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For Patients

Complete intake forms right after sign-up to provide demographic, medical, and insurance information.

For Providers

View complete patient demographic details and medical history in patient records.

For Admins

Access patient tables with insurance details and consent signatures in the admin area.

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Core Features

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Patient Demographic Data

  • Basic Information: Collect name, address, phone, email and other details
  • Template Library: Pre-built forms for common intake scenarios
  • Field Validation: Real-time error checking and input validation
  • Auto-Population: Use existing patient data when available
Patient demographic data collection

Patient demographic data collection

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Medical History Collection

  • Past Medical Conditions: Customizable list of conditions and diagnoses
  • Current Medications: Drug names, dosages, and frequencies
  • Allergies & Reactions: Medication, food, and environmental allergies
Medical history intake form

Medical history intake form

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Insurance Details & Verification

  • Insurance Information: Primary insurance details
  • Card Upload: Photo capture of insurance cards front and back
Insurance details and card upload

Insurance details and card upload

  • Electronic Signatures: HIPAA-compliant digital signature capture
  • Consent Forms: Placeholders for your consent form(s)
Digital consent and signature capture

Digital consent and signature capture

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User Workflows

  • Patient Journey
  • Provider Workflow
  • Admin Management
1

Sign Up

Patient creates account
2

Enter Demographic Information

Provides personal information, contact details, and emergency contacts
3

Provide Medical History

Details past medical conditions, current medications, and allergies
4

Upload Insurance Details

Enters insurance information and uploads insurance card photos
5

Sign Consent Forms

Reviews and provides digital signature for consent and authorization
6

Submit & Continue to Dashboard

Completes intake forms and proceeds to patient dashboard

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Usual Component Interactions

The Intake Forms component integrates seamlessly with other components to create complete patient onboarding workflows: Core Integration:
  • Patient Profile: Creates and updates patient records with intake form data
  • Basic EMR: Automatically populates patient charts with form responses
  • Authentication: Ensures secure access to patient-specific intake forms
Common Enhancements:
  • Questionnaires: Detailed medical questionnaires that follow the generic intake forms
  • Checkout Component: Payment processing and service selection after intake completion
  • Notifications: Send reminders for incomplete forms and completion confirmations

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Implementation Examples

The Intake Forms component comes with standard templates for common healthcare intake scenarios, but you will typically want to customize forms for your specific practice needs. Below are some common customization examples.
  • Custom Medical History Fields
  • Insurance Pre-Authorization Integration
Situation: You want to collect different medical history information than the default past medical conditions, medications, and allergies.
"Add a Surgical History section to the medical history part of our intake form. I want to collect information about patients' previous surgeries alongside the existing medical conditions, medications, and allergies sections. 

Set up a new database table called surgical_history to store this data for each patient. For the surgical history fields, include things like procedure name, date of surgery, surgeon/hospital, and any complications - you decide what makes sense for the data structure and which fields should be required vs optional.

Make sure this surgical history shows up in the EMR sidebar so when providers are seeing patients, they can quickly see their surgical background. The data should automatically flow from the intake form into their chart.

Also, when you're building the form fields, let me know which 2-3 surgical history fields you think should be mandatory vs optional - I want your recommendation on that."
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