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Form Details

• Form Properties
  1. Form Title: Non-Billable Note
  2. Start from an Existing Form No
  3. Copyrighted Form No
  4. Billable Progress Note Yes
  5. Have multiple versions open at same time Yes
  6. Open Blank on new version Yes
• Required Fields Yes
• Lookup Tables Yes
  1. Code will pull from Facilities.
  2. Service Code will pull from Visit Types.
• Pre-Fill Logic Yes
  1. Organization Name will prefill from Setup Program/Billing Defaults Company Info Tab.
  2. Program Name will prefill from the Program the patient is enrolled in.
• Fill to Logic Yes
  1. A completed and signed Non-Billable Note will fill the History Tab of this form for the next version.
• Signatures
  1. Individual Signature
     • Sig type: Patient
  2. Staff Signature
     • Credential required to sign: any sig type.
     • Title will fill title entered in user setup (see eCR University  Users).
     • Signature required.
     • Route To functionality is available.
  3. Supervisor Signature
     • Credential required to sign: Supervisor.
     • Title will fill from title entered in user setup (see eCR University Users).
     • Defaults to N/A checked.
     • Route To functionality is available.

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Session Info Tab

1. Organization Name and Program Name will prefill from Program/Billing Defaults.
2. Narrative text field.
3. Required fields:
   • a. Date of Service; Start Time; Service Code.
   • b. Service Code (visit type) will display visit types mapped to the form.

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Signatures Tab

Signature Credentials

1. Individual Signature
   • Sig type: Patient
2. Staff Signature
   • Credential required to sign: any sig type.
   • Title will fill title entered in user setup.
   • Signature required.
   • Route To functionality is available.
3. Supervisor Signature
   • Credential required to sign: Supervisor.
   • Title will fill from title entered in user setup.
   • Defaults to N/A checked.
   • Route To functionality is available.

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History Tab

1. Table will fill based on completed and signed Non-Billable Notes.

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