IF YOU HAVE A DOWN SITE THAT NEEDS IMMEDIATE ATTENTION PLEASE PERFORM THE FOLLOWING STEPS:

1. SEND MESSAGE WITH THE FORM BELOW
2. CALL 949-675-8894
3. IF YOU HAVE NOT BEEN CONTACTED IN 20 MINUTES VERIFY YOUR CONTACT INFORMATION AND REPEAT STEPS ABOVE.

System Status	up down limited other
Contact Name
Email Address
Telephone Cellular VOIP iNum SIP URL Voicemail Other Number

Facility Name
Address
City
State CA AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip

Modality	MRI CT X-RAY PET ULTRASOUND MAMMOGRAPHY NUCLEAR MED. Other	MFG	GE Philips Marconi Picker Aurora Siemens Toshiba Hitachi Other
Model		SysID

System Availibility
Date (Y/M/D)	Time
17 18 19 20 21 22 23 / 01 02 03 04 05 06 07 08 09 10 11 12 / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : 00 10 20 30 40 50

Problem or Service description:

Make sure that you give proper name, email address and direct telephone number for immediate service. Include as much information as possible. Descriptive words such as up, down, emergency, urgent and others will be parsed out and dispatched according to priority.

Resolution Diagnostics
PO Box 598
Newport Beach, CA 92661
949-675-8894