truForm: DSN - Integration Fields (V11.7, V14 & V16)

How to check my DSN Software Version

This document includes ALL fields that integrate between TruForm and DSN (v11.7, v14 & v16).  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!

  1. OMS PATIENT REGISTRATION & HEALTH HISTORY PBHS STANDARD TRUFORM
  2. ENDO/PERIO PATIENT REGISTRATION & HEALTH HISTORY PBHS STANDARD TRUFORM

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

Integration Field Count: 149 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 / Zip 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
  3. or Referred By Name as one field (patient can type the answer on one line)

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
    9. Orthodontist First Name
    10. Orthodontist Last Name
    11. Nearest Relative First Name
    12. Nearest Relative Last Name
    13. Nearest Relative Phone Number
    14. Preferred Pharmacy
    15. Preferred Pharmacy Phone
    16. Personal Payment Type
    17. Have you ever been a patient of our practice?
    18. Has a family member ever been a patient of our practice?
    19. Emergency Full Name
    20. Phone Home
    21. Phone Work
    22. 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 / Zip 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
  1. Address Street Name
  2. Address Apt #
  3. Address City
  4. Address State or Province
  5. Address Zip or Postal Code 
  6. Home Phone
  7. Work Phone
  8. Cell Phone
  9. Email 

DOES NOT INTEGRATE:

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

 

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 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 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

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

 

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
  6. Student Status (full/part/not)
  7. Employment status (full/part/retired/not)
  8. Marital Status (married/ divorced/ widow/ single/ legally separated)

 

This entire section will not integrate:

HEALTH HISTORY INFORMATION, MEDICATION & ALLERGIES

(pages 2-3 of our standard form).

 

NOTE:

  1. Returning patients that re-register online can be converted into DSN v14 unlimited times. The first time the patient is imported as a "new" patient. After that, the office would "update" that existing patient.
  2. This integration for v11.7, v14, v16 does not include health history
  3. 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).