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.  

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!

PATIENT INFORMATION:

  • Prefix
  • First Name
  • Last name
  • Middle Initial
  • Suffix
  • Gender
  • Date of Birth
  • Social Security Number
  • Work Phone
  • Home Phone
  • Cell Phone
  • Email Address
  • Address Street Name
  • Address Apt
  • City
  • State or Province 
  • Zip or Postal Code
  • Drivers License
  • Marital Status
  • Employment Status
  • Employer Name
  • Employer Address
  • City, State Zipcode
  • Dentist First Name
  • Dentist Last Name
  • Doctor First Name
  • Doctor Last Name
  • Referred by First Name
  • Referred by Last Name

SCHOOL AND INSURANCE
INFORMATION:

  • School Status
  • School Name
  • School Address
  • City
  • State or Province 
  • Zip or Postal Code
  • School Phone
  • Marital Status
  • Employed Status

 

EMERGENCY CONTACT 
INFORMATION:

  • Emergency Full Name
  • Phone Home
  • Relation 

RESPONSIBLE PARTY 
INFORMATION:
 

  • Relationship Description
  • First Name
  • Last Name
  • Social Security Number
  • Date of Birth
  • Email
  • Drivers License
  • Address Street Name
  • Address Street Name 2
  • City
  • State or Province
  • Zip or Postal Code
  • Employer Name
  • Phone Home
  • Phone Work
  • Phone Cell

PRIMARY & SECONDARY DENTAL / 
MEDICAL INSURANCE 
INFORMATION:

  • Employer Name
  • Employer Address Street Name
  • Employer City
  • Employer State or Province 
  • Employer Zip or Postal Code
  • Employer Work Phone
  • Employer Plan Name
  • Insurance Company Name
  • Insurance Company ID
  • Insurance Company Address Street Name
  • Insurance Company City
  • Insurance Company State or Province
  • Insurance Company Zip or Postal Code
  • Insurance Company Phone
  • Insurance Company Group Name
  • Insurance Company Group Number
  • Insured First Name
  • Insured Last Name
  • Insured Relation to Patient
  • Insured Birthdate
  • Insured Gender
  • Insured Social Security Number
  • Insured Home Phone
  • Insured Address Street Name
  • Insured City
  • Insured State or Province
  • Insured Zip or Postal

Software Integration Re-cap:

This software integration integrates a set amount of fields for:

  • Patient Demographic fields
  • Primary/Secondary Medical & Dental Insurance Fields 
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