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Sepsis platform order form

HASNYS Sepsis platform

HANYS’ Sepsis Platform provides hospitals with a direct messaging solution to transfer continuity of care documents and patient encounter data to HANYS for processing and file development to meet the requirements of NYSDOH Public Health Law, Sections 405.2 and 405.4 of Title 10.

About your organization

Primary contact person

Information about platform users

List the facilities within your organization that will be using the platform.
List name(s) and email address(es) of individual(s) who are authorized to use the software.

Information services/technology contact

Please include the IS/IT person in your organization who is responsible for Secure File Transfers.

Billing information

Product offerings

Please indicate the pricing tier level that applies to your organization. This information will be verified and confirmed by HANYS prior to issuing the invoice.

Administrative claims data capture (merged with balance of data elements collected by hospital), and file validation. The annual fee schedule for this service is as-follows:

Purchase of the platform includes start-up support, training, technical support, ongoing enhancements and Data Dictionary revisions.

File validation only. The annual fee schedule for this stand-alone service is as follows:

Payment terms: All license fees are payable within 30 days of invoice date and are non-refundable.

Please direct questions to sepsis_collab@hanys.org.