Skip to main content

truForm: DSN

  • DSN Version

    1. Within your DSN software, select the "Help" drop down menu located at the top
    2. Select "About" and a window will open
    3. You will see the version of the software you are on, and the date it was installed

    Please note, DSN v18.x will only work with the truForm integration shown above.  Version 18.x will only work if installed on 08/31/2018 and after.

    In order to import the additional items below, you must have v.18 installed 06/19/19 build or above.
    1. Health Alerts
    2. Allergies
    3. Current Medications
    4. Attachments
  • Overview

    Converting TruForm Into PMS
    1. Within your DSN software, select the Go menu
    2. Select the Online Patient Registration Option
      360001211886 - 360067986191 - dsn1.jpg
    3. This will show the screen directly below, select the Import button
    4. The import routine will download any pending online registration/TruForms
      360001211886 - 360067986211 - dsn2.jpg
    5. Registrations will appear like this below:
      360001211886 - 360067986231 - dsn3.jpg
    6. You can now decide if this truForm submission should be imported as a new patient or an existing patient.

    Importing a New Patient:

    1. Select the Add button seen directly below
    2. This will take you to the new patient wizard, any submitted truForm(s) will be displayed here:
      360001211886 - 360067782572 - dsn4.jpg
    3. The New Patient DSN wizard will walk you through this process, here you can change or add to the information provided.
    4. Some of the information is not automatically added, and the user will need to select the appropriate item or add a new item.
      • For example, the patient employer is not automatically added, you will need to decide if they have that employer on file or you need to add it in.  If it is on file, you can pick the employer from the dropdown box.  If you need to add it, just select the Plus icon.  This will start the add of the employer with the information from the online registration filled in.   We do it this way so the user does not end up with many copies of the same employer on file within the DSN system.
    5. New Patient Wizard Patient Information:
      (note:  this area below in red is to display what was entered in the online registration, so you know what it was if they change it.  This is a feature that is only partially implemented at this time and more is coming soon per DSN).
    6. Select the Next button once done verifying information:
      360001211886 - 360067782592 - dsn5.jpg
    7. The New Patient Wizard Account Information screen will appear
    8. Select the Next button once done verifying information:
      360001211886 - 360067782612 - dsn6.jpg
    9. The New Patient Wizard Contact and Referral Information will appear
    10. Select the Next button once done verifying information:
      360001211886 - 360067986251 - dsn7.jpg
    11. The New Patient Wizard Dental Insurance Primary will appear
    12. Select the Next button once done verifying information:
      • The Dental Secondary, Medical Primary, and Medical Secondary entry look exactly the same
        360001211886 - 360067782632 - dsn8.jpg
    13. The New Patient Status Information will appear
    14. Select the Finish button once done verifying information:
      360001211886 - 360067986271 - dsn9.jpg
    15. Once you select Finish above, the patient will be added to the system.

    You can now view and sign the submitted truForm through DSN (LINK COMING SOON).

  • PDF


    The online registration PDF/truform will be added to the DSN New Patient Attachments area.

    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.

    Please follow the steps provided below:

    1. Export/save submitted truform PDF from DSN, locally to your computer
    2. Open the truForm PDF in the correct application for signing a PDF form
    3. Once all signatures are complete, you can save the completed truForm locally to your computer again
    4. Upload the updated signed TruForm PDF back into patients account (noting this will be a newly signed attachment and will not replace the original).
  • Fields
    • 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).
    • 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).
  • Support


    You can contact DSN Support Below (for existing clients only):

    Phone: 800-871-9271
    Hours: M-F 5am- 5pm PST
    Email: support@dsnsoft.com
    Support Page: [Click Here]