Enter Study Data

category Patient Info

Completion Date (Auto-calculated)

Auto-populated with current date

2026-03-04

De-identified Patient ID *

Free text (e.g., P12345)

Insurance Type *

category Prescription Info

Medication Name *

Dropdown is grouped by type with prefixes: JI- for JAK Inhibitors, Bio- for Biologics

Medication Type *

Date of Prescription *

category Workflow Milestones

Date Prior Authorization (PA) Submitted *

Date PA Approved *

Date First Fill Completed *

Was Appeal Needed? *

Date of Appeal Submission *

Date Appeal Resolved *

Required when Was Appeal Needed = Yes; hidden otherwise

category Process Timings

Time Rx to PA Submission (days) (Auto-calculated)

Auto-calculated: Date PA Submitted - Date of Prescription

Time PA Submission to Approval (days) (Auto-calculated)

Auto-calculated: Date PA Approved - Date PA Submitted

Time PA to First Fill (days) (Auto-calculated)

Auto-calculated: Date First Fill - Date PA Approved

Total Time: Rx to First Fill (days) (Auto-calculated)

Auto-calculated: Date First Fill - Date of Prescription

category Roles And Responsibility

Who Submitted PA *

Who Followed Up *

Free text / initials

category Barriers Delays

Barrier to prior auth approval *

Insurance delay

Missing info

Step therapy required

Lab needed

EMR error

Notes on Delay *

category Outcome Metrics

Final PA Approval Outcome *

Patient Received Medication? *

Notes on Patient Status *

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