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Registration – QR Code Check-in
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HIDDEN Parking lot Clinic ID
This variable is set by what parking lot the patient has checked into. Variable is Location set by querystring
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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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Referer
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Current url
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HIDDEN - Traffic Source
This is the variable set by where the customer accessed the form
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HIDDEN Arrived
this value is 4, set by querystring, for patient in the parking lot. Otherwise it is 0
You are Checking In to the
Clinic
SOUTHLAKE CLINIC IS CLOSED FOR RENOVATIONS
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HIDDEN FLAG Arrived
this value is 1 for patient in the parking lot. Otherwise it is 0
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Is the patient in emergency medical distress or having a true medical emergency?
(Required)
NO, patient is NOT in life-threatening or EMERGENCY medical distress
Yes, patient is in in life-threatening or EMERGENCY medical distress
YOUR CONDITION IS ACUTE AND REQUIRES IMMEDIATE ATTENTION
Please proceed directly into the clinic with your ID and insurance card.
Have you already started registration or reservation for this visit?
(Required)
Yes, I have already completed registration and have received a VISIT ID number (starts with Z)
No, I have not started the registration process for this visit
Please enter your VISIT ID (Starts with a Z)
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Lookup in View
– Fill Out Other Fields –
Are you in the parking lot of a CommunityMed clinic?
(Required)
Yes
No
Starting the parking lot check-in when you are NOT in the parking lot can result in delays or cancellation of your visit
We are getting an error on your arrival in the parking lot - please see the front desk or jump on a chat session
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HIDDEN visit ID
This is the visit ID looked up from the patient entering the Z-Code.
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HIDDEN Reg Record Found flag
1 is the visit ID is valid, 0 is the visit ID is not valid/not found
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HIDDEN Patient ID from the reg record
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HIDDEN clinic ID from the reg record
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 code,
or let us know below if you need help or will go ahead and complete a new registration
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
I need help from my car - please start a customer service chat session for me
Click NEXT Below and lets get you started
Click NEXT Below and lets get you started
We found your Visit ID from the Z code you entered
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HIDDEN visit Date
YYYY dash MM dash DD
This pulls in the scheduled visit date
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HIDDEN visit hour
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HIDDEN - Current Hour
This captures the current hour of when the patient is completing this form
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HIDDEN - Current Minute
This is the variable showing what the current minutes of the time are for when the patient is completing this form
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HIDDEN - DecimalTime
This is the variable showing what the decimal time the patient is completing this form
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HIDDEN - Today Date
MM slash DD slash YYYY
This is the variable that captures the date of entry for use in calculations
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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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Hospital ID
This is the clockwise hospital ID for the clinic based on the location ID of the parking lot
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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
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Clinic Parkinglot Message
– Fill Out Other Fields –
The Clinic is CLOSED FOR RENNOVATIONS
Please go to our website to see our other locations
https://communitymedcare.com/location-quickpick/
The clinic is behind because we lost power. Please be patient with us.
IMPORTANT MESSAGE
The CommunityMed registration site is down for maintenance and updates - please come back in an hour
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
Clinic is nearing closing time (8pm)
Don't worry - If you are in the parking lot BEFORE 8pm (even if you completing your registration) we will see you.
When you arrive, pop into the lobby to let us know you are here.
At 8pm we stop seeing new patients who are not here at the clinic before 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 in your car, but this way we know you are here to be seen near closing.
Our records indicate this appointment is a walk-in visit and does not have a time assigned yet
If this is in error, please go in and check with the front desk
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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 @September 7, 2024
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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
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
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YOUR VISIT IS LESS THAN 1 HOUR FROM NOW
Please stay in the parking lot and wait. Sometimes we can see you faster than your scheduled block SINCE YOU ARE HERE. IF YOU NEED TO LEAVE AND COME BACK PLEASE LET US KNOW
YOUR VISIT IS 1 OR MORE HOURS FROM NOW
You can choose to stay in the parking lot and wait. Sometimes we can see you faster than your scheduled block IF YOU ARE HERE.
OR
You can leave and be back in the parking lot AT THE BEGINNING OF YOUR TIME BLOCK.
Select below to let us know what you want to do
Stay and wait or leave?
(Required)
I want to STAY IN THE PARKING LOT
We will LEAVE and RETURN. I will watch the patient status screen for where I am in line.
WHEN YOU RETURN
Scan the QR code/go to the check in link again and enter your 9 digit Visit ID (starts with 99) that you receive in email and text when your check-in is complete. Then WAIT IN YOUR VEHICLE and ANSWER YOUR PHONE - we will call you when it is your turn.
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Next Step
Lets get you a spot in line - we reserve spots in blocks - click "Next" below to continue
Clicking "Next" below will check you in as ready to be seen.
We utilize a virtual waiting room from your car for for your protection and convenience. That way, you can wait in the germ-free environment of your car.
One of our medical staff to call you on the number you provided to start your intake process.
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.
Lets get you a spot in line - we reserve spots in blocks - click "Next" below to continue
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 MATH Stay in Parking Lot
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HIDDEN Create Clockwise Flag
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HIDDEN Place in line
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Pull Data for Clockwize
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HIDDEN VID Patient Name
First
Last
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HIDDEN VID Patient DOB
MM slash DD slash YYYY
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HIDDEN VID Pat Phone
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HIDDEN VID Pat Email
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HIDDEN VID Hospital ID
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HIDDEN VID New Patient
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HIDDEN VID Visit Reaosn
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