CommunityMed Family Urgent Care

CMed Online Booking

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HID timeblock for lookup

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walkinid

this is the value of the walkin visit record ID

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did not take walkin

value is 1 if patient took other than walkin, 0 if took walkin

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timeblock data pull

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HIDDEN timeblock

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Hours from now

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HID Visit Time Name

This is the name of the time block selected by the patient

PATIENT LEGAL Name(Required)

Name as it appears on ID or for insurance

First Last

MONTH the PATIENT was born(Required)

Enter the NUMERICAL month the patient was born (01 to 12)

DAY the PATIENT was born(Required)

Enter the NUMERICAL day of the month the patient was born (01 to 31)

YEAR the PATIENT was born(Required)

Enter the NUMERICAL year (4 digits) that the patient was born (YYYY)

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Build birthdate

CONFIRM PATIENT Date of Birth(Required)

We apologize to our RETURNING patients

I AM SO SORRY – we have a new registration system, and it is taking a couple of days to load our existing patients in the system. I know it is a hassle, but we need to ask you to fill out a few additional details you have already completed if you are a return patient. THIS WILL BE FIXED THIS WEEK.

Is the patient a NEW or EXISITING patient for CommunityMed(Required)

NEW patient – Never been to a CommunityMed before

EXISTING Patient – has been to a CommunityMed clinic before

Patient or Parent (for minor) Mobile Phone(Required)

The the number we should call when you are in the parking lot

Enter & CONFIRM Patient or (Parent – for minor) Email(Required)

Enter Email RE-ENTER email to CONFIRM

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FLAG – New Patient

this flag is a 1 =the patient is new or 0 =the patient is existing patient and paperwork is within a 1 year period

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FLAG – Drug Screen

this flag is a 1 =the patient is drug screen or 0 =the patient is not

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FLAG – MVA

this flag is a 1 =the patient is motor vehicle accident or 0 =the patient is not

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FLAG – Work Injury

this flag is a 1 =the patient is work injury or 0 =the patient is not

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FLAG – DOT

this flag is a 1 =the patient is DOT or 0 =the patient is not

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FLAG – School Physical

this flag is a 1 =the patient is school physical or 0 =the patient is not

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HID Visit time block

This variable is carried through the process as the visit time selected. This is the numerical time block (24hr time)

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Time Block ID

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is EPS or WC

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HID Car Make

Pulled from parking lot record

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HID Car color

Pulled from parking lot record

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HIDDEN Arrival Time

from parking lot checkin

Visit ID

99-1-0 Book Time

CMed Online Booking

Website maintenance – we apologize

QUICK REG FOR OFFSITE TIME BOOKING

The SOUTHLAKE Clinic is CLOSED FOR RENNOVATIONS

Additional Visit Details

Because of recent measles outbreaks

As a precautionary measure

CommunityMed will see Motor Vehicle Accident injuries as a self-pay patient

If you have in-network insurance and already used the wellness exam

Child Wellness

Employer Info

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Please Select “Previous” and change answer on “Reason for Visit” to Injury Visit in order to be seen for a workplace injury

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If there are not times, available, the clinic is at capacity

POSSIBLE BIRTHDATE ERROR

We apologize to our RETURNING patients

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