Barwon Medical Imaging (BMI)

Change of Phone/Fax/Email or Primary Contact:

Modify Report Distribution:

Modify Recipient Document Preferences:

Modify Image Access:

Remove Practitioner:

Modify Medical Practice Software:

Practice Name: *

Practice Manager (or primary contact): *

Practice Manager Email:

Street Address: *

Postal Address:

Suburb: *

Postcode:

Practice Phone: *

Facsimile:

Practice Email:

New Phone Number:

New Fax Number:

New Email:

New primary contact/practice manager:

Synapse (PACS) is a software package which enables medical practitioners to view images and reports online from Barwon Medical Imaging, allowing twenty-four hour access to patient information.

Do you have Synapse loaded on your computers to view images on line? Yes No

Do you have a Synapse username and password? Yes No Unsure

A Barwon Medical Imaging representative will call you to discuss installation/access if required.

Contact at your practice for installation:

Practitioner Name: *

Provider Number: *

Practice Name:

Medical Practice Software: Best Practice Medical Director 2 Medical Director 3 Genie Genie Mac Locum Zedmed Mediflex Medilink VIP Other

Other:

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Please Confirm your provider number: *