Option 1: The Patient Affiliation form (see below) can be built in the Healthquest EMR with the instructions help file on creating form templates.
Option 2: Healthquest has created the Patient Affiliation form and clinics will be able to access it at no cost. The Patient Affiliation form below outlines in green the information which will be auto populated from the EMR. Fields in orange could be set up as text fields.
If your EMR specialist has any questions, please ask them to contact our AMA-ACTT EMR Lead Deniese Taylor at: [email protected].
Please note: the physician/clinic team are responsible for initiating the discussion with patients about the responsibilities, benefits and expectations of affiliation to all parties involved, and to obtain the patient and physician signatures.