Medium

Available on

Apple Android Windows

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
  • Toys R Us
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

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!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Hospital Surge Plan Checklist

The purpose of the Hospital Surge Plan Checklist mobile app is to assist hospitals in developing and/or updating their pla...

App Name

HIPAA Response to Patient Request Acc...

Tip sheet that includes information on how to use the form, relevant HIPAA definition, penalties for noncompliance, helpfu...

App Name

Port Security Arrival Checklist

Marinas have security procedures to adhere to and administer. To help your destination marina to comply use this app and s...

App Name

Letter to Credit Bureau: Dispute Frau...

Write a letter to each credit bureau. Repeat what you said in your telephone call. Send copies of your police report and c...

App Name

Informe de Inspeccion de Seguridad de...

Este Informe de Inspección de Seguridad en la Construcción formulario le permite evaluar los riesgos para la salud y la se...

App Name

Business Improvement District Restaur...

"Promote your restaurant businesses using the Business Improvement District Restaurant Database Mobile App to provide tour...

App Name

HIPAA Patient Request to Restrict Use...

Use this attorney-reviewed form to meet your HIPAA obligations. HIPAA gives individuals the right to have covered entities...

App Name

International Airport Badge Security

The International Airport Badge Security mobile app is an efficient way to record returned or cancelled Airport Security B...

More Information