Support Request #
61801738

Please complete the form below to receive product, service and subscription support

By filling out the following form we will be able to understand your specific issues and address your needs. In addition, based on the information you have selected the system may send you additional support information via email. You must submit a separate request for each class of support issue.

Please verify your email and telephone number before submitting your request. Your requested information will be sent to the email you enter below and support staff may call you to assist you with this request. If you do not receive your confirmation email, please check your spam filter and allow emails from support@dmss.us.

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What is your primary need?	Incorrect process Missing Modules/Steps Hardware Issues Software Issues Access to the system issues Request to modify the system/screens/forms Request for Training - Software Request for Training - Hardware Request for general system of care consulting/support
What system are you primarily having problems with?	Basic Client Information Management Utilization Management Foster Home Management Therapeutic Foster Home Management Group Home Management Specialized Group Home Management Therapeutic Group Home Management Utilization Management - Service Management Utilization Management - Cost Management Standardized Case Management Targeted Case Management Multidisciplinary Case Management Placement Management ICPC Management Contract Management Referral Management Referral Processing and Case Assignment Foster Parent Recruitment & Licensing Assisted Living Facility Licensing School Based Children's Informaiton System Children's Advocacy Center Management - Multidisciplinary Children's Advocacy Center Management - Referral Service Community Based Children's Information System Juvenile Justice Based Children's Information System Private Practitioner Children's Information System Counselor/Therapist Children's Information System Billing/Invoicing for Human Services Agencies Adult Services Accreditation - Consulting Only Accreditation - I Need a Data System Only to meet Accreditation Standards Accreditation - Consulting and Data Management System Documents System Email System Computer Server Issues Desktop Computer Laptop/Notebook Computer Phone System Blackberry Phone Windows Mobile Phone Regular Cell Phone
Is this a request to add functionality or another module? (If so, select from below)	Yes No Child Welfare - Operations Reports Child Welfare - Client Information Child Welfare - Home/Facility Licensing Child Welfare - Home/Facility Operations Child Welfare - Intake Child Welfare - Placement Child Welfare - Assesments Child Welfare - QA/QM Reports Child Welfare - Case Management Reports Child Welfare - Child Advocacy Child Welfare - Utilization Management Child Welfare - Contract Management Child Welfare - Provider Management Child Welfare - Service Management Child Welfare - Foster Home Management Child Welfare - Revenue Maximization Reports Adult Welfare Services - Operations Management Adult Welfare Services - ALF Management Consulting - Child Welafare Services Consulting - Service Automation General System of Care Consulting Systems Integration & Conversion Special Request in Note Section Below Select the item that best describes your need and the system will assign the correct product.
Organization Name:	Enter the full name of your agency
Your name:	Enter your full name
Is this an emergency?	No Yes
Phone:	(Include Area Code)
Fax:	(Include Area Code)
Aprox. # of co-workers affected by this problem:	(Approx.)
Enter your Email:
Please enter a short note about your request/problem: