The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

dyZZH3bajiLpM5nId8gthJ2r8nCIktGZxjh6ZW87V8L3JQ8BBvCURgvL8HDGCGWHVVVov3cu6DEqK9aog8vC97AUWxiB4I66PkyNot6d7r2xpQ845tTsvDxvWntYGte

CMBHS Support Request Form

To request technical support via email, please fill out the form below.

Our Tech Support team will respond to your email Monday through Friday, 8:00 am - 5:00 pm. Reach out to our team at any time if you have any questions at BeWellTXHelpDesk@uthscsa.edu.

Would you like to to submit a helpdesk ticket or schedule a training?

* must provide value

Helpdesk Ticket

Schedule a training

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Organization/Location

* must provide value

Other

* must provide value

Contact name

* must provide value

Email address

* must provide value

Phone number

User role

If you don't know your user role, you can skip this question.

Users often have different permissions and see things differently depending on the role.

Please see this link for more descriptions of each role type and rights and limitations.

This will help us reproduce the same results and identify the problem.

Please describe your training needs (Examples include CMBHS documentation, CMBHS functionality, GPRA... etc.):

* must provide value

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Web browser
CMBHS is compatible only with Internet Explorer versions 9.x or higher and Google Chrome version 40 or higher. If you are having trouble accessing through another web browser, please try these browsers before completing your ticket.

Type of request

* must provide value

User support (password, account, etc)

Technical support (CMBHS error, read or write access, claims, etc)

Suggestions/feedback

Please indicate all the user support requested:

Password reset

Enable account

Create new user

Change role type

Other

Technical support description

Please provide a description of the technical support issue with as much detail as possible.

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Please upload a screenshot of the CMBHS error to help us reproduce the issue.

Note: Be Well Texas through UT Health San Antonio uses REDCap - a secure, web-based solution that is designed to support and develop databases for collecting and managing data, including compliance with HIPAA and GDPR.

This form allows us to safely and securely exchange images that may contain PHI related to your CMBHS issues. For more information about the REDCap application, please visit UT Health San Antonio.

Upload file

CMBHS Client Number

If you have a client number for this ticket, please include it below using the label "Client #:" before each separate client number related to this issue. For example, if you have financial eligibility questions related to 3 clients, you would enter your ticket with the following information:

Client 1:123456

Client 2: 789101

Client 3: 121314

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CMBHS screen name

Please select each CMBHS screen where you encountered an issue and this will help us identify if the errors are related to the roles and user priveleges for each screen.

Admission

Administrative Notes

Assessment

Claims

Client Profile

Daily Capacity Report

Discharge

Financial Eligibility

GPRA Assessment

Lab/Test Results

Medicaid Eligibility Verification (MEV)

Medication List

Medication Order

Medication Service

Progress Note

Provider Census Board

Psychoeducational Notes

Reports

Screening

Service Authorization Request

Service Begin/Service End

Treatment Plan

Waitlist

Other

Suggestions/feedback

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Internal documentation ONLY

Please update the status in the following fields.

Ticket Open Date

M-D-Y

HelpDesk User determined this was the CMBHS screen name

Please select each CMBHS screen where you encountered an issue and this will help us identify if the errors are related to the roles and user priveleges for each screen.

* must provide value

Client Profile

Screening

Financial Eligibility

Medicaid Eligibility Verification (MEV)

Admission

Service Authorization Request

Service Begin/Service End

Assessment

GPRA Assessment

Treatment Plan

Medication Service

Medication Order

Medication List

Progress Note

Lab/Test Results

Administrative Notes

Psychoeducational Notes

Discharge

Reports

Claims

Waitlist

Provider Census Board

Daily Capacity Report

Other

Ticket Assignee

* must provide value

Elliott Jointer

Rachel Dowdy

Sonia Contreras

David Cruzan (DO NOT SELECT)

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Logging comments
Enter any information you think is necessary to support or correct the ticket submitted.

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Priority

High: The defect must be resolved as soon as possible as it affects the system severely and cannot be used until it is fixed

Medium: During the normal course of the development activities defect should be resolved. It can wait until a new version is created

Low: The defect is an irritant but repair can be done once the more serious Defect has been fixed

Status

Open: Every new ticket is marked as open until it is moved to another status

On Hold: If you are awaiting additional information from the customer then it is on hold

In progress: If the ticket is being worked on and an update will be provided as soon as it is completed.

Escalated: The issue cannot be resolved from the ground-level or needs immediate support (e.g. related to a blockage for patient treatment or financial issues).

Converted to HHSC: The issue needs to be turned over to HHSC and submitted to the CMBHS support desk with a support ticket number.

Completed from HHSC: HHSC has closed the ticket and communicated with TxMOUD about the resolution and TxMOUD has communicated the findings to the client.

Closed:When we are reasonably sure that we have provided the customer with a solution to their problem and when the customer acknowledges that the problem has indeed been resolved. If the customer has not replied, the standard practice is to automatically close the ticket after 48 or 72 hours.

HHSC Helpdesk Ticket Number:

Ticket Closed date:

M-D-Y

Resolution Explanation

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User Keyword Bookmarked

This box is for you to enter words to remind you of what this ticket was about if you think you'll want to reference it in the future.

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Fiscal Year

2021

2022

2023

2024

2025

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.