truForm: DSN - Integration Fields (V18x And Above)

**If you have DSN v11.7, v14 & v16, click here.

In order to import the additional items listed below, you must have v.18 installed 06/19/19 build or above

  1. Health Alerts
  2. Allergies
  3. Current Medications
  4. Attachments

How to check my DSN Software Version

This document includes ALL fields that integrate between TruForm and DSN v18 (06/19/19 build or above).  If your custom form is setup for integration correctly, items listed below will populate within your software. Note, if you have additional fields on your form that are NOT listed below, you can manually enter them into your patient's account once integration is completed!

If you use our standard form below, the sections listed below are already integrated!

Anything labeled with "DOES NOT INTEGRATE", is a field that exists on our standard form above, but does not automatically integrate.

Integration Field Count: 241 total fields integrate!

 

PATIENT INFORMATION

*IF YOU ARE USING A CUSTOM FORM:

  • Patient Name on the form must be split out into first name last name in order to integrate correctly.
  • Patient Address/ City/ State must be split out into its own fields in order to integrate correctly.
  • Referred By on the form must be split out into first name last name in order to integrate correctly.
  1. Prefix
  2. First Name
  3. Last name
  4. Middle Initial
  5. Gender
  6. Date of Birth
  7. Social Security Number
  8. Work Phone
  9. Home Phone
  10. Cell Phone
  11. Email
  12. Employer Name
  1. Address Street Name
  2. Apt 
  3. City
  4. State or Province
  5. Zip or Postal Code
  6. Employer Name
  1. Referred By First Name
  2. Referred By Last Name

 

DOES NOT INTEGRATE:
  1. Nickname
  2. Suffix
  3. Age
  4. Drivers License
  5. Dentist First Name
  6. Dentist Last Name
  7. Doctor First Name
  8. Doctor Last Name
  1. Orthodontist First Name
  2. Orthodontist Last Name
  3. Nearest Relative First Name
  4. Nearest Relative Last Name
  5. Nearest Relative Phone Number
  6. Preferred Pharmacy
  7. Pharmacy Tel
  8. Personal Payment Type
  1. Have you ever been a patient of our 
    practice?
  2. Has a family member ever been a patient of our practice?
  3. Emergency Full Name
  4. Phone Home
  5. Phone Work
  6. Emergency Relation to Patient

 

This entire section will not integrate:

SPOUSE OR OTHER GUARANTOR INFORMATION

 

RESPONSIBLE PARTY INFORMATION

*IF YOU ARE USING A CUSTOM FORM:

  • Responsible Party Name on the form must be split out into first name last name in order to integrate correctly.
  • Patient Address/ City/ State must be split out into its own fields in order to integrate correctly.
  1. Relationship to Patient
  2. Prefix (ex. Mr., Mrs., Miss., Dr.)
  3. First Name
  4. Last Name
  5. Middle Initial
  6. Suffix
  7. Social Security Number
  8. Home Phone
  9. Work Phone
  10. Cell Phone
  11. Email 
  1. Address Street Name
  2. Address Apt #
  3. Address City
  4. Address State or Province
  5. Address Zip or Postal Code 

DOES NOT INTEGRATE:

  1. Employer Name
  2. Age
  3. Date of Birth
  4. Drivers License
  5. Relationship description (if other)

 

This entire section will not integrate:

SCHOOL AND INSURANCE INFORMATION

  1. School Name
  2. School Address Street
  3. School Address City
  4. School Address State or Province
  5. School Address Zip or Postal Code
  1. Student Status (full/part/not)
  2. Employment status (full/part/retired/not)
  3. Marital Status (married/ divorced/ widow/ single/ legally separated)

 

INSURANCE INFORMATION

*IF YOU ARE USING A CUSTOM FORM: 

  • Each insurance type (primary medical, primary dental, secondary medical, secondary dental must be separated into its own area for each question below in order to integrate correctly.  
  • All Address/ City/ State / Zip must be split out into its own fields in order to integrate correctly.
  • Insured Name on the form must be split out into first name last name in order to integrate correctly. 

PRIMARY DENTAL

  1. Primary/Secondary Insurance Type (Dental, Medical, Both)
  2. Insured First Name
  3. Insured Middle Initial
  4. Insured Last Name
  5. Insured Gender
  6. Insured Social Security Number
  7. Insured Date of Birth
  8. Insured Home Phone Number
  9. Insured Street Address
  10. Insured Home Address Street
  11. Insured Home Address City
  12. Insured Home Address State or Province
  13. Insured Home Address Zip or Postal Code
  14. Insurance Company Name
  15. Insurance Company Address Street
  16. Insurance Company Address City
  17. Insurance Company Address State or Province
  18. Insurance Company Address Zip or Postal Code
  19. Insurance Company Phone Number
  20. Insured Insurance Policy Group Number
  21. Insured Insurance Policy ID
  22. Insured Employer Name
  23. Insured Employer Address Street
  24. Insured Employer Address City
  25. Insured Employer Address State or Province
  26. Insured Employer Address Zip or Postal Code
  27. Insured Employer Phone Number
  28. Insured Relationship

SECONDARY DENTAL

  1. Primary/Secondary Insurance Type (Dental, Medical, Both)
  2. Insured First Name
  3. Insured Middle Initial
  4. Insured Last Name
  5. Insured Gender
  6. Insured Social Security Number
  7. Insured Date of Birth
  8. Insured Home Phone Number
  9. Insured Street Address
  10. Insured Home Address Street
  11. Insured Home Address City
  12. Insured Home Address State or Province
  13. Insured Home Address Zip or Postal Code
  14. Insurance Company Name
  15. Insurance Company Address Street
  16. Insurance Company Address City
  17. Insurance Company Address State or Province
  18. Insurance Company Address Zip or Postal Code
  19. Insurance Company Phone Number
  20. Insured Insurance Policy Group Number
  21. Insured Insurance Policy ID
  22. Insured Employer Name
  23. Insured Employer Address Street
  24. Insured Employer Address City
  25. Insured Employer Address State or Province
  26. Insured Employer Address Zip or Postal Code
  27. Insured Employer Phone Number
  28. Insured Relationship

PRIMARY MEDICAL

  1. Primary/Secondary Insurance Type (Dental, Medical, Both)
  2. Insured First Name
  3. Insured Middle Initial
  4. Insured Last Name
  5. Insured Gender
  6. Insured Social Security Number
  7. Insured Date of Birth
  8. Insured Home Phone Number
  9. Insured Street Address
  10. Insured Home Address Street
  11. Insured Home Address City
  12. Insured Home Address State or Province
  13. Insured Home Address Zip or Postal Code
  14. Insurance Company Name
  15. Insurance Company Address Street
  16. Insurance Company Address City
  17. Insurance Company Address State or Province
  18. Insurance Company Address Zip or Postal Code
  19. Insurance Company Phone Number
  20. Insured Insurance Policy Group Number
  21. Insured Insurance Policy ID
  22. Insured Employer Name
  23. Insured Employer Address Street
  24. Insured Employer Address City
  25. Insured Employer Address State or Province
  26. Insured Employer Address Zip or Postal Code
  27. Insured Employer Phone Number
  28. Insured Relationship

SECONDARY MEDICAL

  1. Primary/Secondary Insurance Type (Dental, Medical, Both)
  2. Insured First Name
  3. Insured Middle Initial
  4. Insured Last Name
  5. Insured Gender
  6. Insured Social Security Number
  7. Insured Date of Birth
  8. Insured Home Phone Number
  9. Insured Street Address
  10. Insured Home Address Street
  11. Insured Home Address City
  12. Insured Home Address State or Province
  13. Insured Home Address Zip or Postal Code
  14. Insurance Company Name
  15. Insurance Company Address Street
  16. Insurance Company Address City
  17. Insurance Company Address State or Province
  18. Insurance Company Address Zip or Postal Code
  19. Insurance Company Phone Number
  20. Insured Insurance Policy Group Number
  21. Insured Insurance Policy ID
  22. Insured Employer Name
  23. Insured Employer Address Street
  24. Insured Employer Address City
  25. Insured Employer Address State or Province
  26. Insured Employer Address Zip or Postal Code
  27. Insured Employer Phone Number
  28. Insured Relationship

 

HEALTH HISTORY

*IF YOU ARE USING A CUSTOM FORM:  

  • If you have a group of problems/issues in one question- they will not integrate.  They must be laid out similar to the format given below.

Some items we group together, will come over as one item, see below:

  1. Are you in good health
  2. Height
  3. Weight
  4. Have there been any changes in your general health in the pas year
  5. Are you under the care of a physician
  6. Date of last visit
  7. If so, for what are you being treated
  8. Have you had any illness, operation or been hospitalized in the past five years
  9. If so describe
  10. Do you have unhealed / recurrent injuries or inflamed areas, growths or sore spots in or around your mouth
  11. If so, describe where
  12. Do you have a prosthetic joint / implant
  13. If so, describe where
  14. Have you had a heart valve replacement or vascular graft
  15. Have you ever had general anesthesia
  16. Have you, or a family member, had any unusual or serious reactions to general anesthesia
  17. Has a physician or previous dentist recommended that you take antibiotics prior to your dental treatment
  18. Rheumatic fever
  19. Damaged heart valves / mitral valve prolapse
  20. Heart murmur
  21. High blood pressure
  22. Low blood pressure
  23. Chest pain / angina
    • Comes over as angina
  24. Heart attack(s)
  25. Irregular heart beat
  26. Cardiac pacemaker
  27. Heart surgery
  28. Pneumonia, bronchitis, chronic cough
    • Comes over as bronchitis/chronic cough
  29. Asthma
  30. Hay fever / sinus problems
  31. Snoring
  32. Sleep apnea / CPAP
  33. Difficult breathing / other lung trouble
    • Comes over as other lung trouble
  34. Tuberculosis
  35. Emphysema
  36. Do you smoke or vape
    • DOES NOT INTEGRATE:
      If so, how much a day do you smoke/vape
  37. Do you use chewing tobacco

  1. Blood transfusion
  2. Blood disorder such as anemia
    • Comes over as anemia
  3. Bruise easily
  4. Bleeding tendency / abnormal bleed
    • Comes over as bleeding tendency
  5. Hepatitis, jaundice, or liver disease
  6. Infectious mononucleosis
  7. Gallbladder trouble
  8. Fainting spells
  9. Convulsions / epilepsy
  10. Stroke
  11. Thyroid trouble
  12. Diabetes
  13. Low blood sugar
  14. Kidney trouble
  15. High cholesterol
  16. Are you on dialysis
  17. Swollen ankles / arthritis / joint disease
    • Comes over as arthritis
  18. Osteoporosis / osteopenia
  19. Osteonecrosis
  20. Stomach ulcers / acid reflux
    • Comes over as stomach ulcers
  21. Contagious diseases
  22. Sexually transmitted diseases
  23. Problems with immune system? Possibly from medication / surgery, etc.
  24. Delay in healing
  25. A tumor or growth
  26. Cancer / radiation therapy / chemotherapy
    • Comes over as xray or chemo
  27. Chronic fatigue / night sweats
  28. Are you on a diet
  29. A history of alcohol abuse
  30. A history of marijuana or other drug use
  31. Contact lenses
  32. Eye disease / glaucoma
  33. Mental health problems / anxiety / depression
    • Comes over as mental health problems)
  34. A removable dental appliance
  35. Pain or clicking of jaws when eating

DOES NOT INTEGRATE:

  1. COVID-19
  2. Autoimmune disease
  3. Alcohol intake? 
  4. If so, drinks per Day
  5. If so, drinks per Week

 

 This entire section will not integrate:

WOMEN ONLY

 

MEDICATION 

  1. Any kind of medication, drug, pills
  2. Please list any medication you are currently taking:
    (1-20 list, including medication name, dosage and frequency)
    If you are using a CUSTOM FORM!! 
    This question must be accompanied by a YES/NO question in order to integrate into your software correctly. 
    Ex:  Are you taking any kind of medication, drug, pills?  YES / NO

DOES NOT INTEGRATE:

  1. Blood thinners (coumadin, plavix, aspirin, vitamin E, Ginko biloba, aggrenox, Xarelto, Eliquis, Fish oil)
  2. Have you ever taken diet pills
  3. Any natural product, herbal supplement or homeopathic remedy
  4. Are you taking, or have you ever taken, bone density meds. RANKL inhibitors or bisphosphonates such as Prolia, Fosamax, Boniva, Actonel, IV-Zometa, Aredia, Reclast, Xgeva, or Evista in the past 12 years
  5. Tranquilizers, sleeping pills, anti-depressants, and/or narcotics on a regular basis 
    • If so, please list:
  6. If you are under the care of a physician for pain management, or recovering from drug addition please select the medication you are currently taking
      • Treating doctor first name
      • Treating doctor last name

 

ALLERGIES

  1. Local anesthetic (numbing meds.)
  2. Penicillin
  3. Other antibiotics
  4. Sulfa drugs
  5. Sodium pentothal / Valium /other tranquilizers
  6. Aspirin
  7. Amoxicillin
  8. Codeine or other narcotics
  9. Latex
  10. Soy
  11. Eggs / yolk
  12. Sulfites
  13. Do you have any known allergies
  1. Please list any allergies other than drug allergies:
    If you are using a CUSTOM FORM!! 
    This question must be accompanied by a YES/NO question in order to integrate into your software correctly. 
    Ex:   Do you have any known allergies?  YES / NO

  2. Please list any other medication or antibiotic you are allergic to:
    1. Medication/Antibiotic #1
    2. Medication/Antibiotic #2
    3. Medication/Antibiotic #3
    4. Medication/Antibiotic #4
    5. Medication/Antibiotic #5
    6. Medication/Antibiotic #6
    7. Medication/Antibiotic #7
    8. Medication/Antibiotic #8
    9. Medication/Antibiotic #9
    10. Medication/Antibiotic #10

 

FAMILY HISTORY

  1. Family History of Cancer
  2. Family History of Diabetes
  1. Family History of Heart Disease
  2. Family History of Anesthetic Problems

 

This entire section will not integrate:

INJURY INFORMATION

  1. Date of injury
  2. Type of accident- auto/work/other
  3. Insurance Company Handling Claim
  4. Claim Number
  5. Attorney or Adjustor
  6. Attorney Phone

 

This entire section will not integrate:

HEALTH HISTORY PERSONAL INFORMATION

  1. Is there any condition concerning your health that the Doctor should be told about?  
  2. If Yes, why?
  3. Do you wish to speak to the Dr. privately about anything

 

NOTE

  1. DSN software saves all imported truForm documents. It does not overwrite the originally imported truForm when an existing patient re-registers online.
  2. v18.x integration includes patient demographic and health history
  3. v18.x integration includes integration of truForm attachments (attached images or documents are imported into the DSN Attachment window for the specific patient).
  4. When a submitted TruForm PDF is imported into DSN, it will be stored in DSN (for quick access) – and can be viewed but cannot be edited.  If you need to sign the submitted TruForm PDF after integration, you must export it out of DSN first:
    1. Export/save submitted Truform PDF locally to your computer
    2. Open in Adobe Acrobat and sign
    3. Save document locally to your computer
    4. Upload new signed submitted TruForm PDF back into patients account (noting this will be a newly signed attachment and will not replace the original).