This article covers the steps to build a Custom Form along with a video tutorial of the process.
Create a Custom Form
- Navigate to Settings
- Click Patient Forms
- Click "Add a Form"
- Name your Form
- Choose Form Properties.
For more information please see How to Choose Form Properties.
- Click "Save & Next"
- Drag & Drop question type into the form and format your questions as needed.
Note: A signature is included by default for all RevenueWell forms, dragging in a "Signature" will indicate that the patient needs to sign more than once.
How can I add HIPPA consent to a custom form?
The last drag-and-drop option when creating a custom form is "HIPPA"
By dragging the HIPAA option to the form, you will see that you have 3 options to choose from:
- Notice of Privacy Practices (Default selection)
- HIPAA Consent
- HIPAA Authorization
All HIPAA options can be added to a document; however, the HIPAA options can only be used once per form. Keep the following rules in mind to help ease the creation of your HIPAA form:
- One option can be chosen per checkbox
HIPAA elements will require a check to complete a form.
- When an option has been selected it will no longer be available to select again, which means it will be grayed out on other HIPAA elements.
- When all 3 options have been selected for use in the form, another element can no longer be added.
- When the "Question" field has not been filled in, there will be "suggestive text" filling in the text box until you begin to type your question.
How do I create a custom form with multiple signature blocks? You will use the same "drag and drop" action for placing the signature box where you would like, within the form layout:
A few helpful descriptions with the signature box are as follows:
- "Signature Of": Describes whose signature is needed. For Example: the Doctor's Signature/Patient's Signature/Responsible Party's Signature
- "Description": Statement describing to the patient what they are signing
- "Relationship To The Patient": These signer options are the drop down options visible to the patient for the signature
- "Name If Not The Patient": A box to fill in the name of the signer.