Dictation and Transcription Self-Edit Dictation Software Request Form First Name * Last Name * Email * Direct Contact Phone Number * Role * Physician Nurse Practitioner Registered Nurse SIPPA Resident Clerk Fellow Other Name of Preceptor/Attending First Onsite Date of Rotation City Hospital/Clinic/Site Name Department/Specialty Types of Reports you will be dictating * Inpatient Outpatient History & Physical Discharge Operative/Procedure Consult Other Other * EMR/Application you will be dictating into * Sunrise Clinical Manager (SCM) Med Access QHR Accuro Momentum Healthware (Mental Health Addiction Services) Microsoft Word Other Other * Additional Comments Submit 3sHealth is committed to protecting your personal information × By clicking the "I agree" button you are stating that you have read the 3sHealth privacy policy and consent to the collection and use of your information for software request purposes.