Custom Forms
Forms are designed using the Create Forms application under Activities Menu – Custom Forms.
Custom Forms are used to provide the templates for Patient Statements, Patient Invoices, Credit Memos, Information Sheets, Super Bills, and any other form that your practice requires.
The Custom Form screen lets you add text, database, and other objects to a form. These forms can then be printed using the Print Menu - Print Forms – Custom Form. The objects that you can add are:
· Text
· Database Field
· Lines
· Boxes
· Patient Statement Object
· Patient Invoice Object
· Page Number
· Current Time
· Current Date
· Images
· Background Image
To add one of these objects to your form, use the Tools menu or click on one of the objects in the Tool Bar. After you’ve selected an object, click your mouse somewhere in the vicinity of where you want to place the object.
Text Fields:
When you select the text object and click on the form, you can begin typing the text that you want. You can type multiple lines of text by pressing the enter key when you want to start a new line. When you are finished typing your text, press the Esc key to exit the text editing mode.
Database Fields:
For database fields, you are given a choice of what database field you want to use.
You can choose from the following database tables:
1. Patients
2. Providers
3. Facilities
4. Payers
5. Practice
6. Claims
After you’ve chosen a table, the list of available items for that table will populate. The Text field of this screen will default to the name of the item that you’ve selected. This text will only be displayed on the form when you’re editing the form. Once the form is printed, the actual data from the database will appear at this location.
Lines and Boxes
Draws line and boxes. Use your mouse and click the upper left or left side of the box or line that you want to draw. Then hold the left button down and drag the mouse to the lower right or right side of the box or line. Then release the mouse. You can resize the box or line by clicking the small handles in the corners and dragging your mouse. To move the object select the item and use your arrow keys to move the item to the correct location.
Page Numbers
Page Number will insert the page number of the form that is printed. The page number object will only apply when a Patient Statement object is present on the form. Patient Statement objects are the only objects that may produce multiple pages from a custom form.
Current Date/Time
Current Date or Current Time will show the date or time on the form.
Images
Add an image to your form. You can add the following image types. GIF, JPG, BMP, TIF. Images can be moved around and positioned anywhere on the page.
Background Image
Adds a background image to the page. Use this if you already have a scanned template of your form. The background image can be any file of type GIF, JPG, BMP, or TIF. The image is automatically stretched to fill an 8.5x11 sheet of paper in either landscape or portrait mode. This image cannot be sized or moved. If the paper in your printer already has the image pre-printed, check the box that says Do not print background image.
Patient Statement Object
Use the Patient Statement Object when you are creating a form to be used as a Patient Statement. When you insert a Statement, a large block will be placed on the form. Double click your mouse on the line numbers shown at the left side of the block.
Place a check mark next to the items that you want to show on your statement. Enter the x-position of where these columns should begin. These positions represent inches from the left side of the paper. The associated items text will appear in this position.
The following options apply:
1. Skip a line after every claim. This will spread the items out by including an extra empty line in between claims.
2. Indent payments and adjustments. If this box is checked, payments and adjustments will be indented to the right. Insurance payments and adjustments will be printed directly below the charge that they were applied to. Patient payments will appear at the bottom of the statement. For clarity, patient payments are grouped by date into one payment rather than showing the breakdown of the payments and how they were applied to each charge.
3. Replace procedure description with the following text. By default, the description for each charge will be the description used when the claim was created. This is typically the description of the procedure or CPT code. If this box is checked, enter the text that you want displayed as an alternative to the description from the claim.
4. Additional information; claim has been filed and patient owes claim balance. You can include additional information on the charge line that indicates that status of the claim. Use these fields for further clarification to the patient regarding the status of the claim.
If the statement exceeds the Number of lines per page then a 2nd page will print.
Use the Patient Invoice Object in a similar way. The only difference between the Patient Statement and the Patient Invoice is that an invoice will only show services and applied payments for a single visit. Patient Credit Memos should be created using the Patient Invoice Object.
Object Linking
Sometimes database objects will need to be linked in order for the text to display properly. When you want to have the text of a database object directly follow the text of another database object, you will need to link the objects together. Without linking, you will either have large gaps between the database objects, or the object on the left will overwrite the object to its right. This occurs because the length of the actual text that gets printed varies depending on the data that is selected.
To link database objects, add the objects to your page working from left to right. Use your mouse and select all the objects. Once the objects are selected, make sure that their vertical base position is the same. You can set all of them to the same vertical base position by clicking the align bottom on the tool bar.
Then click the link button on the tool bar.
For example, if your form prints the city state and zip code, your form layout may look like.
These items have been linked. The first item is the anchor since it is on the far left, it will be printed first. The state will be printed directly after the city, and finally the zip code is printed directly after the state.
The resulting form when printed looks like:
Printer Selection
You can have your form automatically print to a specific printer. Before saving your form, select the printer that you want to use in the Printer Selection drop list. You can also specify the orientation of the page to be landscape or portrait.
Expressions
Some database fields are logical fields or numeric fields that carry a certain meaning. For example, patient sex is stored in the database as a logical field. Logical queries are returned from the database as ‘Yes’ or ‘No’. In MDC, a logical ‘Yes’ indicates Male and a logical ‘No’ indicates Female. If your custom form uses a logical field, you will more than likely not want the words Yes or No to appear on the form. Rather, you’ll want some other text that indicates what Yes means and what No Means. When this is the case, click the Expression check box. You can enter an expression in the Text field that MDC will interpret when the form data is processed. The following expression would apply to the patient sex item.
IF$= "YES" THEN "MALE";IF$= "NO" THEN "FEMALE" (separate these items with a semi-colon)
In this expression, the word ‘Male’ is printed if the logical is equal to Yes. ‘Female’ is printed if the logical is No.
You can use expressions to place X’s on pre-printed forms. For example, suppose you are creating a form whose data is going to be printed on a preprinted form. The preprinted form has a series of boxes indicating Patient Marital Status. You can use the expression:
The expression IF$= “0” THEN “X” will place the text ‘X’ at the specified location if Patient Marital Status is equal to 0. If the Marital Status in not equal to 0, then no text gets printed.
Click here for information on database values where expressions may apply.
Note: make sure that there is a space directly following the IF$= command and also spaces in front of and behind the THEN command.
In this example, a custom form is being created where we are going to indicate the marital status in 1 of 3 check boxes. The 3 checkboxes from left to right have the following expressions:
IF$= "0" THEN "X"
IF$= "1" THEN "X"
IF$= "2" THEN "X"
Each of these expressions is using the Patient table with database item ‘Marital Status’. The actual marital status value will be displayed at the top. When creating a form, an expression will always be denoted by the words EXP.
The Patient and Primary Insured sex are also going to be printed. The Patient sex is using the Patient table with item ‘Patient Sex’ and the Primary Insured sex is using the Patient table with item ‘Primary Insured Sex’. The expressions for both are:
IF$= "YES" THEN "MALE";IF$= "NO" THEN "FEMALE"
When the form is printed, the resulting page looks like:
The IF$ command can be any of the following:
· IF$=
· IF$>
· IF$<
· IF$>=
· IF$<=
· IF$<>
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Last updated: 1/8/2009