INFOREQ              Maintain Request Log                     

#19 from Other Processes

                   Select :  _

                   1. Requests for existing patients

                   2. Requests for patients not on file

                   3. Report of open requests

Add Request

Date SVC: 07/15/05      Doctor: 1    Place: 1    Type: 4_  1 FACE SHEET

To Who:   1   Office     Received:                         2 AUTH'S

  Code:                                                    3 OP REPORT

                                                           4 INSUR CARD

                                                           5 DIAGNOSIS

   ***************** Request Notes ********************    6 CHART NOTES

   *oh Happy days                                     *    7 REFERRING DOC

   *Springtime is here, but we need face sheet from   *    8 XRAY

   *hospital, reflecting charges and surgery codes    *    9 CPT CODE

   *                                                  *    10 PICTURE

   *                                                  *

   *                                                  *

   *                                                  *

   ****************************************************

Change What(0 for None,   88 Fax,  99 Print): __

Field Explanations

Date SVC:  Enter the Date for which you need info., eg Date of surgery, visit

Doctor:  Which doctor performed service.  Can be left blank

Place:    If there are multiple offices, which office.  Can be left blank

Type :  What type of information?  Select from a list. Enter up to 6 types. ESC to exit.

To Who:  Is request sent to Office,  Insurance,  Referring Doctor ??  Press TAB to get scroll thru choices

Code   :  If request sent to Insurance or Ref Doctor,  which Insur or Doctor code ?

Received:   When you finally get the info , enter a received date.

Request Notes:  Enter any free form note.

Open Request Log

Date             Patient                          Type        D.O.S.              Note                    .

07-02-05    92812-2  JONES,MARY       OP-REPORT   05-15-05

07-12-05    91229     SMITH,HANNIBAL     AUTH         04-19-05     Need auth for 2^nd surgery

Sample Request Print Out

09/14/05 12:30 PM 

From:

     Zybex PAM Dept              ß  This text is from the boilerplate

     10655 Roselle St.               heading.  Use menu 98 to change.

     San Diego,  CA  92121         

     858-558-8488

To:

    PLACE ONE               

    PO BOX 11111            

    SAN DIEGO, CA  92120

                      Information Request    

Patient : AGUILA,MARIA                   Chart :     123

Rsp Prty: THOMAS,RONNY                   Birth : 12/03/1995

          1234 MAIN ST                   Injury: 06/12/97

          SAN DIEGO, CA 92111

Ins 1 :   13 AMA INSURANCE AGENCY    ID: 553924800          Grp: 548600237B

Ins 2 :   12 AETNA LIFE INS          ID: 553924800-01       Grp: sdasda XX

---------------------------------------------------------------------------

Orig Request Date:  09/13/05                     Request by:  Zybex Mast

Item Requested   :  AUTH'S / TAR                 Date of SVC: 06/15/05

                    DIAGNOSIS

                    Remicade

                    Bone Density

                    CHART NOTES/MED REC

                    CPT CODE

         Actually need forms for entire week of 6-15-05                        

Thank You  

Account Manager: Zybex Mast

         vvvvvvvvvv  This text is boilerplate  tail  vvvvvvvvvvvvv

      ****  Please Fax back this cover sheet with your return Fax Info  ****

                             Fax # : 858-558-1537

                             Voice : 858-558-8488   

Sample Types of requests,  from  inqtype.crd

!  INQTYPE.CRD can be in both RUN ppn or Indiv log PPN

!   The one in Run PPN is a standard one for all D-Bases, and the

!    individual DBase can also have addtional types.

!   In Run PPN,  INQTYPE.CRD can have max of 10 entries

!   In Log PPN,  INQTYPE.CRD can have max of  5 entries

1-FACE SHEET

 2-AUTH'S

 3-OP REPORT

 4-INSUR CARD

 5-DIAGNOSIS

 6-CHART NOTES

 7-REFERRING DOC

 8-XRAY

 9-CPT CODE

10-PICTURE

CSR Setup:  When sending files,  make sure permissions are rw-rw-rw.

In Run PPN:  inforeq.run     inforq.scr

Files Created or needed

Inqtype.crd   in either Log ppn or Run PPN

Log PPN:

Inforeq.id*          These 2 files are automatically created the first time

Inforeq.mmo             you run this program.

Inforeq.hed:  Standard text that prints at top of letter. Use  VUE.

Inforeq.tal:    Standard text that prints at bottom of letter. Use  VUE.