NYSCRI Pre-Admission Note (NYPAN)

Form Details

• Form Properties
  1. Form Title: NYSCRI Pre-Admission 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 - No
  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 enrolled in.
• Fill to Logic - None.
• Signatures
  1. Individual Signature
     • Sig type: Patient
  2. Staff Signature
     • Sig type: Any
     • Route-To is available.
     • Signature locks the form.
  3. Supervisor Signature
     • Sig type: Supervisor
     • N/A box defaults to checked.
     • Route-To is available.
     • Signature locks the form.

Session Info Tab

1. Provide a narrative description of this session.
2. Note the Date of Service for this session.
3. Indicate the session Start Time.
4. Select appropriate Service Code (visit type).
   • Visit type drop down prefills from visit type table.

Signatures Tab

Signature Credentials (see Credentials)

1. Individual Signature
   • Sig type: Patient
2. Staff Signature
   • Sig type: Any
   • Route-To is available.
   • Signature locks the form.
3. Supervisor Signature
   • Sig type: Supervisor
   • N/A box defaults to checked.
   • Route-To is available.
   • Signature locks the form.

History Tab

1. No input. Individual’s Pre-Admission visit history will display.

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