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. Your TruForm link would be placed on your practice website for patients to complete online:  [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 Integration accepts 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


*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:


Reason for today's office visit

  1. Are you in good health
    • Height
    • Weight
  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
  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 or vape  
    • If so, how much 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 marijuana or other drug use
  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 (QUESTIONS 66 - 69)

  66. Is there a possibility of pregnancy
  67. Expected delivery date
  68. Are you nursing
  69. Are you taking birth control pills
        
    MEDICATION (QUESTIONS 70 - 77)

  70. Any kind of medication, drug, pills
  71. 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., RANKL inhibitors or bisphosphonates such as Denosumab, Fosamax, Boniva, Actonel, IV– Zometa, Aredia, Reclast or Evista in the past 12 years
  75. Tranquilizers, sleeping pills, anti-depressants, and/or narcotics on a regular basis? If so, please list:    
  76. DOES NOT INTEGRATE BUT WILL SOON!    
    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
    • treating doctor last name
  77. Please list any medications you are currently taking: (1-20)

          
    ALLERGIES (QUESTIONS 78 - 92)
  78. Local anesthetic (numbing meds.)
  79. Penicillin
  80. Other antibiotics
  81. Sulfa drugs
  82. Sodium pentothal / Valium /other tranquilizers
  83. Aspirin
  84. Amoxicillin
  85. Codeine or other narcotics
  86. Latex
  87. Soy
  88. Eggs / yolk
  89. Sulfites
  90. Do you have any known allergies
  91. Please list any allergies other than drug allergies
  92. Please list any other medications or antibiotic you are allergic to (1-10 medication/antibiotic name)

FAMILY HISTORY 

  1. Family History of Cancer
  2. Family History of Diabetes
  3. Family History of Heart Disease
  4. Family History of Anesthetic Problems

 INJURY INFORMATION

  1. Is this visit related to an accident
    • If Yes, what type of accident (auto/work related/other)
  2. Date of injury
  3. Insurance Company Handling Claim
  4. Claim Number
  5. Name of attorney / adjustor
  6. Telephone number

HH PERSONAL INFORMATION

  1. 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
  2. Is there any condition concerning your health that the Doctor should be told about
    • If Yes, describe
  3. Do you wish to speak to the Dr. privately about anything

 


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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