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Healthcare Outreach Field Visit Report Mobile App

Health conditions mobile form to check the status of the patient.Form starts off by asking for customers basic information like,worker, month, HH, date, visit times, client, address, phone, and status post visit. Symptoms that will be asked are, qualifying condition, significant behavioral, medical of social risk factors, and significant behavioral, medical of social risk factors.

  • Lendlease
  • The Cooperative
  • PG&E
  • Toys R Us
  • Red Bull
  • Mirvac

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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

    Worker

  • Ico dropdown

    Month

  • Ico dropdown

    HH

  • Ico date

    Date

  • Ico time

    Visit Start Time

  • Ico time

    Visit End Time

  • Ico textbox

    Client

  • Ico multiline

    Address

  • Ico textbox

    Home Phone

  • Ico textbox

    Cell Phone

  • Ico dropdown

    Enrollment

  • Ico dropdown

    Disenrollment

  • Ico dropdown

    Continue Outreach

  • Ico multiline

    Describe What Transpired

  • Ico dropdown

    Reason (Select all that are appropriate)

  • Ico textbox

    As Evidenced by:

  • Ico dropdown

    Have they seen a mental health professional

  • Ico dropdown

    Reason

  • Ico statictext

    Significant Behavioral, Medical of Social Risk Factors

  • Ico multiline

    As Evidence by:

  • Ico dropdown

    Reason

  • Ico statictext

    History of poor connectivity to care, including but not limited to

  • Ico multiline

    As Evidenced by

  • ...and More!

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