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Healthcare Surge: Charge Capture Form Mobile App

The Healthcare Surge: Charge Capture Form presented is to be used to capture charges for service, medication, and supplies for individual patients during a healthcare surge and was developed from the suggested minimum data list for charge capture. MyCanvas allows GoCanvas users to now share documents with their customers

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

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Take a peek inside the Healthcare Surge: Charge Capture Form 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.'}}

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Included Fields

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

  • Ico textbox

    Patient Name (Last, First):

  • Ico textbox

    Unique Patient Identifier (#):

  • Ico textbox

    Provider Name:

  • Ico textbox

    Disaster Incident Number:

  • Ico textbox

    Service Description

  • Ico textbox

    Department

  • Ico integer

    Units of Service or Quantity

  • Ico date

    Date of Service

  • Ico statictext

    To be completed by Billing

  • Ico dropdown

    Code:

  • Ico decimal

    Service Price

  • Ico calculator

    Posted Charge

  • Ico summary

    Total Charges

  • ...and More!

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