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Form Details

• Form Properties
  1. Form Title: Attestation PROS
  2. Start from an Existing Form - Yes, if there is a previous version signed and locked
  3. Copyrighted Form - No
  4. Billable Progress Note - No
  5. Have multiple versions open at same time - No
  6. Open Blank on new version - No
• Required Fields - Yes
• Lookup Tables - No
• Pre-Fill Logic - Yes
  1. Program Name pre-fills from Setup > Program/Billing Defaults
  2. Program Address prefills from Setup > Program/Billing Defaults > Company Info Tab
  3. Participant Information (SS#, Medicaid ID, Medicare ID) prefills from Patient Details
• Fill to Logic - None
• Signatures
  1. Individual Signature
     • Sig type: Patient
  2. PROS Staff Signature
     • Sig type: LPHA
     • Title will fill title entered in user setup
     • Signature locks the form

Registration Tab

• Program Name prefills from program enrolled in.
• Program Address prefills from Billing/Program Defaults/Company Info tab.
• Participant information (SS#, Medicaid ID, Medicare ID) prefill from Patient Details.

See Program/Billing Defaults and Patient Details articles for more information.

Attestation Tab
 

Select one option

Signatures Tab
 

1. Signature Type Credentials
   • Individual Signature
     • Sig type: Patient
   • PROS Staff Signature
     • Sig type: LPHA
     • Title will fill title entered in user setup
     • Signature locks the form

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