Creating patient forms

You can create patient forms as needed.

Notes:

You can create forms for new patients and existing patients.
You can create consent forms for new patients and existing patients.
You can provide a terms of use consent form that patients have to acknowledge to use the online portal.

To create a patient form

If you are not already viewing the correct location, select it on the Location menu.
On the Settings menu, under Patient Care, select Form Builder.

The Patient Forms page opens on a new browser tab.

Note: You can filter the list of forms by their assigned patient types. Under Patient Type (on the left), either select the All checkbox, or select the New Patient or Existing Patient checkbox.
Click (or tap) Create Form.

The All Templates options appear. You can create a form, starting from scratch or using a template.
Click (or tap) one of the following options: Blank (to start with an empty form), New Patient Registration, Health History, Basic Consent, Patient Screening, Dental History, Dental Insurance, or Medical History.

The Form Builder page opens.

The panel on the left contains all available elements that you can add to the form.

Sync - These standard elements correspond to patient information, some of which can update data in your Dentrix Ascend database.

Currently, the following demographic elements (added individually or using the Patient Basic Information element) on a form can update a patient's record:

Preferred Name - The patient's preferred name.

Patient Address - The patient's home address.

Email Address - The patient's email address.

Mobile Phone - The patient's mobile phone number:

If a mobile phone number does not exist for the patient, the one entered on the form is added to the beginning of the patient's list of phone numbers.

If a mobile phone number does exist for the patient, and it matches the mobile phone number on the form, it is moved to the beginning of the patient's list of phone numbers (if it is not already the first).

If a mobile phone number does exist for the patient, but it does not match the mobile phone number on the form, the one entered on the form is added to the beginning of the patient's list of phone numbers.

Note: Duplicate phone numbers are allowed in Dentrix Ascend only if they are assigned different types (such as Home and Mobile). You can have multiple phone numbers of the same type if they are different numbers.

With the Medical Conditions and/or Allergies elements on a form, only the medical alerts that have been flagged for inclusion on forms appear on the form. Active medical alerts that are associated with a patient's record are selected automatically on the form. If a patient selects a medical alert to add it on the form (a "positive" response, such as indicating that he or she has asthma), the patient's record will be updated. If a patient removes a selected medical alert on the form (a "negative" response, such as indicating that he or she no longer has high blood pressure), the patient's record will be updated. Any of the following may occur when responses to medical condition and allergy questions on the form are synchronized with a patient's record:

If a medical alert does not exist for the patient, and that medical alert on the form has a positive response (the condition or allergy is active), it is added to the patient's list of medical alerts. An expired medical alert is considered not to be an existing medical alert in the patient's record.

Notes:

For a medical alert that has been added to the patient's record, a note is included and contains the text "Indicated by patient via forms" and the date. Also, the default status of the Show alert and Is permanent switches for the medical alert assigned to the patient are based on the status of those switches for that medical alert in the medical alerts library, and the default value of the Severity grade for the medical alert assigned to the patient is "Select a grade," which indicates that the severity has not yet been specified by office staff.

When the patient indicates on a patient form that he or she no longer has a medical alert, an entry, which states that the addition of the medical alert for the patient was indicated by the patient via a patient form, is added to the audit log.

If a medical alert does exist for the patient, it is not expired, and that medical alert on the form has a positive response (indicating that the condition or allergy is active), it remains in the patient's list of medical alerts.

If a medical alert does exist for the patient, it is not expired, and that medical alert on the form has a negative response (indicating that the condition or allergy is not active), it remains in the patient's list of medical alerts but is marked as "Expired."

Notes:

For a medical alert that has been expired in the patient's record, the text "Expired by patient via forms" and the date are appended to any existing note text.

When the patient indicates on a patient form that he or she no longer has a medical alert, an entry, which states that the medical alert for the patient was expired by the patient via a patient form, is added to the audit log.

With the Medications element on a form, only the medications that have been flagged for inclusion on forms appear on the form. Active medications that are associated with a patient's record are selected automatically on the form. If a patient selects a medication to add it on the form (a "positive" response, such as indicating that he or she is taking Allegra), the patient's record will be updated. If a patient removes a selected medication on the form (a "negative" response, such as indicating that he or she no longer takes Advair), the patient's record will be updated. Any of the following may occur when responses to a medication question on the form are synchronized with a patient's record:

If a medication does not exist for the patient, and that medication on the form has a positive response (the medication is active), it is added to the patient's list of medications. An expired medication is considered not to be an existing medication in the patient's record.

Notes:

For a medication that has been added to the patient's record, a note is included and contains the text "Indicated by patient via forms" and the date. Also, the default status of the Show alert and Critical switches for the medication assigned to the patient are based on the status of those switches for that medication in the medications library.

When the patient indicates on a patient form that he or she no longer takes a medication, an entry, which states that the addition of the medication for the patient was indicated by the patient via a patient form, is added to the audit log.

If a medication does exist for the patient, it is not expired, and that medication on the form has a positive response (indicating that the medication is active), it remains in the patient's list of medications.

If a medication does exist for the patient, it is not expired, and that medication on the form has a negative response (indicating that the medication is not active), it remains in the patient's list of medications but is marked as "Expired."

Notes:

For a medication that has been expired in the patient's record, the text "Expired by patient via forms" and the date are appended to any existing note text.

When the patient indicates on a patient form that he or she no longer takes a medication, an entry, which states that the medication for the patient was expired by the patient via a patient form, is added to the audit log.

Currently, the following elements on a form do not update a patient's record:

Date of Birth - The patient's birth date.

Emergency Contact - The patient's emergency contact person (name, phone number, and relationship).

Employer Information - The patient's employer (name, phone number, and address)

Family Status - The patient's family status (single, married, child, or other).

First Name - The patient's first name.

Gender - The patient's gender (male, female, or other).

Last Name - The patient's last name.

Marketing Consent - Whether the patient wants to receive marketing communications from your practice or not, and if so, the patient's preferred method of receiving such communications (text message, phone call, or email message).

Middle Initial - The patient's middle initial.

Physician Contact - The patient's primary physician (name, phone number, and specialty).

Responsible Party - The person who is financially responsible for charges incurred by the patient: the patient or someone else. If it is someone other than the patient, that person's relationship to the patient, name, birth date, email address, mobile phone number, and address.

The ID Scan element (added individually or using the Patient Basic Information element) allows a patient to use the camera on his/her mobile device to take a picture of a driver’s license to populate some patient information on the form automatically.

The Dental Insurance Information and Medical Insurance Information elements allow a patient to use the camera on his/her mobile device to take a picture of an insurance card to populate some insurance information on the form automatically.

Note: If a patient uploads or takes pictures of an insurance card and/or a driver's license or other type of ID card to fill in insurance and/or personal information for a form, copies of the cards are saved in the patient's Document Manager after the patient submits the completed form.

Fields - These custom elements correspond to information that cannot update data in your Dentrix Ascend database.

Static - These static elements are for the presentation and functionality of the form. You can add text, such as headings and paragraphs. You can add images. You can add buttons, such as a reset button and a submit button.

Layout - These layout elements are for laying out the form. You can add tabs and steps to break up the form into smaller chunks instead of having one long form page to scroll through. You can add a container to group elements visually. You can add columns and lists.

The center area is the form preview area. You drag elements from the left to the preview area and arrange those elements as desired.

The panel on the right provides options for the form (if no element is selected) or a selected element on the form.

With the form container selected (not an element on the form), under Properties, enter a Form Name.

Perform any of the following tasks to build/modify the form:

You can drag a Layout element, such as Steps, to the form.

You can drag a Sync element, such as Patient Basic Information, to the form.

To view a different step, select it.

Then, you can drag another element, such as Responsible Party, to that step of the form.

To add a step, click the Add icon (plus sign).

Add other steps and elements as needed.

Notice that, with tabs and steps, a Finish button is included automatically for the last item.

If you do not use steps or tabs, you must add a Submit button manually. Drag it from the Static elements list to the form.

Important: If the form includes steps or tabs, a Submit button is added automatically to the form. However, if the form does not include steps or tabs, and you do not add a Submit button manually, patients will not be able to submit the form after completing it, so remember to include this element.

To change the label of an element, such as a step, select it, and then change the Label.

Here are some examples of changes you can make to elements:

Type and Content (for a heading).

Align (centered on form).

Required (a response is required).

List of selections (in this example, only one option can be selected). For the first option, enter a value and a label; for each subsequent option, click (or tap) Add option, and then enter a value and a label.

Text, On label, and Off label (for toggle/switch)

To resize an element, drag its edge to the left or right.

To remove an element, select it, and then click (or tap) the Remove button (trash can icon).

The vertical toolbar to the left of the preview area allows you to switch from editing the form to previewing the final look and functionality of the form.

Click Next.

The Form Settings page opens.

Set up the following options:

Form Status - If you want to publish the form immediately upon saving it, set the switch to Published; otherwise, leave the switch set to Unpublished.

Patient Type - This determines which patients the form will be due for:

New Patients - The form is for any patient whose status is "New" in Dentrix Ascend.

Existing Patients - The form is for any patient whose status is anything other than "New" in Dentrix Ascend.

Note: If this is an On Demand form, you do not have to select a Patient Type; otherwise, if you do not select at least one patient type, the form will never be due for any patient.

On Demand - If you want to allow the form to be requested on an as-needed basis so the form is not limited to the specified Form Frequency, turn on the Allow this form to be sent manually to any patient switch; otherwise, leave the switch off.

Signature - If you want to require that the form to be reviewed by a provider, turn on the Requires Provider Review switch; otherwise, leave the switch off.

Form Frequency - This determines how often patients must complete the form. Select one of the following frequencies: One time, Every appointment, Every 3 months, Every 6 months, Every year, or Custom (select Days, Weeks, Months, or Years; and enter the applicable number).

Is Org-wide Form? - If the form is for all locations, leave the checkbox selected. However, if the form is only for specific locations (it applies only to patients whose preferred location is one of the selected locations), clear the check box; on the Select one of more locations below list, select the checkbox of each applicable location; and then click Select.

Click (or tap) Done.

You are returned to the Patient Forms page, and the form you created appears in the Forms list.

Note: If the Status of the form is "Unpublished," it will never be due for any patient and cannot be requested on demand.