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Description of Fields

Patients -> Demographics

What follows is a description of the fields found on the Demographics form, broken down by tab.

Tab: Intake

FIELD NAME

FIELD DESCRIPTION

ADDITIONAL INFO

Intake Section

Type

Intake or Patient. See section above for description.

Child / Adult

This selection will change the appearance of some forms throughout the program. For instance, the Parent/Guardian Tab will only display on Demographics if patient is listed as a Child.

Will appear if Ages Served is set to Both in the Options Form. Otherwise, will default to global selection and will not be displayed.

Status

Active or Discharged. See section above for description.

Intake By

Name of staff member entering the intake.

List of all active staff names

Contact Method

Indicate whether the patient walked in or initiated contact by telephone.

Initial Contact Name

Name of the person who initiated the contact.

Can be renamed through Custom Labels

Referral Section

Heard About Us From

Enter how the patient heard about your clinic. Can be configured at: Utilities -> Maintenance -> Heard About Us From.

Referred By

Name of person referring patient to treatment.

Referral Phone Number

Referrer’s phone number.

Referral Source

Referral source can be selected from the dropdown list, or entered manually.

Maintenance Item: Referral Source

Allowable values can be constrained by the “Restrict entries: Referral Source” option on the preferences tab on the options screen

Reason For Referral

Reason for Referral (2) and (3)

Reason for Referral can be selected from the dropdown list or entered manually.

Maintenance Item: Reason For Referral

Allowable values can be constrained by the “Restrict Entries: Referral Reason” option on the preferences tab on the options screen .

Patient Group Section

Patient Group

This is where you can assign patients into separate groups for reporting purposes. The default group is named General.

Required Field

Maintenance Item: Patient Group

Patient Group ID#

If there is an identification number associated with this patient group, enter it here.

Additional Patient Groups

This is where you can note additional Patient Groups the patient belongs to. This is simply for recording purposes; the system is only interested in the Main Patient Group for reporting purposes.

Maintenance Item: Patient Group

Miscellaneous Section

Hospital Number

Global chart number for the patient.

Will display on paperwork output.

Additional ID #

Enter any other identification number.

Can be renamed through Custom Labels

Family ID #

Enter an identifier for the patient’s family. This will allow you to track related family members within your program.

Once a Family ID is entered, click the icon to the right to display a list of all clients with the same Family ID

Case Worker

Enter the caseworker name if applicable.

Client Characteristics

Select from a list of custom values configured through the maintenance menu.

Key Dates Section

NOTE: All dates on the Key Dates section of Demographics include a clock icon to the right. It lets you include a time component with the dates you enter. We added this option so you could include a specific admission or discharge hour for institutional claims. A user will need permission granted at Alter Key Patient Info in order to adjust the active/discharged status of a client.

Date Entered

The date that the demographic information is entered.

Date Packet Sent

If information is sent by mail prior to service delivery, enter the date sent here.

Date Packet Returned

If information is sent by mail prior to service delivery, enter the date the information is returned here.

Date Of Contact For Appointment

This is the date the patient is first contacted to schedule an appointment. If unscheduled use the date actually seen. Can be the same date but not later than the date of first appointment.

Date Of Intake Appointment

Date of the initial appointment.

Date Admitted

Date the intake is formally admitted to the click. Type should be switched from Intake to Patient.

If you enter a Date Admitted but leave Type as Intake, the system will prompt you to switch the Type to Patient.

If you set the Type to Patient but leave Date Admitted empty, the system will prompt you to enter a Date Admitted.

Date Assigned To Follow-Up Clinician

Date clinician is assigned to a case. Maybe same date as date first seen but not later.

Date Of Discharge

Date intake/patient is discharged. See section above for more information.

Will only be enabled if Active/Discharged is set to Discharged

Successfully Discharged

Check this box if the client was discharged after successfully completing treatment.

In the CD version, this will determine if a Discharge Plan is required.

Mental Health/Chemical Dependency Section

Mental Health

Check this box for Mental Health patient.

No Compliance

Check this box to not create a compliance record.

Chemical Dependency

Check this box for chemical dependency patient.

No Compliance

Check this box to not create a compliance record. If this box is checked, the system will bypass rules for the module(s) marked as "No Compliance".
For example if a customer has MH and CD modules enabled, and only MH is marked as "No Compliance', the rules that are valid for CD will still be applied. Only the MH rules will be bypassed.

Primary

Choose primary: Mental Health or Chemical Dependency.

Assignments Section

Intake Service

Intake Service performed.

Maintenance Item: Intake Service

Intake Clinician

Name of clinician that will complete the intake. This will be automatically set as the clinician on the Compliance record if Compliance Automation is set in the Options form and a follow-up clinician has not already been assigned.

List of all active clinicians

Follow-Up Clinician

Indicate the clinician assigned to the case after intake. This will be automatically set as the clinician on the Compliance record if Compliance Automation is set in the Options form.

List of all active clinicians

Intake Disposition

A description of what happened with the intake (selected for a specific program, referred out, etc.).

Maintenance Item: Disposition

Primary POS

Primary Place of Service: where the patient will receive services by the clinician.

Maintenance Item: Building

Diagnosis Type

Enter diagnosis type here as configured in: Utilities -> Maintenance -> Diagnosis Type Input.

Notes Section

Notes

Enter any additional information you would like to store about this patient.

Basic Information

Photo

Click Add to add a photo of patient.

Scheduled Appointments (over next 60 days)

View a list of appointments over the next 60 days.

Staff Assignments

Click this button to open Staff Assignments.

Program Assignments

Click this button to open Program Assignments.

Collect Copay

Click this button to open Collect Copay screen.

Insurance Auths

Click this button to open Insurance Authorizations.

Scheduling Groups

Click this button to open Scheduling Groups Setup.

Foster Home Placement

Click this button to open Foster Home Placement.

Completed Paperwork

Click this button to open a list of completed paperwork.

Tab: Demographics

FIELD NAME	FIELD DESCRIPTION	ADDITIONAL INFO
Patient Details Section
Last Name	Patient’s last name.
First Name	Patient’s first name.
Middle Name	Patient’s middle name.
Alias	Any other name the patient may be known as including nickname.
Suffix	Any suffix that patient uses as part of their legal name
Gender	Male or Female. Patient’s gender.
SSN	Patient's Social Security Number.
Date of Birth/Age	Patients date of birth and age.
Address Section
Unknown	Check this box if the patient's address is unknown.
Homeless	Check this box if the patient is homeless.
Address	The legal street address of the patient.	Additional options for “Unknown” or “Homeless” will satisfy the requirement for the address fields.
City	The city where the patient lives.	You can also use the Zip Code lookup feature to populate the patient's address.
State	The state where the patient lives.	You can also use the Zip Code lookup feature to populate the patient's address.
Zip	The zip code for the patient address.	You can also use the Zip Code lookup feature to populate the patient's address.
County of Residence	Enter patient’s county, or select from dropdown list.	Can be renamed through Custom Labels (for instance Ward in DC). Maintenance Item: County Allowable values can be constrained by the “Restrict Entries: Counties” option in the preferences tab on the options screen.
County of Financial Responsibility	Enter the county where the patient’s responsible party resides.	Allowable values can be constrained by the “Restrict Entries: Counties” option in the preferences tab on the options screen.
Country of Birth	Enter the country where the patient was born.
Contact Info Section
Phone Number	Patient’s phone number.
Other Number	Patient’s alternate phone number.
Email Address	Patient’s email address
Cell Phone	Patient's cell phone.
Preferred Contact Method	Preferred method of contact.
Time Zone	Time zone of patient.
Miscellaneous
Smoking Status/Comments	Does patient smoke? Enter any comments as appropriate.
Offered Cessation Counseling	Check here if patient was offered cessation counseling.
Reason for Not Offering Counseling	Enter a reason that cessation counseling was not offered.
Contact Notes:	You can enter calling preferences, allowed to leave a message, etc.
Requires Interpreter	Check here if patient requires an interpreter.
Requires Transportation	Check here if patient requires transportation.
Is Disabled	Choose appropriate selection.
Household Information	List people living with patient and comment on employment status. Also note if they are currently or have ever received treatment at this agency in the past and when.
Directions and Scheduling Notes/Launch Google Maps	Enter any specific directions or notes here as well as being able to launch Google Maps.
Other Details Section
Sexual Orientation	Patient's sexual orientation.
Employer	Patient's employer.
Race	Patient's race.
Race Other	Patient's race if not found above.
Ethnicity	Patient’s ethnicity.
Citizenship Status	Patient's citizenship status.
Marital Status	Patient's marital status.
Advanced Directive	Does patient have an advanced directive?
Primary Language	Patient's primary language.
Tribe	If you select a race of ‘Native American,’ this will display a list of tribes.

Tab: Parent/Guardian

Note: Only visible if patient is flagged as Child on Intake Tab

FIELD NAME

FIELD DESCRIPTION

ADDITIONAL INFO

Marital Status

Indicate the marital status of the patient’s biological parents.

Number of Children in Family

Total number of siblings.

Number of Children in Home

Total number of siblings in patient’s home.

Number of Children in Same School

Total number of siblings in patient’s school.

School Name

Patient’s school name.

Child Only.

Maintenance Item: School

School District

Patient’s school district.

Child Only

Grade

Patient’s grade level. Enter current grade, if summer enter grade starting in the Fall.

Child Only

Father’s Information

Provide the legal name, current address, phone numbers, occupation, and years of education for the biological father. There is a section for notes as well as a checkbox to indicate if the father is deceased.

Click the Same as Child button to automatically fill certain information from the Demographics Tab.

Mother’s Information

Provide the legal name, current address, phone numbers, occupation, and years of education for the biological mother. There is a section for notes as well as a checkbox to indicate if the mother is deceased.

Click the Same as Child button to automatically fill certain information from the Demographics Tab.

Primary Legal Guardian

Enter demographics for primary legal guardian if other than parent.

Secondary Legal Guardian

Enter demographics for secondary legal guardian if other than parent.

Custodial Guardianship

Indicate who has legal custody of patient.

Tab: Outside Providers/Contacts

This tab records information about outside agencies currently involved with the client. The data entered in the Pediatrician, Outside Mental Health Provider, and Pharmacy sections can be used to create mailing labels by going to Actions -> Create Envelope Label.

FIELD NAME

FIELD DESCRIPTION

ADDITIONAL INFO

Pediatrician/Primary Care Physician

Record information about the consumer’s pediatrician or primary care physician (depending on age category).

Maintenance Item: Pediatrician/Primary Care Physician

Outside Mental Health Provider

Record information about the consumer’s outside mental health provider.

Pharmacy

Record information about the consumer’s pharmacy.

Use the Pharmacy Lookup to populate the Pharmacy fields.

Emergency Contact Info

Enter additional emergency contact information.

External Contacts

Indicate other people/agencies involved, including additional family members or professionals.

Tab: Insurance

This tab contains space for up to three insurers. To more prominently indicate when you record a payor, the system will put asterisks on either side of the Demographic form's insurance tabs (as in, *** Secondary Details ***) when you select a payor within that tab.

FIELD NAME

FIELD DESCRIPTION

ADDITIONAL INFO

Company

Select the name of the insurance company.

Policy/Member ID Number

Insurance ID Number.

Group Number

Insurance Group Number.

Policy Holder

Policyholder of coverage.

Insured’s Employer

Policyholder’s employer.

Individual Copay

Enter the patient's individual copay amount.

Insured’s DOB

Policyholder’s date of birth.

Last Qualification Date

Last date when insurance card was presented.

Next Requalification Date

Next date when insurance card needs to be presented.

Can be automatically calculated based on information entered in Maintenance Screen for Insurer.

Insurance Coverage Cap

Enter the insurance coverage cap.

Group Copay

Enter any group copay amount.

Scan Insurance Card

Click this button to scan an image of the insurance card from any compatible scanner. Once you do this, a thumbnail image will appear in the box below the button. Clicking on the thumbnail will display the full image. If you have an image attached and want to remove it, click the Remove Insurance Card button.

Image will also be saved in patient’s Related Documents record.

Service Specific Fees

Click here to enter any Service Specific Fees.

Patient Relationship to Insured

If the policyholder is not the patient, completes this section.

Annual Deductible ($)

The patient's annual deductible. This field is also available in the Report Builder's main Demographic Views.

Annual Deductible Met ($)

How much of the annual deductible has been met. This field is also available in the Report Builder's main Demographic Views.

Tab: Financial

This tab contains information related to a client’s financial status.

FIELD NAME	FIELD DESCRIPTION	ADDITIONAL INFO
Responsible Party Section
Responsible Party	Select who is the responsible party for billing purposes (client, other, mother, father). If Other is chosen, enter the custom information in the fields on this page. If your clinic has the Credit Card Module enabled, The Integrated Credit Card Processing option will default to this confirmation email address (rather than the patient's) when submitting payments. This section also contains a "Push to Open Claims" button. You can update the responsible party on any open claim with the current information by clicking this button.	Mother and Father are only visible if client is flagged as Child.
Reduced Fee Section
Not Billable for Any Services	Check this box if patient is not billable for any service.
Reduced Fee Eligible	Check this box if patient is eligible for reduced fees for services performed. Patients with this item checked will qualify for the reduced fee schedule configured in BillingTracker.
Gross Income	Enter gross income to determine reduced fee amount.
People in Family	Enter number of people in family to determine reduced fee amount.
Additional Information Section
Signature on File	Patient signature required for HCFA claim submission.
Financial Assignment	Assigns practice to receive payments for services.
Reduced/Free Lunches	Check this option if the client received reduced or free lunches at school.	Only visible if client is flagged as Child.
Open Balances Section
Open Balances	If linked to BillingTracker, all open balances for the patient and his/her insurers will be displayed here.
Accident Information (For Workers' Comp Claims)
Accident Information	Enter information here if treatment is due to a Workers' Comp claim.
Insurance Type Code (Used for Secondary Claims)
Insurance Type Code	If there is a selection in this drop down field, upon transition, the system will check for this value, and if present, use that to populate the existing field in the Additional Claim Details for SBR05. When submitting a claim, if the payor that is being submitted to is not primary and the payor has the existing insurance plan setting enabled for include SBR05, then pass the value from additional option. For more information on how to include the SBR05 in Loop 2000B, see #15 on the Secondary Claims Tab.

Tab: Info Release

Used to track authorization to disclose confidential health information. If you notice that this tab is colored yellow, it indicates that one or more consents are expired or set to expire in less than 30 days.

FIELD NAME

FIELD DESCRIPTION

ADDITIONAL INFO

Authorized Recipient

The name of the person authorized.

Relationship to Patient

Authorized person’s relationship to patient.

Phone Number

Authorized person’s phone number

Authorized By

Who granted the authorization?

Date Permission Granted

Date authorization granted.

Date Permission Expires

Date authorization expires.

You can run a report on all authorizations about to expire by going to Admin Reports -> Compliance Information -> Information Distribution Consent Tracking.

On Discharge

Check this box if you would like the permission to expire when the patient is changed to discharge status.

Notes

Enter additional information, including what you are authorized to disclose.

Void

When a consent expires, rather than deleting it, which will remove any record of a consent existing, simply check the Void checkbox. This will cause the consent to not turn the Info Releases Tab yellow as well as removing it from the Information Distribution Consent Tracking report.

Once you have entered all the authorization information, click the Save button below, which will add the record into the Authorization List on the left. You may repeat this process to enter as many authorizations as you wish. To make modifications to an existing record, double-click its entry in the Authorization List on the left. Make the necessary changes and click the Save button, or press the Delete button if you wish to remove the record.

Completing Release of Information Forms

This feature is only available to agencies who have licensed the eForms module. Once you have created a record of the authorization, you can complete a full release of information form, and collect signatures. You can also record information regarding the revocation of consents. With an authorization record loaded, click the Complete Consent Form button. You will see two tabs, one for Authorization, and one for Revocation. All the information you entered in the Info Release screen will be displayed on the Authorization tab. In addition, you can add details concerning the authorized information, the purpose of authorization, and any additional notes. The Revocation tab allows for collecting the date of revocation and additional notes. Each section allows for up to three signatures (collected via signature tablets) from the patient, parent/guardian, and a witness. For each signature entry, you can either collect an actual signature, or click the button that says None Needed. The button colors will update depending on the status. Green buttons indicate you can collect a signature. Red buttons indicate signature has already been collected (or you indicated a signature was not needed).

Once all three signatures have been entered, the authorization becomes record-locked. You will no longer be able to make changes to the information on that tab, or the corresponding information displayed in the Info Releases tab. A column in the Info Releases grid labeled Locked will show the current status of all releases. It will display Y or N followed by a slash, followed by Y or N. The first letter represents if the Authorization tab is locked. The second letter represents if the Revocation tab is locked.

Disclosure Tracking

Once the authorization record exists, you have the ability to track disclosures related to that authorization. Load the Authorization Record (double-click the corresponding item in the list on the left side of the Info Releases Tab) and click the Disclosure Tracking button. This will bring up the Information Disclosure Tracking Form. In a similar fashion, enter the date of disclosure and a description of the disclosure. Hitting the Save button will add the record to the list on the bottom of the form. When you have finished recording disclosures, close this form to return to the Info Releases Tab.

Note:

A picture of a hand holding paper next to the Disclosure Tracking button indicates there are linked disclosure records for the selected authorized individual.

Description of Fields

Tab: Intake

Intake Section

Referral Section

Patient Group Section

Miscellaneous Section

Key Dates Section

Mental Health/Chemical Dependency Section

Assignments Section

Notes Section

Basic Information

Scheduled Appointments (over next 60 days)

Tab: Demographics

Patient Details Section

Address Section

Contact Info Section

Miscellaneous

Other Details Section

Tab: Parent/Guardian

Tab: Outside Providers/Contacts

Tab: Insurance

Tab: Financial

Responsible Party Section

Reduced Fee Section

Additional Information Section

Open Balances Section

Accident Information (For Workers' Comp Claims)

Insurance Type Code (Used for Secondary Claims)

Tab: Info Release

Completing Release of Information Forms

Disclosure Tracking