ENITS Modality Request Form

Emergency Neurosurgery Image Transfer System (ENITS) PACS Modality Change Form

Site / Hospital Name(Required)

Name(Required)

Email(Required)

Phone(Required)

Name

Phone

Name

Phone

Due Date for Completion of this Request(Required)

Select Request

Add

Modify

Remove

Modality Type

Modality Make and Model(Required)

AE Title(Required)

Internal IP for the Modality

Port(Required)

NAT'D IP

A NAT’D IP should be available from your network team.

Add ModalityRemove Modality

ENITS programming details:

AE Title: EAENITS
Port: 104
Server IP: 138.218.233.250