gle/zxxhUtKA1K82dUA76)
to help us understand how you currently manage your health and the challenges you face with your existing tools.