truForm: Software Integration | Online Medsys

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Instructions below ONLY apply to truForm.

In this section we will go over the following:

TruForm Integration Overview

Form Options:

It is highly recommended by both Practice Advisory Group and PBHS that you utilize our PBHS Standard v.6 TruForm. 

This will ensure:

  • Every field from this standard form will integrate within Online Medsys Software

If you choose to use your own custom form, please note any questions which are NOT present on our PBHS Standard v.6 TruForm will not integrate from your custom form within the software.  

Registration Process:

  1. This link would be placed on your website for patients to fill out and submit:  [Preview HTML Form]
  2. Once the above form is submitted, your office would receive this completed PDF form [Preview PDF Form] which would integrate directly into your Online Medsys software!

This form integrates ALL fields from our standard form below:

 

*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.

TruForm Integration Fields

This includes ALL fields that integrate between TruForm and Online Medsys.  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!

PATIENT INFORMATION:

Prefix
First Name
Middle Initial
Last Name
Gender
Birth Date
Age
Social Security Number
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.

[See Example]

Address Street Name
Apt 
City
State or Province
Zip or Postal Code


Home Phone
Cell Phone
Have you ever been a patient of our practice?
Has a family member ever been a patient of our practice?
Employer Name


*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.

[See Example]

Referred By First Name
Referred By Last Name
Dentist First Name

Dentist Last Name
Orthodontist First Name
Orthodontist Last Name
Doctor First Name
Doctor Last Name
Nearest Relative First Name
Nearest Relative Last Name


Nearest Relative Phone
Driver’s License
Payment Method


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).

[See Example]


Emergency Full Name
Emergency Relation

Phone Home

 

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.

[See Example]

First Name
Last Name


Relationship to Patient
Social Security Number
Date of Birth
Age
Phone Home
Phone Cell
Email Address


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

[See Example]

Address Street Name
Address Apt
City
State or Province
Zip or Postal Code


Driver's License
Employer Name
Phone Work

SPOUSE OR OTHER GUARANTOR INFORMATION

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

[See Example]

First Name
Last Name


Relation
Social Security Number
Date of Birth
Home Phone
Employer Name
Work Phone

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

[See Example]

Address Street Name
Apt
City
State
Zip

 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.

[See Example]

School Name
School Address Street Name
School City
School State or Province
School Zip or Postal Code


Student Status (Full, Part, Not)
Employed Status (Full, Part, Retired, Not)
Marital Status (Married, Divorced, Widow, Single, Legally Separated)

Do you belong to a PPO or HMO?

 

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. 

[See Example]


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

[See Example]


*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.

[See Example]


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




HEALTH HISTORY:

Reason for today's office visit?
Height
Weight
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?
8. Have you ever had general anesthesia?
9. Have you, or a family member, had any unusual or serious reactions to general anesthesia?
10. 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:


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

17. Heart attack(s)?
18. Irregular heart beat?
19. Cardiac pacemaker?
20. Heart surgery?
21. Pneumonia, bronchitis, chronic cough? 

22. Asthma?
23. Hay fever / sinus problems?
24. Snoring?
25. Sleep apnea / CPAP?
26. Difficult breathing / other lung trouble? 
27. Tuberculosis?
28. Emphysema?
29. Do you smoke?  

  • If so, number of packs a day

30. Do you use chewing tobacco?
31. Blood transfusion?
32. Blood disorder such as anemia? 

33. Bruise easily?
34. Bleeding tendency / abnormal bleed? 

35. Hepatitis, jaundice, or liver disease?
36. Infectious mononucleosis?
37. Gallbladder trouble?
38. Fainting spells?
39. Convulsions / epilepsy?
40. Stroke?
41. Thyroid trouble?
42. Diabetes?
43. Low blood sugar?
44. Kidney trouble?
45. High cholesterol?
46. Are you on dialysis?
47. Swollen ankles / arthritis / joint disease? 

48. Osteoporosis / osteopenia?
49. Osteonecrosis?
50. Stomach ulcers / acid reflux? 
51. Contagious diseases?
52. Sexually transmitted diseases?
53. Problems with immune system? Possibly from medication / surgery, etc.
54. Delay in healing?

55. A tumor or growth?
56. Cancer / radiation therapy / chemotherapy? 
57. Chronic fatigue / night sweats?
58. Are you on a diet?
59. A history of alcohol abuse?
60. A history of drug abuse?
61. Contact lenses?
62. Eye disease / glaucoma?
63. Mental health problems / anxiety / depression? 

64. A removable dental appliance?
65. Pain or clicking of jaws when eating?


 WOMEN ONLY:

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


 MEDICATION:

70. Any kind of medication, drug, pills?
71. Blood thinners (Coumadin, Plavix, Aspirin, Vitamin E, Ginko biloba, Aggrenox, Pradaxa, Fish oil)?
72. Have you ever taken diet pills?
73. Any natural product, herbal supplement or homeopathic remedy?
74. 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?
75. Tranquilizers, sleeping pills, anti-depressants, and/or narcotics on a regular basis? If so, please list:    
76. Please list any medications you are currently taking: (1-20)

DOES NOT INTEGRATE BUT WILL SOON!    
76. If you are under the care of a physician for pain management, or recovering from drug addiction please select the medication you are currently taking: (other description & treating doctor first name/last name)


ALLERGIES:

77. Local anesthetic (numbing meds.)?
78. Penicillin?
79. Other antibiotics?
80. Sulfa drugs?
81. Sodium pentothal / Valium /other tranquilizers?
82. Aspirin?
83. Amoxicillin?
84. Codeine or other narcotics?
85. Latex?
86. Soy?
87. Eggs / yolk?
88. Sulfites?
89. Do you have any known allergies?
90. Please list any allergies other than drug allergies:
91. Please list any other medications or antibiotic you are allergic to (1-10 medication/antibiotic name)


 FAMILY HISTORY:

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


 INJURY INFORMATION:

Is this visit related to an accident?
If Yes, what type of accident? (auto/work related/other)
Date of injury
Insurance Company Handling Claim
Claim Number
Name of attorney / adjustor
Telephone number

HH PERSONAL INFORMATION:

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?

Is there any condition concerning your health that the Doctor should be told about?  

  • If Yes, describe?

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




Online Medsys Software Support Information:

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

Phone: 713-961-2723
Email: support@omsp.com
Support Page: [Click Here]

 

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