Harmony Information Systems, Inc.
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Please complete the required fields below. To better serve your needs, please complete the optional section as well, or click on “Skip to Bottom” and select the Submit button at the bottom of this form. Thank you.
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The following questions are optional but will help us to better serve your needs.
What best describes your role in the decision making process?
Make Final Decisions
Approve Budget
Recommend Solutions/Strategies
Evaluate Solutions – From a Fiscal Perspective
Evaluate Solutions – From a Technology Perspective
Member of Committee Involved with Software Development
End-User
Business Analyst/Liaison
No Involvement
Other: Please Specify
Please indicate your area(s) of interest by selecting the appropriate boxes below.
Aging Services
Adult Protective Services
Integrated Case Management (Multi-program Social Services)
Child Welfare
Developmental Disabilities
Substance Abuse
Customer Support
Education Services
Other: Please Specify
How would you describe your organization's annual operating budget? Please select one.
$0 - $5,000,000
$5,000,000 - $15,000,000
$15,000,000 - $25,000,000
$25,000,000 - $50,000,000
Over $50,000,000
Unknown
Are you actively engaged in the evaluation/selection process for any of these initiatives where:
Your company has mandated a purchase because of identified need.
Your company has initiated research to determine what if any solutions exist.
You have taken a personal initiative to get up to speed on available solutions.
No active project.
If you determine that you will purchase a solution, when do you anticipate a final vendor decision will be made?
Less than 6 months
6 - 12 months
Over 12 months
Unknown
How did you learn about Harmony Information Systems, Inc.?
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Please provide a brief description of your Agency below:
What product capabilities are you interested in?
Case Management
Claims Management
Provider Billing
Benefit Payments
Reporting
Provider Management
Outcomes Measurement
I&R
Public Portal (Web-based Resource Center/Consumer Self Service)
Other (please specify)
Please provide the following information about your organization as applicable:
Number of Locations
Total Number of Clients
Total Number of Employees
Number of Case Managers
Number of Funding Sources
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How can we help you today?
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