truForm: Software Integration | Medims

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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 document includes ALL fields that integrate between TruForm and Medims. If your custom form is setup correctly, items listed below will populate within your software.

The form itself will populate into the patients file as a downloadable attachment. 

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!

Integration Fields Total Count:  84

PATIENT INFORMATION:

  1. Prefix
  2. First Name
  3. Last name
  4. Middle Initial
  5. Suffix
  6. Gender
  7. Date of Birth
  8. Social Security Number
  9. Work Phone
  10. Home Phone
  11. Cell Phone
  12. Email Address
  13. Address Street Name
  14. Address Apt
  15. City
  16. State or Province 
  17. Zip or Postal Code
  18. Drivers License
  19. Marital Status
  20. Employment Status
  21. Employer Name
  22. Employer Address
  23. City, State Zipcode
  24. Dentist First Name
  25. Dentist Last Name
  26. Doctor First Name
  27. Doctor Last Name
  28. Referred by First Name
  29. Referred by Last Name

SCHOOL AND INSURANCE
INFORMATION:

  1. School Status
  2. School Name
  3. School Address
  4. City
  5. State or Province 
  6. Zip or Postal Code
  7. School Phone
  8. Marital Status
  9. Employed Status

 

EMERGENCY CONTACT 
INFORMATION:

  1. Emergency Full Name
  2. Phone Home
  3. Relation 

RESPONSIBLE PARTY 
INFORMATION:
 

  1. Relationship Description
  2. First Name
  3. Last Name
  4. Social Security Number
  5. Date of Birth
  6. Email
  7. Drivers License
  8. Address Street Name
  9. Address Street Name 2
  10. City
  11. State or Province
  12. Zip or Postal Code
  13. Employer Name
  14. Phone Home
  15. Phone Work
  16. Phone Cell

PRIMARY & SECONDARY DENTAL / 
MEDICAL INSURANCE 
INFORMATION:

  1. Employer Name
  2. Employer Address Street Name
  3. Employer City
  4. Employer State or Province 
  5. Employer Zip or Postal Code
  6. Employer Work Phone
  7. Employer Plan Name
  8. Insurance Company Name
  9. Insurance Company ID
  10. Insurance Company Address Street Name
  11. Insurance Company City
  12. Insurance Company State or Province
  13. Insurance Company Zip or Postal Code
  14. Insurance Company Phone
  15. Insurance Company Group Name
  16. Insurance Company Group Number
  17. Insured First Name
  18. Insured Last Name
  19. Insured Relation to Patient
  20. Insured Birthdate
  21. Insured Gender
  22. Insured Social Security Number
  23. Insured Home Phone
  24. Insured Address Street Name
  25. Insured City
  26. Insured State or Province
  27. Insured Zip or Postal 
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