Skip to content
Home
CommunityMed Registration Test
Hidden
Querystring HIDDEN – Traffic Source
checkinid: This is the variable set by where the customer accessed the form
Hidden
Querystring HIDDEN Arrived
this value is 4, set by querystring, for patient in the parking lot. Otherwise it is 0
Hidden
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
Hidden
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
Hidden
Select Clinic
(Required)
Melissa Hwy 5
Arlington
Wichita Falls
Princeton
Haslet FM156
Haslet Avondale US287
Southlake
McKinney
Melissa on Hwy 121
Lantana
Telemed
Prosper
Crossroads
Heath
Mansfield
Midlothian
Celina
Training
Hurst
Frankford
Hidden
New Querystring of location
set in new querystring
–
Hidden
visit ID Code
z code read from querystring if applicable
Hidden
preload HIDDEN – Current Hour
This captures the current hour of when the patient is completing this form
Hidden
preload HIDDEN – DecimalTime
This is the variable showing what the decimal time the patient is completing this form
Hidden
preload HIDDEN – Today Date
MM slash DD slash YYYY
This is the variable that captures the date of entry for use in calculations
Hidden
current URL
Hidden
referring URL
Hidden
Calculated HIDDEN FLAG Arrived
this value is 1 for patient in the parking lot. Otherwise it is 0
Hidden
EMR used at clinic
Hidden
Clinic Parkinglot Message
– Fill Out Other Fields –
You are Checking In to the
Clinic
Hidden
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
We are having intermittent registration system issues, please come inside 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.
Hidden
HIDDEN VISIT ID from entry
Hidden
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
Hidden
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
Hidden
Visit_ID_Code from phoner number lookup
– Fill Out Other Fields –
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
Hidden
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 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
– Fill Out Other Fields –
Select which time block booking you are checking in for
You have multiple bookings setup under the same phone number
– Fill Out Other Fields –
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
Hidden
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)
Hidden
Lookup in View
– Fill Out Other Fields –
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
Hidden
Patient ID
Hidden
Section Break to show page ID
St-0 P-1
Hidden
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
Hidden
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
Hidden
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
Hidden
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
Hidden
HIDDEN visit Date
YYYY dash MM dash DD
This pulls in the scheduled visit date
Hidden
HIDDEN visit timeblock start
Hidden
HIDDEN Days from today
This is the variable of how many days from today is the selected visit date.
Hidden
Hours from now
How many hours from now is the appointment time
Hidden
HIDDEN – Wrong Location Flag
Hidden
HIDDEN – Wrong Visit DATE Flag
Hidden
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.
Hidden
Section Break
St-0 P-2
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 @November 2, 2024
Hidden
Section Break
St-0 P-3
Parking Lot Info
What is your Car color
What is the Make and model of your car
Patient Name
(Required)
First
Last
Hidden
Patient Date of Birth
(Required)
MM slash DD slash YYYY
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
Hidden
Section Break
St-0 P-4
Hidden
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
Hidden
Clinic Main Phone Number
Hidden
HIDDEN Create Clockwise Flag
Hidden
HIDDEN Place in line
Hidden
Section Break
St-0 P-5