Schedule

Location Name *

Address

City

State

ZIP

Phone

Fax

Email

Facility NPI

Taxonomy

Must match the type of entity above (Box 33b). Same entity as Facility NPI, not the individual therapist.

Tax ID (EIN)

Federal EIN of the entity that bills from this location. Appears on the claim as the billing provider tax ID.

Place of Service Code

Submitter ID

Identifier the clearinghouse expects for this location. Usually the same as the Tax ID unless the clearinghouse assigned a different one.

Timezone *

All appointment times will be displayed in this timezone for users at this location.

Set as primary (default) location

Allow clinicians to view all clinicians' signed notes & visits

When enabled, clinicians at this location can view signed clinical notes and patient visits from all clinicians. When disabled, clinicians can only view their own notes and visits. Admins always see all.

User Access

Assign to Clinic *

First Name * Required

Last Name * Required

Date of Birth * Required

Gender

SSN

Date of Injury For medical lien or workers' comp cases

Phone

Email

Address

City

State

ZIP

Provide emergency contact information for the patient. This will be used in case of emergencies.

Contact Name

Relationship

Phone

Alternate Phone

Personal Details

Marital Status

Race

Ethnicity

Language

Occupation

Primary Care Physician

Employer Information

Employer Name

Employer Phone

Employer Address

City

State

ZIP

Care Episodes

Care episodes are automatically created when an Initial Evaluation note is signed. Use the button above only if you need to create one manually.

No care episodes found for this patient.

Upload patient documents such as insurance cards, ID, referrals, or medical records. All files are encrypted at rest for HIPAA compliance.

Document Category

Description (Optional)

Upload Documents

Drag and drop files here or click to browse

Supported: PDF, JPG, PNG, DOC, XLS, TXT (Max 70MB each)

Uploaded Documents

File Name	Category	Size	Uploaded	Uploaded By	Actions

Appointment

Date:

-

Time:

-

Type:

-

Patient

Name:

-

Provider

Name:

-

Not Started

00:00

Elapsed Time

Your recording session is saved automatically. You can pause and resume at any time.

On a phone: keep this tab open and the screen on. If you lock the screen or switch apps, recording stops and that audio is lost.

Assign to Clinic *

First Name *

Last Name *

NPI *

Credentials

Specialty

Taxonomy

Email

Phone

License Number

License State

License Expiry

Default Appointment Duration (min)

Profile Color

Active

Require CPT codes when signing notes When enabled, provider must review and add CPT codes before signing the last note for an appointment.

Work Schedule (Duty Hours)

Set the provider's working hours for each day. Available slots will be generated based on this schedule.

Day	Available	Start Time	End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Provider Signature

Upload a signature image (JPG or PNG) that will be used when signing clinical notes with the {{provider_signature}} placeholder. Use {{provider_name}} in a template to auto-fill your name at sign time.

No signature uploaded

Upload Signature Image Max 2MB. JPG or PNG format.

User Account (Auto-Created)

A user account will be automatically created for this provider using the email above.

Password *

Required for user account creation

As Director (View all Schedules)

Clinician Director can view every clinician's schedule

Clinic Information

Clinic Name *

Phone

Email

Address

City

State

ZIP

Tax ID

NPI

Plan

Initial Location

Location Name *

Time Zone *

This will be the default location for this clinic. You can add more locations later.

Clinic Administrator

Admin First Name *

Admin Last Name *

Admin Email *

Admin Password * Minimum 8 characters

Assign to Clinic *

Role *

First Name *

Last Name *

Phone

Email *

Password *

Minimum 8 characters

Location Access

Active

Create HTML templates with placeholders that will be replaced with actual patient and clinic data when generating the PDF.

Template Name *

Status

Active (available for use)

Description

Clinic * Template will be available only for this clinic

Location * Template will be used for this specific location

Available Placeholders

Patient Information

{{PatientName}} - Full name
{{PatientAddress}} - Full address
{{DateOfInjury}} - Date of injury

Attorney Information

{{AttorneyName}} - Name
{{AttorneyAddress}} - Address
{{AttorneyPhone}} - Phone
{{AttorneyEmail}} - Email

Provider Information

{{ProviderName}} - Name
{{ProviderSignature}} - Signature image

Clinic Information

{{ClinicName}} - Clinic name
{{ClinicAddress}} - Full address
{{ClinicPhone}} - Phone number
{{ClinicFax}} - Fax number
{{ClinicEmail}} - Email address

Location Information

{{LocationName}} - Location name
{{LocationAddress}} - Full address
{{LocationPhone}} - Phone number
{{LocationFax}} - Fax number
{{LocationEmail}} - Email address
{{LocationNpi}} - Facility NPI

Other

{{TodayDate}} - Current date

Template Content (HTML) * Use the placeholders above to insert dynamic content

Add patient

Dates of service

Post

Tab order runs left to right, row by row. CARC says why the amount was reduced; RARC is the payer's supplemental remark.

CPT / Description	Billed	Allowed	Deduct. i	Copay i	Coins. i	Adj. i	CARC	RARC / Remark	Paid

CARC (Claim Adjustment Reason Code) says why the amount was reduced. RARC (Remittance Advice Remark Code) is the payer's free remark, e.g. N657.

This check so far

Close the check

Reason money was left unapplied

Notes on this check

No notes yet.

Notes cannot be edited or deleted once posted.

Attached files

No files attached.

Quick Edit covers the fields a claim depends on. For effective dates, attorney and adjuster details, or allowed visits, use the full patient edit.

Payer Name (type to search)

Payer ID (type to search)

The code sent to the clearinghouse. Placeholders like 0000 are rejected.

Policy Number / Member ID

Group Number

Copay

$

What the plan says the patient pays per visit. Front desk sees it at check in as "Expected today".

Coverage Order

Insurance Type

Subscriber

Subscriber First Name

Subscriber Last Name

Relationship to Patient

Clinical Note

Patient Information

Attorney Information

Provider Information

Clinic Information

Location Information

Other

Filters

-

Initial Evaluation

Follow-up / Visit

Re-Evaluation

Discharge

FCE Eval / Work Hardening

Recertification Progress

Work Hardening / Conditioning Follow Up

Single Appointment

Recurring Series

Available Time Slots

Messages

Expected today i
Already received for this visit i
Patient owes i

Verification Code

User

Reset Password

Switch Location

Manage Locations

Clinic Locations

Add Location

User Access

New Patient

Personal Details

Employer Information

Care Episodes

Uploaded Documents

Patient Consent History

Current Consent Status

Clinical Note

Attach Documentation

Request Time Off

Patient Details

New Provider

Work Schedule (Duty Hours)

Provider Signature

User Account (Auto-Created)

User Account Management

Provider Details

Confirm Deactivation

Clinical Note

Clinical Notes

Care Episode

Treatment Plan

Episode Status

Appointments

Clinical Note

Complete Care Episode

Extend Care Episode

Add New Clinic

Clinic Information

Initial Location

Clinic Administrator

New Note Template

Change Password

Add New User

Provider Association *

Location Access

Reset User Password

Change User Email

Create New Claim

New Consent Template

Template Preview

Delete Template

Kiosk Settings

Confirm Action

Upload Consent Form

Medical Lien Form Template

Patient Information

Attorney Information

Provider Information

Clinic Information

Location Information

Other

Claim Detail

New EOB

Post EOB

Missing Notes

Missing Signature

Require Schedule

No Show Alerts

Missed Appointments

Ending Visits

Missing Required Fields

Insurance Visit Mismatch

Insurance Information

Confirm Care Episode

Extracted Diagnosis

Add Authorization

Delete Authorization

Insurance/Authorization Issue

Review CPT Codes for this Visit

Already Added (from previous notes)

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