REGISTRATION KIOSK 2

I would like to create a program that sends a questionnaire to patients to fill in demographic and medical information. The information will then need to be AUTOMATICALLY populated into two online programs . The program must be user-friendly for cellphones, computers (Mac or PC), and tablets. Hosting must be determined. I would like it to be self-contained in my office server, if possible. It must present a URL as a SAFE site I DO NOT HAVE API’S FOR THE PROGRAMS. The program needs to AUTOMATE the extraction of information from the questionnaire (see screenshots) and populate the corresponding fields in two programs. (please note: the screenshots are concepts, not exact specifications and WILL need to be modified) Programs are: a. PM (Patient Management) - b. EMR (Electronic Medical Records) - (We have attached videos of the input of information into these two programs). There are two categories of patient input. NEW PATIENTS (NP) Will receive a link with the questionnaire. (See questionnaire) – the questionnaire will need to be adjusted as we work – We will need to be able to add/delete/change questions independently after the program is complete – Each question has a corresponding field in PM and/or EMR. (See video). – The data provided from the questionnaire need to be 'typed' into the PM automatically by YOUR software (AUTOMATED). • Once the patient is created in PM, a “bridge” that the NP into EMR. This will need to be automated. ESTABLISHED PATIENTS (EP) - already exist in PM and EMR. - The questionnaire will be PRE-POPULATED WITH THE EXISTING DATA FROM PM and EMR. - The patient can review and update this information. - Revisions will be uploaded into PM and EMR in the same manner as a NP is entered. - If no changes are made, the patient will check a box- "no changes". - A note will be made in a “sticky note” field of the EMR recording the date of the uploaded questionnaire. - A PDF of the filled in questionnaire will be stored as an attachment in the EMR OTHER FEATURES - There will be LINKS for the patient to upload their insurance cards (both sides) and their driver's license or photo ID. The upload should be made possible from a cellphone picture or scanned image. - FORMS will need to be electronically signed . • Some of the forms will be presented based on responses to the questionnaire (e.g., patients with Medicare will receive the Medicare document, others will not) - The program must hide fields that do notpertain once a choice is made, e.g., if a patient chooses ‘none’ the other choices in the list will gray out. - Some fields will need to allow a drop down to select: right or left or both - The program should allow me to: • add/delete/move fields at any time and to track them into corresponding fields in the PM and EMR. • designate fields as required (*) or not required at any time. - ALL OF THE INFORMATION FROM THE QUETIONNAIRE NEEDS TO BE STORED IN A DATABASE: • It must be searchable (e.g., Excel), generate reports and allow transfer of data at any time. • A PDF of the questionnaire must be sent to the office's email in case a field is not properly populated or the data does not integrate properly. • A PDF of the finished questionnaire must be sent to the patient email as confirmation of their enrollment The program should alert the user to an entry error at the time. The patient must have the choice to submit the questionnaire at various points without completion and to return to it later Caveats: 1. I WILL ONLY RELEASE A MILESTONE AT COMPLETION. Partial projects have NO value for me. 2. I must own ALL of the program data so that if I need to make changes in the future it is all available and negotiable 3. The coder will need to provide FULL, WRITTEN instructions regarding changing, hosting orother details relevant to maintaining the program Please review and bid YOUR ACTUAL PRICE. I will not negotiate after we chat. Thank you