Patient Quick Entry Screen

Organization Name 

The Organization Name pick list displays all of the Provider Organizations.  By default the Organization Name that the user is logged in as will be displayed.

Last Name

This is the patient's last name. Assign or change a last name by typing the desired name into the Last Name text box.

First Name

This is the patient's first name. Assign or change a first name by typing the desired name into the First Name text box.

Birth Date

This is the day on which the patient was born. Assign or change the birth date by typing the desired date into the Birth Date text box using the format MM/DD/CCYY. Or, click on the calendar icon to set the date.

Please note that the system will not allow the changing of Birth Date to a date that is after existing immunizations. If such a date is entered, an error message will appear and the user will be expected to resolve the conflict with the existing immunizations via the edit immunization screen or by changing the Birth Date.

Mother's Maiden Last

This is the patient's mother's maiden last name. Assign the mother's maiden last name by typing the desired name into the Mother's Maiden Last text box.  Once the Mother's Maiden Last Name is populated and saved the text box will no longer appear and (On File) will display for this text box instead notifying that this information is recorded already.

Mother's First Name

This is the patient's mother's first name. Assign or change the mother's first name by typing the desired name into the Mother's First Name text box.

Gender

This is the patien'ts gender. Select the patient's gender from the gender pick list.

Middle Name

This is the patient's middle name. Assign or change a middle name by typing the desired name or initial into the Middle Name text box.

Suffix

This is the patient's name suffix if applicable.  Select the patient's suffix from the Suffix pick list.

SSN

This is the patient's SSN. Assign the SSN by typing in the patient's SSN into the SSN text boxes.  Once the SSN is populated and saved the text boxes will no longer appear and (On File) will display for these text boxes notifying that this information is recorded already.

Medicaid ID

This is the patient's Medicaid identification number. Assign or change the medicaid id by typing the medicaid id into the Medicaid ID text box.

Birth State

This is the State that the patient was born in.

Patient Identifier

This is the primary patient identifier that associates the patient to the provider organization.

Street Address

This is the  first line of the street address for the patient.

Other Address

This is the  second line of the street address information for the patient, which may include apartment, room, or suite numbers.

City

This is the patient's city.

State

This is the patient's state.

Zip

This is the  patient's 5-digit postal zip code.

Zip+4

This is the 4-digit zip code extension for the patient.

Phone Number

This is the patient's phone number.

 Event Description

This is the name of the pandemic response event or preparedness exercise.

Begin Date

This is the Begin Date of the Event

  End Date 

This is the End Date of the Event.

Age Group

The age group category is not required. Age will be calculated at the time of the vaccination and included in aggregate reporting.

Priority Group

Effective priority group categories are available in the pick list displayed. The Priority Group Value (Code) is displayed in the pick list. When selected, a full description of the selected priority group will be listed below the event.

Clicking the Save button will validate all required fields and will do a patient search in the database to find the patient being entered.  If the patient being entered is not found then the patient will be saved, otherwise the patient match detected screen will display to either select an existing patient already in the registry or to select this patient to be entered into the system.

Clicking the Add Next button will validate all required fields and will do a patient search in the database to find the patient being entered.  If the patient being entered is not found then the patient will be saved and the screen will clear for a new patient to be entered, otherwise the patient match detected screen will display to either select an existing patient already in the registry or to select this patient to be entered into the system.

Clicking the Add New Imm button will validate all required fields and will do a patient search in the database to find the patient being entered.  IF the patient being entered is not found then the patient will be saved and user will be displayed the Add New Immunization screen for the patient just entered, otherwise the patient match detected screen will display to either select an existing patient already in the registry or to select this patient to be entered into the system.

Clicking the Add Historical Imm button will validate all required fields and will do a patient search in the database to find the patient being entered.  If the patient being entered is not found then the patient will be saved and the user will be displayed the Add Historical Immunizations screen for the patient just entered, otherwise the patient match detected screen will display to either select an existing patient already in the registry or to select this patient to be entered into the system.

When the Cancel button is clicked, the key data fields will not be examined for data validity, and the patient data will not be saved to the database. Instead, the announcements page will be displayed.