Clinic and contact details

Provide the information needed to identify this assessment and confirm your acknowledgements before reviewing the IT readiness categories.

Do not enter patient information anywhere in this assessment.

Clinic information

Clinic name *

Primary contact name *

Primary contact phone *

Primary contact email *

Privacy officer name (optional)

Clinic type (optional)

Clinic address (optional)

BlueBird technician

Technician name *

The BlueBird iT Solutions technician performing this assessment.

Acknowledgements

All four acknowledgements must be confirmed before proceeding. Your confirmation is saved with this intake record.

I confirm I am authorized to provide information about this clinic's IT infrastructure.I understand this assessment is conducted by BlueBird iT Solutions for the purpose of determining readiness for Ontario's Primary Care Action Plan digital health initiatives, including the Provincewide Primary Care Medical Record System.I understand the results of this assessment may be used to prepare a BlueBird proposal or government application.I understand this assessment does not constitute a formal security audit or legal compliance certification.

Complete the required fields and all four acknowledgements to continue.