Phase 2 Brief Medical Screening v2 (NYP2BMHv2)

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Form Details

• Form Properties
  1. Form Title: Phase 2 Brief Medical Screening v2
  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
  1. Organization Name will prefill from Setup → Program/Billing Defaults → Company Info.
  2. Program Name will prefill from the Program the patient is enrolled in.
  3. Medications and Allergies will prefill from ePrescribing.
• Fill to Logic – None.
• Signatures
  1. Completed By signatures (2)
     • Sig type: Any
     • Signature locks the form.
     • Route-To is available.

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Medical Screening Tab

• The Organization Name will prefill from the Program/Billing Defaults/Company Info.
• The Program Name will prefill from the Program the patient is enrolled in.

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Screening Tab (1)

Screening Tab (2)

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Medications Tab

• Medications will automatically prefill from the medication listings in Dr First (eprescribe).

Allergies Tab

• Allergies will automatically prefill from the allergy listing in Dr First (eprescribe).
• Under Medical hospitalizations/significant operative and invasive procedures, selecting Yes to enter information. Select No to grey out the table.

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Nutrition Tab

• In The Joint Commission section, selecting Yes will allow you to complete the section. Selecting No will grey out the text field.
• The For Women Only section will be greyed out if the patient is indicated as male in Patient Details.

Children Tab

1. Signature Type Credentials
   • Completed By signature
     • Sig type: Any
     • Signature locks the form.
     • Route-To is available.

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Medical Assessment Tab

• For Pain is adequately controlled, selecting Yes will open a text field for a response.
• For If no, is individual under medical care, selecting Yes will open a text field for a response.

Actions Taken Tab

• Under The Joint Commission, selecting Yes will open the date and text field for a response.

Referrals Tab

1. Signature Type Credentials
   • Completed By signature
     • Sig type: Any
     • Signature locks the form.
     • Route-To is available.

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