Scan Imaging Project Information: Scan Imaging Capture Form Customer Contact Information Company Name: * Contact Name: * Title: Address: Address line 1 Address line 2 City State/Province Zip/Postal Phone Number: * Email Address: * About the Project Project completion date (If Applicable): Type of engagement: One time project Day Forward (ongoing) Type of Records: (Example: Medical Records, Patient Files, Client Folders, Etc.) Medical Records Client Folders Vendor Folders Other Size of the Document 8.5” x 11” or 8.5” x 14” Other (Small Sized, 11” x 15”, Etc.) Color Required Option 1 Volumes: Estimated Number of Files: Estimated Number of Boxes: Average Pages per File or Box: Double Sided No Yes. Estimated Percentage Double Sided: Technical Requirements LIGHT Lightly fastened documents (less than 1 fastener every 20-25 pages) 99% bond paper, 99% letter size and less than 1% require repair or mounting to the carrier sheets. Less than 5 manual sorts Less than 1% out sort (non-scan documents) MEDIUM Moderately fastened documents (less than 1 fastener every 5 pages) 99% bond paper, remaining office type documents.95% letter size and less than 1% require repair or mounting to the carrier sheets. Between 5 to 10 manual sorts. Less than 1% out sort (non-scan documents). HEAVY Heavily fastened documents (more than 1 fastener every 5 pages) Including documents contained in envelopes which require opening and extracting: 80% bond paper, remaining office type documents; 80% letter size and less than 2% require repair or mounting to the carrier sheets. All wide format documents will be considered heavy preparation. Reassembly: None Required Simple Full Assembly Image Output: Multipage TIF Multipage PDF Searchable PDF PDFA Release Method CD/DVD USB External Hard Drive Access (How often are these files accessed?): Daily Weekly Monthly Annually Other Retention Policy (How long do these files need to be kept?): 5 Years 6 Years 7 Years 10 Years Indenfinitely Other Indexing: Index Field Name (Information on top of the file tab). Example: (Patient Name, D.O.B. Year of Chart, Month of File, Client Name, Vendor Name, Etc.) After the project has been completed: Return to Customer Destroy Store with Data Storage Centers Submit
