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Customized Forms and Reports
Does your State require you to complete numerous time-consuming, lengthy forms?
Do you spend hours filling out Immunization Certificates, School Entry Forms, Camps Forms, Sports Evaluations, Medical Order Forms?
Now these forms are available in Office Practicum so they are instantly and automatically completed and printed; ready for the patient/parent to collect at the front-desk!
Save on hours of paperwork, time searching through files and records, transcribing by hand and compiling information! Now with just the click of a button all of your forms and reports can be completed!
All of the forms listed below are now available for purchase and download into the Office Practicum system. If you are a current Office Practicum client and you would like to have any of the forms available in your system, simply log-in to your online account and visit the "Downloads" page. At the Downloads page you can access the "Customized Forms" and select the forms you would like for your practice.
A low, one-time purchase fee will be charged to your account and you will receive an invoice shortly after the download is complete.
If you do not see customized forms or reports for your State listed below, simply contact us and we will work with you to make those forms available.
If you are not currently an Office Practicum client, but you are interest in learning more about this, and any of the other Office Practicum features, please do not hesitate to contact us. We are happy to answer your questions and we also invite you to schedule a live, over-the-web demo of Office Practicum, during which you can take a thorough tour of the entire system.
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- EPSDT Forms (Early and Periodic Screening, Diagnosis and Treatment)
- The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate in Medicaid requires states to conduct regularly scheduled examinations (screens) of all Medicaid-eligible recipients under the age of 22 to identify physical and mental health problems.
- The Arizona Health Care Cost Containment System (AHCCCS) requires Arizona State providers to complete 16 different EPSDT forms, each at different ages through out the patient's life.
- All of the AHCCCS EPSDT forms are now available to download into Office Practicum. Each form can be completed automatically - data is pulled from the system and applied to the fields on the form so it prints in seconds, directly from the Office Practicum system.
- Click here to view an enlarged screen shot of an Arizona EPSDT form
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- California State Forms coming soon.
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- The Tri-State Headstart/Early Childhood Programs, Child Physical Exam form is customized and available for download into Office Practicum.
- All the information fields are filled automatically as the system retrieves the patient information and applies it to the form.
- Click here to view an enlarged screen shot of the Colorado Child Physical Exam Form
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- The Florida Department of Health Certification of Immunization form is customized and available in Office Practicum.
- The form prints with all of the patient's immunization data filled into the Immunization grid.
- The pages are customized so they print directly to the blue paper forms required by the Florida Department of Health.
- The Florida Department of Health School Entry Health Exam is also customized and available in Office Practicum.
- The double-sided form is customized to fill all the necessary patient data automatically.
- Click here to view an enlarged screen shot of the Flordia Certification of Immunization form
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- The Iowa Department of Public Health Certificate of Immunization is customized and available in Office Practicum.
- The form prints with all of the patient's immunization data filled into the Immunization grid.
- Click here to view an enlarged screen shot of the Iowa Department of Public Health Certificate of Immunization
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- Kentucky State Forms to be added soon!
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- There are several Maryland State forms customized and available in Office Practicum. Please see the list below:
- Maryland Department of Health and Mental Hygiene Blood Lead Testing Certificate
- Maryland Uniform Consultation Referral Form
- Maryland Department of Health and Mental Hygiene Immunization Certificate
- Maryland State Department of Education, Office of Child Care - Medication Order Form
- Authorization for release of medication/treatment information records for admission to school
- Maryland Schools - Record of Physical Examination
- Maryland Department of Education - Medical Evaluation of Student for participation in Interschool Sports
- Click here to view an enlarged screen shot of the Maryland Certificate of Immunization
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- The Mississippi State Department of Health Certificate of Immunization Compliance is customized and available in Office Practicum.
- The form prints with all of the patient's immunization data filled into the Immunization grid.
- Click here to view an enlarged screen shot of the Mississippi Certificate of Immunization Compliance form
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- There are several New York State Forms/Reports automated and available within Office Practicum, including:
- New York City Department of Health and Mental Hygiene, Bureau of Day Care, Children's Medical Record - New Admission Record
- New York City Department of Health and Mental Hygiene, Bureau of Day Care, Children's Medical Record - Periodic Exam/Follow-up Record
- New York State - Medical Report of Child in Day Care
- Click here to view an enlarged screen shot of the NYC Bureau of Day Care - New Admission Record form
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- The Ohio State Child Medical Statement is automated and available in the Office Practicum system.
- Click here to view an enlarged screen shot of the Ohio Child Medical Statement form
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- Texas State Forms/Reports available soon!
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Office Practicum is Registered trademark of Connexin Software, Inc.
Copyright © 1998-2014 Connexin Software, Inc. All Right Reserved
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