I now have an experimental beta version of Synapse EHR that uses Asterisk to initiate outbound telephone calls. When the called party picks up, your own extension then rings allowing you to complete the connection. It uses Asterisk call files. See http://www.the-asterisk-book.com/unstable/call-file.html To get this working, you need to install rebol on your Asterisk/PBX in a flash box. Install rebol following this link http://www.rebol.com/download-core.html so in the linux shell logged in as root Code: wget http://www.rebol.com/downloads/v278/rebol-core-278-4-3.tar.gz tar -xzf rebol-core-278-4-3.tar.gz Then change to the directory: \releases\rebol-core Code: cd releases cd rebol-core Copy the rebol interpreter (rebol) to /bin Code: cp rebol /bin Check that it works by typing Code: rebol and the interpreter will come up. Type: quit (to quit the intepreter.) You now need to install a cgi script in the apache cgi-bin directory. On my centos build, it is /var/www/cgi-bin/ so Code: cd /var/www/cgi-bin/ wget http://synapsebeta.s3.amazonaws.com/callback.cgi chmod +x callback.cgi Code: cd /var/www/cgi-bin/ wget http://synapsebeta.s3.amazonaws.com/call-both.cgi chmod +x call-both.cgi You can now use the script from a PC inside your network ( no way should apache be exposed to public ) http://18.104.22.168/cgi-bin/callback.cgi?extension=100&MaxRetries=2&RetryTime=60&waittime=30&context=from-pstn&priority=2&channel=SIP/VFX/1234567 where here the number being called is 1234567, and the channel is SIP/VFX, and my extension that asterisk should call once it connects is 100.