truForm & Eaglesoft Integration Fields

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Instructions below ONLY apply to truForm with Eaglesoft.

This includes ALL fields that integrate from truForm into your Eaglesoft software.  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 any of our standard forms below, the fields listed below are already set to integrate!

We do have fields from our standard forms that will NOT integrate.  Click here to review.

Integrated Field Count:  154 total fields integrate!

  1. Patient Information
  2. Responsible Party
  3. School and Insurance Information
  4. Health History
  5. Women Only
  6. Medications
  7. Allergies

 

PATIENT INFORMATION

*IF YOU ARE USING A CUSTOM FORM: Patient Name on the form must be split out into first name last name in order to integrate correctly.  [See Example]  *IF YOU ARE USING A CUSTOM FORM: Patient Address/ City/ State / Zip must be split out into its own fields in order to integrate correctly.  [See Example]
  1. Prefix
  2. First Name
  3. Middle Initial
  4. Last Name
  5. Nickname
  6. Gender
  7. Martial Description
  8. Date of Birth
  9. Home Phone
  10. Work Phone
  11. Work Ext.
  12. Cell Phone
  13. Email
  1. Address Street Name
  2. Apt 
  3. City
  4. State or Province
  5. Zip or Postal Code
  6. Driver’s License
  7. I would like to receive correspondences via e-mail

*IF YOU ARE USING A CUSTOM FORM:  Emergency Name must be one field (can't be split into first name last name fields, or else it will not integrate).  [See Example]

  1. Emergency Full Name
  2. Emergency Phone Home 

 

RESPONSIBLE PARTY INFORMATION

*This section will NOT integrate for existing patients already in the system.  This will ONLY integrate for brand new patients that don't have an existing Eaglesoft record. 
*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] *IF YOU ARE USING A CUSTOM FORM: Patient Address/ City/ State / Zip must be split out into its own fields in order to integrate correctly.  [See Example]
  1. First Name
  2. Middle Initial
  3. Last Name
  4. Date of Birth
  5. Home Phone
  6. Work Phone
  7. Work Ext
  8. Cell Phone
  1. Address Street Name
  2. Address Street Name 2
  3. City
  4. State or Province
  5. Zip or Postal Code
  6. Email Address
  7. Driver's License

 

SCHOOL AND INSURANCE INFORMATION

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


  1. School Name
  2. Patient School Address Street Name
  3. School City
  4. School State or Province
  5. School Zip or Postal Code
  1. School Status (Full, Part, Not)
  2. Employer Status(Full, Part, Not)
  3. Employer ID
  4. Medicaid ID

 

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:

 
  1. AIDS/HIV Positive
  2. Alzheimer's Disease
  3. Anaphylaxis
  4. Anemia
  5. Angina
  6. Arthritis/Gout
  7. Artificial Heart Valve
  8. Artificial Joint
  9. Asthma
  10. Blood Disorder
  11. Blood transfusion
  12. Breathing Problems
  13. Bruise easily
  14. Cancer
  15. Chemotherapy
  16. Chest pains
  17. Cold Sores/Fever Blisters
  18. Congenital Heart Disorder
  19. Convulsions
  20. Cortisone Medicine
  21. Diabetes
  22. Drug Addiction
  23. Easily Winded
  24. Emphysema
  25. Epilepsy or Seizures
  26. Excessive Bleeding
  27. Excessive Thirst
  28. Fainting spells
  29. Frequent Cough
  30. Frequent Diarrhea
  31. Frequent Headaches
  32. Genital Herpes
  33. Glaucoma
  34. Hay fever
  35. Heart attack(s)
  36. Heart murmur
  37. Cardiac pacemaker
  38. Heart Trouble/Disease
  39. Hemophilia
  40. Hepatitis A
  41. Hepatitis B or C
  42. Herpes
  43. High blood pressure
  44. High cholesterol
  45. Hives or Rash
  46. Hypoglycemia
  47. Irregular heart beat
  48. Kidney trouble
  1. Leukemia
  2. Liver disease
  3. Low blood pressure
  4. Lung Disease
  5. Mitral valve prolapse
  6. Osteoporosis / osteopenia
  7. Pain in Jaw Joints
  8. Parathyroid Disease
  9. Psychiatric care
  10. Radiation Treatments
  11. Recent Weight Loss
  12. Renal Dialysis
  13. Rheumatic fever
  14. Rheumatism
  15. Scarlet Fever
  16. Shingles
  17. Sickle Cell Disease
  18. Sinus Trouble
  19. Spina Bifida
  20. Stomach/Intestinal Disease
  21. Stroke
  22. Swelling of Limbs
  23. Thyroid trouble
  24. Tonsillitis
  25. Tuberculosis
  26. Tumor or growth
  27. Stomach ulcers / acid reflux
  28. Sexually transmitted diseases
  29. Yellow Jaundice
  30. Do you take, or have you take, Phen-Fen or Redux?
  31. (cont) If yes explain
  32. Do you use controlled substances?
  33. (cont) If yes explain
  34. Have you ever had a serious head or neck injury?
  35. (cont) If yes explain
  36. Are you on a special diet?
  37. Are you under the care of a physician
  38. (cont) If yes explain
  39. Have you ever had any serious illness not listed above?
  40. (cont) If yes explain
  41. Have you had a heart valve replacement or vascular graft?
  42. Have you ever been hospitalized or had a major operation?
  43. (cont) If yes explain
  44. Do you use tobacco?

 

WOMEN ONLY QUESTIONS

  1. Are you nursing
  2. Are you taking birth control pills
  1. Is there a possibility of pregnancy

 

MEDICATIONS

  1. 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
  2. (cont) If yes, explain. 
  1. Medication Name (up to 20 medications):
    1. Medication #1
    2. Medication #2
    3. Medication #3
    4. Medication #4
    5. Medication #5
    6. Medication #6
    7. Medication #7
    8. Medication #8
    9. Medication #9
    10. Medication #10
    11. Medication #11
    12. Medication #12
    13. Medication #13
    14. Medication #14
    15. Medication #15
    16. Medication #16
    17. Medication #17
    18. Medication #18
    19. Medication #19
    20. Medication #20

 

ALLERGIES

  1. Acrylic
  2. Aspirin
  3. Codeine or other narcotics
  4. Latex
  5. Local anesthetic (numbing meds.)
  6. Metal
  7. Penicillin
  8. Sulfa drugs
  9. Please list any allergies other than drug allergies (up to 10 allergies):
    1. Allergy #1
    2. Allergy #2
    3. Allergy #3
    4. Allergy #4
    5. Allergy #5
    6. Allergy #6
    7. Allergy #7
    8. Allergy #8
    9. Allergy #9
    10. Allergy #10
  1. Please list any other medication or antibiotic you are allergic to (up to 10 medication/antibiotics):
    1. Medication/Antibiotic #1
    2. Medication/Antibiotic #2
    3. Medication/Antibiotic #3
    4. Medication/Antibiotic #4
    5. Medication/Antibiotic #5
    6. Medication/Antibiotic #6
    7. Medication/Antibiotic #7
    8. Medication/Antibiotic #8
    9. Medication/Antibiotic #9
    10. Medication/Antibiotic #10

 

Eaglesoft does not allow the following fields or sections to be integrated and/or updated, please review below.

  1. Social Security Number
    • It is a masked/encrypted field in the software, and must be manually entered by the practice.
  2. Policy Holder
    • Services contain extensive logic to validate if claims are open prior to switching. This is not possible with direct database access and can result in a corrupted database.
  3. Employer
    • Services contain extensive logic to validate if claims are open prior to switching. This is not possible with direct database access and can result in a corrupted database.
  4. Insurance information
    • Services contain extensive logic to validate if claims are open prior to switching. This is not possible with direct database access and can result in a corrupted database.
  5. Switching Employer and Insurance information on an existing patient
    • Services contain extensive logic to validate if claims are open prior to switching. This is not possible with direct database access and can result in a corrupted database.
  6. Switching Responsible Party on an existing patient
    • Services contain extensive logic to transfer account balances appropriately. This is not possible with direct database access and can result in a corrupted database. 
    • Creation of a Responsible party is allowed on initial patient entry only.

 

Integration Fields that will NOT Integrate

This list below will include all fields from our standard forms that currently cannot integrate within Eaglesoft.

*Note, although these fields will not integrate- you will have the completed form (with the question answered) as an attachment within your patients record to review at anytime!

PATIENT INFORMATION

  1. Patient Age
  2. Social Security Number
  3. Payment Method
  4. Have you ever been a patient of our practice?
  5. Patient Employer Name
  6. Preferred Pharmacy Phone
  7. Preferred Pharmacy
  8. Doctor First Name
  9. Doctor Last Name
  10. Referred By First Name
  11. Referred By Last Name
  12. Dentist First Name
  13. Dentist Last Name
  14. Nearest Relative First Name
  15. Nearest Relative Last Name
  16. Has a family member ever been a patient of our practice?

RESPONSIBLE PARTY INFORMATION

  1. Relationship to Patient
  2. Relationship to Patient (Other Description)
  3. Age
  4. Social Security Number
  5. Responsible Party Employer Name

DENTAL INFORMATION

  1. Reason for today’s visit
  2. Are you in pain?
  3. For how long?
  4. Discomfort, clicking, or popping in jaw
  5. Red, swollen, or bleeding gums
  6. A removable dental appliance
  7. Blisters / sores in or around the mouth
  8. Prolonged bleeding from an injury / extraction
  9. Recent infections or sore throat
  10. My teeth are sensitive to hot
  11. My teeth are sensitive to cold
  12. My teeth are sensitive to sweets
  13. My teeth are sensitive to biting
  14. Stained teeth
  15. Locking jaw
  16. Bad breath
  17. Toothache
  18. Burning tongue / lips
  19. Lost / broken filling(s)
  20. Teeth grinding / clenching
  21. Ringing in ears
  22. Broken / chipped tooth
  23. Gum disease
  24. Difficulty closing jaw
  25. Difficulty opening jaw
  26. Loose / shifting teeth
  27. Food caught between teeth
  28. Swelling / lumps in mouth
  29. Other Problem
  30. Other Description
  31. Last dental exam

HEALTH HISTORY INFORMATION

  1. Height
  2. Weight
  3. A history of alcohol abuse
  4. A removable dental appliance
  5. Are you in good health
  6. Chronic fatigue / night sweats
  7. Contact lenses
  8. Contagious diseases
  9. Delay in healing
  10. Do you smoke?
  11. If so, number of packs a day
  12. Gallbladder trouble
  13. Has a physician or previous dentist recommended that you take antibiotics prior to your dental treatment?
  14. Have you had any illness, operation or been hospitalized in the past five years?
  15. Have you ever had general anesthesia?
  16. Have you, or a family member, had any unusual or serious reactions to general anesthesia?
  17. Heart surgery
  18. Infectious mononucleosis
  19. Low blood sugar
  20. Osteonecrosis
  21. Problems with immune system (possibly from med. / surg.)
  22. Reason for today’s visit
  23. Sleep apnea / CPAP
  24. Snoring
  25. Trouble climbing 1-2 flights of stairs
  26. Swollen Ankles
  27. Prosthetic implant

SPOUSE OR OTHER GUARANTOR INFORMATION

**this entire section does not integrate


PRIMARY & SECONDARY DENTAL/MEDICAL INSURANCE

**this entire section does not integrate


 MEDICATIONS

  1. Medication Dosage per each medication
  2. Medication Frequency per each medication
  3. Antidepressants
  4. Blood thinners (Coumadin, Aspirin)
  5. Diet pills
  6. Insulin
  7. Muscle relaxers
  8. Nerve pills
  9. Pain killers (including aspirin)
  10. Stimulants
  11. Tranquilizers

ALLERGIES

  1. Amoxicillin
  2. Eggs / yolk
  3. Medication / Antibiotic Allergy
  4. Sodium pentothal / Valium /other tranquilizers
  5. Soy
  6. Sulfites
  7. Other antibiotics
  8. Do you have any known allergies

WOMEN ONLY QUESTIONS

  1. Expected delivery date

EMERGENCY CONTACT INFORMATION

  1. Emergency Contact Relation
  2. Emergency Contact Work Phone

 

 

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