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Querystring HIDDEN – Traffic Source

checkinid: This is the variable set by where the customer accessed the form

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Querystring HIDDEN Arrived

this value is 4, set by querystring, for patient in the parking lot. Otherwise it is 0

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preload HIDDEN Parking lot Clinic ID

ARTIFICIALLY SET TO 2, ERASE WHEN DONE – This variable is set by what parking lot the patient has checked into. Variable is Location set by querystring

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preload HIDDEN Parking lot Clinic Name from ID

This variable is set by what parking lot the patient has checked into. Variable is Location set by querystring

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Select Clinic(Required)

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Is clinic active

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New Querystring of location

set in new querystring

–

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visit ID Code

z code read from querystring if applicable

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preload HIDDEN – Current Hour

This captures the current hour of when the patient is completing this form

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preload HIDDEN – DecimalTime

This is the variable showing what the decimal time the patient is completing this form

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preload HIDDEN – Today Date

This is the variable that captures the date of entry for use in calculations

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current URL

Clinics are closed for Thanksgiving and reopen on Friday 11/29 at 8am

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referring URL

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Calculated HIDDEN FLAG Arrived

this value is 1 for patient in the parking lot. Otherwise it is 0

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EMR used at clinic

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Clinic Parkinglot Message

You are Checking In to the Clinic

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Section Break to show the emergency message

cant move on to next step without agreeing to the emergency message

IF PATIENT IS HAVING MEDICAL EMERGENCY THREATENING LIFE OR LIMB

Please proceed directly into the clinic with your ID and insurance card.

Medical emergencies may include, but are not limited to:

Chest pain
Symptoms of a stroke (e.g. facial drooping arm/leg weakness or paralysis, speech difficulty)
Distressing difficulty breathing
Severe trauma or bleeding
Severe abdominal pain
Drug overdose/accidental poisonings

Completing electronic forms will let us see you faster, please see the front desk if you have any problems

Please enter cell phone number

We will use this number to look up if you already booked a visit up in our system using this phone number. If the visit was booked using a different mobile number, enter that number here.

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HIDDEN VISIT ID from entry

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copyto HIDDEN visit ID

This is the visit ID populated by copyto from either 169 or 170. it is -1 or blank? if there are no z-codes generated

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Lookup cell phone

this looks up the cell phone on the visit table to see if there is already 1 and only 1 visit entered into the visit table with this cell number. If therre are more than one visit entry with the same phone number, have the person enter their visit Z code to differentiate wich visit they are checking in for

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Visit_ID_Code from phoner number lookup

if there is only one visit table entry for the cell number, lookup the visit ID code (z code) for that visit and use it to populate the z-code lookup. If there is MORE than one or LESS than one entry for that cell number, then ask if they are already registered, and, if they are, then ask for the patient the z-code

We Found Your Visit

from your cell phone number

We Found Multiple Visits

from your cell phone number, we found multiple bookings.

Reason for multiple bookings(Required)

There are multiple patients to be seen

There is one patient, but I booked multiple time blocks

There is one patient, multiple bookings is a mistake

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multiple bookings

Select below which patient you are checking in

Select below which booking time you are checking in for, we will delete any others

Select which patient booking you are checking in for

You have multiple bookings setup under the same phone number

Select which time block booking you are checking in for

You have multiple bookings setup under the same phone number

We DID NOT find a visit booking

from looking up your cell phone number.

if you know you have a visit setup
and have received your VISIT ID (Starts with a Z), you can proceed and use that to identify your visit.

OR you can also hit “Back” and correct or try another possible number that was used when the visit was setup

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Registration Lookup

this section allows patients who hd either more than one or 0 records returned when looking up their cell number – this allows an already-registered patient to enter their Z code

Have you already started registration or reservation for this visit?(Required)

Yes, I have already booked a spot and done paperwork, and have the VISIT ID number (starts with Z)

No, I have not booked a spot yet for this visit

Please enter your VISIT ID (Starts with a Z)

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Lookup in View

this looks up all the patient data for the visit based on the Visit_ID_code (z-code) and populates the field array with any information required for the visit

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Patient ID

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Section Break to show page ID

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field array HIDDEN Patient ID from the reg record

this populates the patient ID from the populate anything field array from field 136 lookup in view

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FLAG – calculated Z-code reg Record Found

1 is the visit ID is valid, 0 is the visit ID is not valid/not found. it takes the visit record number (field 136 Lookup in View) and calculates it as a 1 or 0

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field array HIDDEN clinic ID from the reg record

This populates the clinic Location_ID from the field array of populate anything for field 136

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HIDDEN EXISTING Registration Flag

1 if reg is existing, 0 if patient is pulling in for new registration – Calculated based on the field 116 Hidden Patient ID having a value

We did not find your Visit ID from the Z code you entered

Please press “Previous” button at the bottom of the screen and re-enter the correct Visit ID code,
or let us know below if you need help or will go ahead and complete a new registration

DELETE? We were unable to find your Visit ID Z code

I will go ahead and create a new registration – I realize that I may not get the same time slot

Alert the front desk – I will pop in and ask for help after I finish this check-in

We will open a chat session to help you -Front Desk – we need some help with a Visit ID Code

We found your Visit ID from the Z code you entered

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HIDDEN visit Date

This pulls in the scheduled visit date

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HIDDEN visit timeblock start

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HIDDEN Days from today

This is the variable of how many days from today is the selected visit date.

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Hours from now

How many hours from now is the appointment time

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HIDDEN – Wrong Location Flag

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HIDDEN – Wrong Visit DATE Flag

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HIDDEN – ERROR

This field will calculate to a 1 if there is an error to display and a 0 if there is no error

IMPORTANT MESSAGE

Clinic is currently closed –
Don’t worry – We can still book you for when we are open!

We are open Mon – Sat 8am-8pm and Sun 12pm-8pm

Please go ahead into the clinic to let the front desk know you are here and completing your paperwork.
You can still complete it on your phone, but this way we know you are here to be seen near closing.

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There Seems to Be an Error

You MAY be at the wrong clinic from where you registered…

Our records show you registered at the {:74} clinic, and you are actually at the clinic.

You MAY be at the clinic on the wrong Visit Date…

Our records from the Z-code visit ID you entered show you registered for a visit on , and today’s date is @May 10, 2025

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Parking Lot Info

What is your Car color

What is the Make and model of your car

Patient Name(Required)

First Last

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Patient Date of Birth(Required)

POSSIBLE BIRTHDATE ERROR

Please check birthdate – we can’t see newborns except emergency.

We will use THIS phone number to contact you for this visit(Required)

We will use the number below to contact you IN YOUR CAR for this visit, Please add or update the number to the correct mobile phone

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Next Step

Lets get you a spot in line – click “Next” below to continue

Clicking “Next” below will check you in as ready to be seen.

We utilize a virtual waiting room, waiting from your car for your protection and convenience.
Our medical staff to call you on the number you provided to start your visit.

If you have any questions or want to wait in our limited-space waiting room, please proceed into the clinic and talk to the front desk.

Pop into the front desk for help

When you complete this form, we will let the front desk know you are coming in because your visit ID was not found

the unique ID below is only for the temporary parking lot queue for patients who are starting the reg process but have not completed it yet. Iit will also be used to pull in patient details to the reg paperwork

Parking Lot Unique ID

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Clinic Main Phone Number

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HIDDEN Create Clockwise Flag

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HIDDEN Place in line

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CommunityMed Registration Test

Clinics are closed for Thanksgiving and reopen on Friday 11/29 at 8am

You are Checking In to the Clinic

Section Break to show the emergency message

IF PATIENT IS HAVING MEDICAL EMERGENCY THREATENING LIFE OR LIMB

Completing electronic forms will let us see you faster, please see the front desk if you have any problems

We Found Your Visit

from your cell phone number

We Found Multiple Visits

from your cell phone number, we found multiple bookings.

multiple bookings

We DID NOT find a visit booking

from looking up your cell phone number.if you know you have a visit setupand have received your VISIT ID (Starts with a Z), you can proceed and use that to identify your visit.OR you can also hit “Back” and correct or try another possible number that was used when the visit was setup

Registration Lookup

Section Break to show page ID

We did not find your Visit ID from the Z code you entered

We found your Visit ID from the Z code you entered

IMPORTANT MESSAGE

Clinic is currently closed – Don’t worry – We can still book you for when we are open!

Section Break

There Seems to Be an Error

You MAY be at the wrong clinic from where you registered…

You MAY be at the clinic on the wrong Visit Date…

Section Break

Parking Lot Info

POSSIBLE BIRTHDATE ERROR

Section Break

Next Step

Lets get you a spot in line – click “Next” below to continue

Clicking “Next” below will check you in as ready to be seen.

Pop into the front desk for help

Section Break

from looking up your cell phone number.

if you know you have a visit setup
and have received your VISIT ID (Starts with a Z), you can proceed and use that to identify your visit.

OR you can also hit “Back” and correct or try another possible number that was used when the visit was setup

Clinic is currently closed –
Don’t worry – We can still book you for when we are open!