Medium

Available on

Apple Android Windows

Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form Mobile App

The Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form allows users to instantly capture and record pertinent data on their smartphones or tablets. It includes items such as; patient information, sight, hearing, decision making capacity, emergency contact, medical condition, infection control issues, patient risk alerts, advance care planning, transfers, physician contacts, time sensitive information, pain assessment, vital signs, health status, nutrition, hydration, treatment and frequency, physical function, skin care, mental status, personal items and physician certification. In addition this mobile application includes a digital signature section to insure accountability.

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

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Take a peek inside the Medical Certification for Medicaid Long-Term Care Services and Patient Transfer 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:

  • Ico date

    Date of Birth:

  • Ico statictext

    A.

  • Ico dropdown

    Gender:

  • Ico dropdown

    Hispanic Ethnicity:

  • Ico dropdown

    Race:

  • Ico textbox

    Specify:

  • Ico dropdown

    Language:

  • Ico textbox

    Specify:

  • Ico statictext

    B.

  • Ico dropdown

    Sight:

  • Ico dropdown

    Hearing:

  • Ico statictext

    C.

  • Ico checkbox

    Capable to make healthcare decisions.

  • Ico checkbox

    Requires a surrogate.

  • Ico statictext

    D.

  • Ico textbox

    Name:

  • Ico textbox

    Phone:

  • Ico camera

    Image Capture:

  • Ico textbox

    Name:

  • Ico textbox

    Phone:

  • Ico camera

    Image Capture:

  • Ico statictext

    E.

  • Ico textbox

    Primary Dx at Discharge:

  • Ico multiline

    Reason for Transfer (Brief Summary):

  • Ico dropdown

    Surgical procedures performed during stay:

  • Ico textbox

    Discribe:

  • Ico textbox

    Other Diagnoses:

  • ...and More!

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