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Healthcare Surge: Paperless Face Sheet Mobile App

The Healthcare Surge: Paperless Face Sheet mobile app is used to record patient registration information.Registration personnel should complete all available fields upon patient registration. The ability to skip screens is called " conditional branching"

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Healthcare Surge: Paperless Face Sheet Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name:

  • Ico textbox

    Disaster incident number:

  • Ico date

    DOB:

  • Ico textbox

    SSN:

  • Ico dropdown

    Sex:

  • Ico multiline

    Mailing Address:

  • Ico textbox

    Home Phone:

  • Ico textbox

    Cell/Message Phone:

  • Ico dropdown

    Marital Status:

  • Ico textbox

    Name of Spouse:

  • Ico textbox

    Maiden Name:

  • Ico textbox

    Race/Ethnicity:

  • Ico textbox

    Primary Language:

  • Ico dropdown

    Translator Required?

  • Ico textbox

    Employer Name:

  • Ico textbox

    Employers Phone Number:

  • Ico textbox

    Employer Address if Work Comp related:

  • Ico textbox

    Occupation:

  • Ico textbox

    Type of accident:

  • Ico date

    Date of Accident/Injury:

  • Ico time

    Time:

  • Ico multiline

    Condition:

  • Ico textbox

    Location:

  • Ico textbox

    Is there legal action involved?

  • Ico textbox

    Attorney or Insurance name:

  • Ico textbox

    Phone:

  • Ico multiline

    Address:

  • Ico textbox

    Policy ID#:

  • ...and More!

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