Sample Issue Submission Form

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Full description

(Please provide a narrative of the problem)


Issue occurs in:

  • Non-Production
  • Production
  • Other (please specify):      

Steps to Reproduce

(For clarity – please document the steps as if you were asking a peer to see if they could recreate the same issue)

  • Patient Name/MRN:      
  • Encounter Date/Time:      
  • Username/Password:      
  • Provider:      
  • Note Type (Specialty, Age Range, Gender):      
  • Task List/Patient List/Text Template, etc:      
  • EHR Version/Build:      
  • Steps to Reproduce:
  • Expected Outcome:      
  • Actual Outcome:      


  • Never used feature before so unknown if it worked previously
  • Work previously – not sure why we have an issue now
  • Recent preference change (indicate preference below)
  • Recent change/upgrade to OS/DB (indicate date and details below)
  • Recent configuration change in TWAdmin or SA (indicate change below)
  • Recent upgrade to a release or a hot fix (indicate version below)
  • Other (indicate below)
  • Details:     

User/Devices Affected

  • Provider
  • Clinical Support
  • Admin/IT/Other


How often does the issue happen for the affected user?

  • Less than once/user/day
  • Once/user/day
  • Less than 5x/user/day
  • Less than 10x/user/day
  • Greater than 10x/user/day

Preventing implementation

Is this issue preventing you from implementing or rolling out a feature?

  • Yes
  • No

Specific to Org/Site/Location

  • Yes
  • No


Error message Text

If an error was encountered, please click on the buttons and copy/paste all information into the issue.