peter_ui_spec.txt 3.6 KB

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  1. CLIENT:
  2. SOURCE:
  3. Memo:
  4. Timestamp:
  5. Detail:
  6. Pro?
  7. Client?
  8. Organization: {FACILITY}
  9. Source data: .....
  10. Is duplicate? FALSE
  11. INTAKE:
  12. Text:
  13. Detail:
  14. DEMOGRAPHICS:
  15. Name:
  16. Prefix:
  17. First:
  18. Middle:
  19. Last:
  20. Suffix:
  21. Nickname:
  22. Maiden:
  23. Previous:
  24. DOB: SYTEM: Age in Years:
  25. Sex:
  26. Gender identity:
  27. Sexual orientation:
  28. Sexually active:
  29. Marital status:
  30. Spouse: {RELATIONSHIP}
  31. Responsible party:
  32. Is someone else the responsible party?
  33. if(isResponsiblePartySomeoneElse){
  34. {RELATIONSHIP}
  35. }
  36. Emergency contact: {RELATIONSHIP}
  37. PHONE:
  38. Home:
  39. Mobile:
  40. Work:
  41. Memo:
  42. EMAIL:
  43. Personal:
  44. 1.
  45. 2.
  46. Work:
  47. 1.
  48. 2.
  49. REMINDERS VIA:
  50. Email:
  51. Text:
  52. Phone:
  53. ADDRESS:
  54. Is home same as mailing address?
  55. Home:
  56. ...
  57. Mailing:
  58. ...
  59. Has secondary address?
  60. Is home same as mailing address?
  61. Home:
  62. ...
  63. Mailing:
  64. ...
  65. Family:
  66. Mother: {RELATIONSHIP}
  67. Father: {RELATIONSHIP}
  68. # siblings:
  69. Birth order:
  70. Multiple birth member?
  71. Relationships:
  72. foreach({RELATIONSHIP})
  73. Citizenships:
  74. Education:
  75. Birth place:
  76. Birth state:
  77. Birth city:
  78. Nationality:
  79. Religious affiliation:
  80. Religious Organization: {FACILITY}
  81. Special diet?
  82. Category:
  83. Memo:
  84. Preferred language:
  85. Other languages:
  86. English level:
  87. Driver license: [State] [Number...]
  88. Is hispanic?
  89. Is black/AA?
  90. Ethnicities:
  91. Race:
  92. Specific races:
  93. Is deceased?
  94. Date/time of death:
  95. Cause of death:
  96. PHARMACY: [STRING]
  97. Facility record: {FACILITY}
  98. SSN:
  99. MCN:
  100. MCN:
  101. SSN:
  102. First name:
  103. Last name:
  104. DOB:
  105. Part B primary?
  106. Hospice?
  107. Response data:
  108. Billing address:
  109. Reason not Part B:
  110. Memo:
  111. Medicare Advantage?
  112. Plan:
  113. MCP: {PRO}
  114. Has MCP done onboarding visit?
  115. if(yes)
  116. MCP onboarding visit date:
  117. MCP onboarding visit note:
  118. Is MCP onboarding visit note outside system?
  119. Reason:
  120. MCP ONBOARDING PRO:
  121. // if(!has_mcp_done_onboarding_visit) {
  122. Is MCP onboarding active? // ONLY MAKES SENSE if !onboardingVisit
  123. Why is MCP onboarding not active? [category]
  124. Memo:
  125. Next onboarding attempt date/time: [DATE] [TIME]
  126. MCP Onboarding Pro: {PRO}
  127. Decision to accept/reject assignment?
  128. At:
  129. (SYSTEM)
  130. # of MCP onboarding phone calls:
  131. # of MCP onboarding in-person visits:
  132. Attempts: (SEELCT * FROM interaction WEHRE purpsoe = "mcp_onbaoaridng")
  133. Date | Pro | Outcome | Memo | Geostamp
  134. Dietitian:
  135. RD: {rdPro}
  136. Eligible for MNT?
  137. Number of MNT hours left this calendar year: {0.5}
  138. CCM:
  139. Care Manager: {PRO}
  140. Eligible?
  141. if(not) Reason:
  142. Enrolled?
  143. Consent method:
  144. Memo:
  145. if(not)
  146. Why not enrolled?
  147. Memo:
  148. CCM Chronic Diagnoses:
  149. 1. {cmReason1}
  150. 2. {cmReason2}
  151. RM:
  152. RME: {rmePro} // manages equipment
  153. RMM: {rmmPro} // bills time each month
  154. Eligible?
  155. if(not) Reason:
  156. Enrolled?
  157. Consent method:
  158. Memo:
  159. if(not)
  160. Why not enrolled?
  161. Memo:
  162. Focus areas:
  163. 1.
  164. 2.
  165. EQUIPMENT:
  166. Awaiting setup?
  167. What equipment:
  168. Setup completed?
  169. What equipment:
  170. Service needed?
  171. What equipment:
  172. WEBCAM:
  173. Has webcam device?
  174. Device type:
  175. Patient portal:
  176. Username:
  177. Password: if(set) *** else <i>Password not set.</i>
  178. Currently in meeting?
  179. if(yes)
  180. Meeting: {MEETING}