truForm: Software Integration | Carestream (WinOMScs)

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Instructions below ONLY apply to truForm.

The TruForm integration requires no additional charge from PBHS, and can be setup at anytime with your PBHS TruForm order. Please contact PBHS Support further if you are ready to start this process.

Once the integration settings are added to your form(s) and truForm account, you will need to set your own integration credentials through your new truForm account's profile settings and provide this information to your software representative directly (PBHS does not have access to this information). Instructions on setting your integration credentials through the portal can be found HERE.

*Please note, you will need to contact your software provider to obtain more information about the pricing for their TruForm bridge, as there may be additional fees.

Integration Fields

This includes ALL fields that integrate between TruForm and WinOMScs.  If your custom form is setup correctly, items below will populate within your software. Note, if you have additional fields that are NOT listed below, you can manual enter them into your patients 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.

PATIENT INFORMATION:

Prefix
First Name
Middle Initial
Last Name
Suffix
Nickname
Gender
Martial Description
Date of Birth
Age
Social Security Number
Home Phone
Work Phone
   Work Ext.
Cell Phone
Email


*IF YOU ARE USING A CUSTOM FORM: Patient Address/ City/ State must be split out into its own fields in order to integrate correctly.


Address Street Name
Apt 
City
State or Province
Zip or Postal Code
Employer Name
Driver’s License
Patient former patient?


*IF YOU ARE USING A CUSTOM FORM:  Dentist/Doctor/Referred By/Nearest Relative Names on the form must be split out into first name last name in order to integrate correctly.


Dentist First Name
Dentist Last Name

Doctor First Name
Doctor Last Name

Referred By First Name
Referred By Last Name

DOES NOT INTEGRATE:
Orthodontist First Name
Orthodontist Last Name

Nearest Relative First Name
Nearest Relative Last Name
Nearest Relative Phone
Payment Method

SPOUSE OR OTHER GUARANTOR INFORMATION:
This entire section will not integrate.

RESPONSIBLE PARTY INFORMATION:


*IF YOU ARE USING A CUSTOM FORM: Responsible Name on the form must be split out into first name last name in order to integrate correctly.


Prefix
First Name
Last Name
Suffix
Relationship to Patient
Social Security Number
Date of Birth

DOES NOT INTEGRATE:
Age
Middle Initial

Email Address

Address Street Name
Address Street Name 2
City
State or Province
Zip or Postal Code
Employer Name
Phone Home
Phone Work


 SCHOOL AND INSURANCE INFORMATION:


*IF YOU ARE USING A CUSTOM FORM: School Name/ Address/ City/ State must be split out into its own fields in order to integrate correctly.


School Status (Full, Part, Not)
School Name
School Address Street Name
School Address Street Name 2
School City
School State or Province
School Zip or Postal Code
School Phone

Employer Status(Full, Part, Not)
PPO or HMO?


EMERGENCY CONTACT INFORMATION:


Emergency Name must be one field (can't be split into first name last name fields, or else it will not integrate).


Emergency Full Name
Phone Home
Phone Work

DOES NOT INTEGRATE:
Emergency contact relation

PRIMARY & SECONDARY
DENTAL / MEDICAL
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. 


*IF YOU ARE USING A CUSTOM FORM: All Address/ City/ State must be split out into its own fields in order to integrate correctly.


*IF YOU ARE USING A CUSTOM FORM: Insured Name on the form must be split out into first name last name in order to integrate correctly.


Insured Relation to Patient
Insured Prefix
Insured First Name
Insured Middle Initial
Insured Last Name
Insured Suffix
Insured Gender
Insured Date of Birth
Insured Social Security 
Number
Insured Home Phone
Insured Home Address Street
Insured Home Address Street 2
Insured City
Insured State or Province
Insured Zip Code or Postal Code
Insured Employer Name
Insured Employer Address
Insured Employer Address 2
Insured Employer City
Insured Employer State or Province
Insured Employer Zip or Postal
Insured Employer Phone Number
Insured Policy Group Name
Insured Policy Group Number
Insured Policy ID
Insured Policy Plan
Insured Insurance Company Name
Insured Insurance Address Street
Insured Insurance Address Street 2
Insured Insurance City
Insured Insurance State or Province
Insured Insurance Zip or Postal Code
Insured Insurance Phone Number

HEALTH HISTORY:

Weight
Height
1. Are you in good health
2. Have there been any changes in your general health in the past year
3. Are you under the care of a physician / If so, for what are you being treated?  / Date of last visit
4. Have you had any illness, operation or been hospitalized in the past five years  /If so, describe
5. Do you have unhealed / recurrent injuries or inflamed areas, growths or sore spots in or around your mouth / If so, describe where
6. Do you have a prosthetic joint / implant / If so, describe where
7. Have you had a heart valve replacement or vascular graft

DOES NOT INTEGRATE:    
8. Have you, or a family member, had any unusual or serious reactions to general anesthesia?

9. Has a physician or previous dentist recommended that you take antibiotics prior to your dental treatment?


*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:


10. Rheumatic fever?
11. Damaged heart valves / mitral valve prolapse?
12. Heart murmur?
13. High blood pressure?
14. Low blood pressure?
15. Chest pain / angina? 

(Comes over as angina)
16. Heart attack(s)?
17. Irregular heart beat?
18. Cardiac pacemaker?
19. Heart surgery?
20. Pneumonia, bronchitis, chronic cough? 

(Comes over as bronchitis/chronic cough)
21. Asthma?
22. Hay fever / sinus problems?
23. Snoring / sleep apnea?
24. Difficult breathing / other lung trouble? 

(Comes over as other lung trouble)
25. Tuberculosis?
26. Emphysema?
27. Do you smoke? 

DOES NOT INTEGRATE:
If so, number of packs a day

28. Do you use chewing tobacco?
29. Blood transfusion?
30. Blood disorder such as anemia? 

(Comes over as anemia)
31. Bruise easily?
32. Bleeding tendency / abnormal bleed? 

(Comes over as bleeding tendency)
33. Hepatitis, jaundice, or liver disease?
34. Infectious mononucleosis?
35. Gallbladder trouble?
36. Fainting spells?
37. Convulsions / epilepsy?
38. Stroke?
39. Thyroid trouble?
40. Diabetes?
41. Low blood sugar?
42. Kidney trouble?

DOES NOT INTEGRATE:
43. High cholesterol?

44. Are you on dialysis?
45. Swollen ankles / arthritis / joint disease? 

(Comes over as arthritis)

DOES NOT INTEGRATE:  
46. Osteoporosis / osteopenia?
47. Osteonecrosis?

48. Stomach ulcers / acid reflux? 
(Comes over as stomach ulcers)
49. Contagious diseases?
50. Sexually transmitted diseases?
51. Problems with immune system? Possibly from medication / surgery, etc.
52. Delay in healing?

53. A tumor or growth?
54. Cancer / radiation therapy / chemotherapy? 
(Comes over as xray or chemo)
55. Chronic fatigue / night sweats?
56. Are you on a diet?
57. A history of alcohol abuse?
58. A history of drug abuse?
59. Contact lenses?
60. Eye disease / glaucoma?
61. Mental health problems / anxiety / depression? 

(Comes over as mental health problems)
62. A removable dental appliance?
63. Pain or clicking of jaws when eating?
If you are having surgery today, have you had anything to eat or drink in the last 6 (six) hours?
Who is driving you home?
HIV/AIDS
Malignant Hyperthermia


 WOMEN ONLY:

64. Is there a possibility of pregnancy?
65. Expected delivery date?
66. Are you nursing?
67. Are you taking birth control pills?


 MEDICATION:

72. Any kind of medication, drug, pills?
73. Blood thinners (Coumadin, Plavix, Aspirin, Vitamin E, Ginko biloba, Aggrenox, Pradaxa, Fish oil)?
74. Have you ever taken diet pills?
75. Any natural product, herbal supplement or homeopathic remedy?

DOES NOT INTEGRATE:    
76. Are you taking, or have you ever taken, bone density meds. or bisphosphonates such as Fosamax, Boniva, Actonel, IV– Zometa, Aredia, or Reclast in the past 12 years?

77. Tranquilizers, sleeping pills, anti-depressants, and/or narcotics on a regular basis? If so, please list:
78. Please list any medications you are currently taking:

**Please note each medication they free type will come over as either a ALERT or a PROGRESS NOTE, from here you will have to click the green plus sign to add/retype each medication manually within your patients chart in WinOMScs.


ALLERGIES:

79. Local anesthetic (numbing meds.)?
80. Penicillin?
81. Other antibiotics?
82. Sulfa drugs?
83. Sodium pentothal / Valium /other tranquilizers?
84. Aspirin?

DOES NOT INTEGRATE:    
85. Amoxicillin?

86. Codeine or other narcotics?
87. Other medications?
88. Latex?
89. Soy?
90. Eggs / yolk?
91. Sulfites?

DOES NOT INTEGRATE:    
92. Do you have any known allergies?

93. Please list any allergies other than drug allergies:


 FAMILY HISTORY:

Family History of Cancer
Family History of Diabetes
Family History of Heart Disease
Family History of Anesthetic Problems


 INJURY INFORMATION:

Date of injury
Type of accident- auto/work/other
Insurance Company Handling Claim
Claim Number
Attorney or Adjustor
Attorney Phone


HH PERSONAL INFORMATION:

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

Software Integration Re-cap:

This software integration integrates a set amount of fields for:

  • Patient Demographic Fields (reviewed above)
  • Responsible Party Fields (reviewed above)
  • Primary and Secondary Dental/Medical Insurance Fields (reviewed above)
  • Health History Fields (reviewed above)
  • Medication Fields (reviewed above)
  • Allergies Fields (reviewed above)
  • Integration of the patients submitted form within the patient's account

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