Data Field Setup

Configure which fields are displayed and required for each practice.

tune Field Configuration

Form Label	Displayed	Required
Patient Info
lock Completion Date
lock De-identified Patient ID
lock Insurance Type
Prescription Info
lock Medication Name
Medication Type
lock Date of Prescription
Workflow Milestones
lock Date Prior Authorization (PA) Submitted
lock Date PA Approved
lock Date First Fill Completed
lock Was Appeal Needed?
Date of Appeal Submission
Date Appeal Resolved
Process Timings
lock Time Rx to PA Submission (days)
lock Time PA Submission to Approval (days)
Time PA to First Fill (days)
Total Time: Rx to First Fill (days)
Roles & Responsibility
lock Who Submitted PA
Who Followed Up
Barriers & Delays
lock Barrier to prior auth approval
Notes on Delay
Outcome Metrics
lock Final PA Approval Outcome
Patient Received Medication?
Notes on Patient Status
Optional Feedback
lock Patient Satisfaction with SDM Tool (1-5)
Staff Ease-of-Use Rating (1-5)
Visit / Shared Decision-Making (SDM)
lock Visit date
lock Type of disease
lock Was a decision aid used for medication selection?
Format used
Version of decision aid
lock Topics discussed
lock SDM use documented in note?
Comfort level before using tool
Comfort level after using tool
Ease of use
Confidence in discussion
Patient felt involved?
Top patient concern addressed
Patient comment
Treatment selected
Monitoring plan in chart?
Date treatment started
Days from visit to treatment start