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Form Details

• Form Properties
  • Form Title: BH024 Adverse Childhood Experience
  • Start from an Existing Form - No
  • Copyrighted Form - No
  • Billable Progress Note - No
  • Have multiple versions open at same time - No
  • Open Blank on new version - Yes
• Required Fields - None
• Lookup Tables - None
• Pre-Fill Logic - None
• Fill to Logic - None
• Signatures
  1. Clinician Signature
     • Sig type: Any
     • Route to Function is available
     • N/A defaults to unchecked
     • Signature required to lock form
  2. Clinical Supervisor Signature
     • Sig type: Any
     • Route to Function is available
     • N/A defaults to unchecked
     • Signature required to lock form

Page 1 Tab

1. Yes / No Questions - Score will populate based on response Yes = 1, No = 0

Page 2 Tab

2. Ace Score will tabulate based on responses to questions
3.  Signature Credentials (see Credentials)
   1. Clinician Signature
      • Sig type: Any
      • Route to Function is available
      • N/A defaults to unchecked
      • Signature required to lock form
   2. Clinical Supervisor Signature
      • Sig type: Any
      • Route to Function is available
      • N/A defaults to unchecked
      • Signature required to lock form

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