Electronic Consents and Signatures

For Newborn Nursery

and NICU

Swivel Always turn screen for Legal Representative to see what they are signing

TopazAlways ‘ctrl + ‘click to sign’

This allows Legal Representative control of the form

StarPanel• Must log in to StarPanel to complete registration forms after Patient has been admitted

in Medipac by Admitting (Always log off StarPanel when unattended.) Choose patient.

1. Select Patient2. Select Enter Data3. Select Forms4. Select appropriate form bundle (English or Spanish)

1. Neonatal Admitting Forms5. Select radio button identifying entry point (Inpatient)

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Completing Consents

ADD Row is only used if Consent can not be obtained

Select Inpatient

Red Tab Indicates Form to be completed

Consent for Treatment

• Must use appropriate script to explain forms

“By signing this form you agree to let us treat your child. You have the right to refuse any tests or treatment you don’t want when your doctor (health care provider) talks with you.

• Must obtain signature upon admitting process

Red Tab Indicates Form to be completed

Consent for Treatment Form

“Verbal Consent by Whom” when necessary

“Click to Sign for signature.”

**then Click STOP to capture signature**

Click to Print Hard Copy of Patient Rights and Responsibilities Upon Request

Copies of all consent forms can be printed upon request

Payment• Must obtain signature upon update process• Must use appropriate script to explain form

“By signing this form, you agree to let us bill your insurance. You also agree to pay for anything not covered by your insurance.”

Payment Form

Government Payer Certification must be completed, if Legal Representative is unsure, select “none of the above”

“Click to Sign for signature.

** then Click STOP to capture signature**

Copies of all consent forms can be printed upon request

HIPAA(Notice of Privacy Practices)

• Must obtain signature upon registration process.• HIPAA forms will be completed once a year• Must use appropriate script for explaining the

form to patients/legal representative“By signing this form you acknowledge that you’ve been offered a copy of our Privacy Practices.”

HIPAA form(Notice of Privacy Practices)

“Click to Sign for signature.

Click to Print Hard Copy of Notice of Privacy Practices Upon Request

**then Click STOP to capture signature**

Finalizing Forms

The yellow buttons are specific to each form and cannot be used for finalizing the forms. There’s no need to use this ‘Save’ button .

To finalize/save the forms, click the red ‘Save as Final’ button.

****DO NOT SAVE AS DRAFT****

• For signed copy, click on the forms from the Patient’s Chart and print forms using the Yellow actions box

Saved Forms Under Wrong MRN?• If you make a mistake with saving forms under the wrong MRN,

save multiple sets of forms for the same patient, or have other issues that need to be corrected, notify Lisa Grunwald CAPS @ 293-7936 or the HELPDESK @ 3-HELP of the error.

• Provide the following information: 1. Incorrect MRN and correct MRN it should be moved to2. Which forms were completed that need to be moved3. Date it occurred

Medical Information Services Management must make the

corrections

What To Do If Patient/family Can Not Come to Nursery to Sign

Consents

Process has not changed1. Go to EDOCS2. Print out forms that are needed

• Consent to Treat• HIPPA• Payment form

3. Stamp with baby card4. Take to mother/family to sign5. Place signed copy in chart6. Provide copy if requested