AAA – Forms To Build List

Questions and feedback for each form – From Clay…06/14/21

1. We need to make the name of the forms be as short as possible – can we shorten any of them?
2. Can we get descriptions and intros for each
3. I need a little help with review of the forms and specifying the “Required fields”.
4. All forms are required to have Patient Name (first and last), Phone Number and Email to be HIPAA compliant.
5. Since all forms MUST HAVE the Patient Name fields and Email fields, should we also collect Name of person making request, Birthdate, and Contact phone or Emergency Phone on each as well?

	Form Name	Issues or Questions	New Form Location
1.	Patient ADHD Refill Instructions (original form)	Needs intro to be rewritten to reflect online submission	ADHD Refill Request Form
2.	Check in flyer for patients	NOT A FORM-JUST A FLYER
3.	Consent for Wart Treatment Form	Requires a signature – did you want this signable digitally?	Consent for Wart Treatment Form
4.	Release of Information Form	Requires a signature – did you want this signable digitally?	Release of Information Form
5.	New Patient Package	This is a huge form – you want the whole thing?
6.	Flu Screening Questionnaire	BUILD THIS FORM Chart Label space at top – what patient data should be collected on this form – just name?	Flu Screening Questionnaire
7.	Asthma Control Test for Children 4 to 11 years (Original pdf)	• This is a highly stylized form but it can be made with little or no effort • Should I work to create this form so it automatically tabulates the total like the paper one?	Asthma Control Test for Children 4 to 11 years Do we want to tabulate a result?
8.	Asthma Control Test for Patients 12 Years or Older (orignal pdf)	SAME QUESTION AS ABOVE • This actually seems to be more of a guideline than a form to submit. • This form would also benefit from the ability to automatically tabulates the total	For Patients 12 Years and Older:
9.	Bright Futures Previsit Questionnaire	THIS ON IS TO BE BUILT	Bright Futures Previsit Questionnaire — 2 Month Visit
10.	Authorization for Treatment of a Minor (original pdf)	Requires a signature – did you want this signable digitally?	Authorization for Treatment of a Minor
11.	18 or Older Authorization (original pdf)	Requires a signature – did you want this signable digitally?	18 or Older Authorization