Initial Client Contact - Self Referral (TGI_ICCSR)

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Form Details

• Form Properties
  1. Form Title: Initial Client Contact - Self Referral
  2. Start from an Existing Form - No
  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 - None
• Lookup Tables - None
• Pre-Fill Logic - Conditional
  1. If using the Pre-Intake Module, no information will prefill.
  2. If the patient is already registered and placed into a chart the Address will prefill from Patient Details.
• Fill to Logic - None
• Signatures - None

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Client Tab

1. Select the type of clinic the client was referred to (if applicable).
2. Enter any client data (if applicable).
3. Enter any personal information (if applicable).

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Personal Tab

1. Enter any patient demographic information (if applicable).
   • Address will prefill from Patient Details.
2. Enter the financial ability of the client (if applicable).
3. Schedule an appointment (if applicable).
4. Check if informed Self pay client of $250 Intake fee and $25 UDS (if applicable).

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