Cover Sheet

Cover Sheet


Member Information




  1. Patient Tab: The active tab will highlight in a Darker Blue color to indicate what tab you are working inside. Simply Clicking any of the other tabs will navigate you to the appropriate section.
  2. Name Section: This section allows you to input Patient name information. All sections are free text. 
  3. Info Section: This section allows you to input the patient's DOB, Sex, Hair color, Race, Ethnicity and Language. 
  4. Status and Patient Numbers: This section allows you to input patients SSN, Patient #, Medicaid, Martial Status, and Smoking Status. 
  5. Attributes Section: This sections allows you to connect  any added treatments or assistance the patient needs including a translator, or special assistance
  6. Save: This button allows you to save the patient information added on this table. 
  7. Print Coversheet: This button allows you to print the coversheet with patient information. 

Address Input



  1. Address Tab:  The active tab will highlight in a Darker Blue color to indicate what tab you are working inside. Simply Clicking any of the other tabs will navigate you to the appropriate section.
  2. Address Input: This section allows you to input patient address information. 
  3. Submit/Reset:  Reset will clear any inputs above to begin entering new information. 

Contact Input 


  1. Contact Input: This table allows you to input any new contact information. 
  2. Comment box: This is a free text box that allows you to add any other information related to contact input.
  3. Submit/Reset: Reset will remove all the entered fields. Submit will save and input into the Contact history table.


Contact History 


  1. Change View: This will change the history from a view like the table above to a list view like the image below.
  2. Print List: Here you can Print the list you are viewing in the history. This will change if you update the filter to view by most recent for example.
  3. Contact Type: These tables allow you to view previous contact history added.
  4. Action: This is where you can Edit or Delete contact notes.

Additional Information 



1. Additional Information Tab: This section allows you to enter any notes needed to finish the chart.
2. Annual Income: Enter in the annual income for the household.
3. Submit/Reset: Reset will remove all entered fields. Submit will save and input into the Additional Info Section. 

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