Pre-registration Referral Tracking

1. Pre-registration Referral Tracking • This presentation includes the screen layout and functional flow of the referral tracking module. • Details are given in the notes section of the slides.

2. Pre-Registration Referral Tracking Sitemap Referral Search Referral Search Results SAR Registration Referral Entry / Edit Correspondence Referral Case notes (system generated case notes)

3. Pre-registration Referral Tracking Search - Referrals Quick Search Options Pending Referrals Date Range Referral Received Begin Date : Referral Received End Date : mm/dd/yyyy mm/dd/yyyy Referral Criteria Referral Type : Referral Tracking Nr: Referral Source : Referral Status : Find Provider/Plan Name: Find Provider/Plan Nr: By Client Advanced Search Options Search Referral Add Referral Reset

4. Pre-registration Referral Tracking Referral Search Results Continue to Registration View / Edit Referral Back Continue to SAR Add Referral

5. Pre-registration Referral Tracking Referral Information for Firstname Middle Lastname Tracking Number: 123456 Referral Information Referral Type : Tracking Number : Referral Entered On : Display only Display only Legal County : Referral Status : Referral Received On : mm/dd/yyyy Referral Source : Provider / Plan Nr : Find Provider / Plan Name : Find Provider / Plan Address : Ext: Phone : Fax: State: Zip: City : display display Find Email : Suspected Diagnosis Description: ICD Code: Find Same screen continued on next slide

6. Requested Services Add Services Inappropriate Referral Information Return Request Reason Multiple selection list Free Text area (if Other is chosen) Number of characters left 25 Comments Free Text area for Comments Number of characters left 15000 Last Updated By: user’s first name last name Last Updated On: MM/DD/YYYY HH:MM AM/PM Previous Back Save Save and Continue to Registration Save and Continue to SAR Add Duplicate Next

7. Pre-registration Referral Tracking Referral Information Patient Name : Last App First Middle Gender : Date of Birth: mm/dd/yyyy SSN: Referral Information Referral Type : Tracking Number : Referral Entered On : Display only Display only Legal County : Referral Status : Referral Received On : mm/dd/yyyy Referral Source : Provider / Plan Nr : Find Provider / Plan Name : Find Provider / Plan Address : Ext: Phone : Fax: State: Zip: City : display display Find Email : Suspected Diagnosis Add Diagnosis Same screen continued on next slide

8. Requested Services Add Services Inappropriate Referral Information Return Request Reason Multiple selection list Submit to add reason to list Free Text area (if Other is chosen) Number of characters left 25 Comments Free Text area for Comments Number of characters left 15000 Last Updated By: user’s first name last name Last Updated On: MM/DD/YYYY HH:MM AM/PM Previous Back Save Save and Continue to Registration Save and Continue to SAR Next

9. Referral Report (will change based on the report selection to the name of the report) Referral Criteria Referral Status: County: Date Referral Received To: Mm/dd/yyyy Date Referral Received From: Mm/dd/yyyy Provider/Plan search Provider / Plan Name: Find Provider /Plan Number: Run Report