A Guide to Form Fields

• Acknowledgment Checkbox
• Appointment Reminder Preferences
• Checkboxes
• Data Row
• Filler
• Headers
• Images
• Labels
• Lists
• Medical Conditions
• Multi-Line Text
• Page Break
• Page Break Online

• Paragraph
• Patient Address
• Patient Birthdate, Weight, Age
• Patient Name
• Referred By
• Segmented
• Separator
• Signature
• Single-Line Text
• Student Status
• Web Pop-up
• Yes/No Question

Acknowledgment Checkbox

The Acknowledgement Checkbox is a checkbox that is used in place of initials on a paper form.

The available options for this component are:

	Header (for online form)	The acknowledgment instructions.
	Statement	The statement that needs to be acknowledged.
	Acknowledgment is required	Makes the field mandatory for the patient to check the checkbox to proceed.
	Destination	Choosing a destination determines where the checkboxes will be displayed. You can choose between “iPad”, “Online” or “Both”.

 The animation below shows you how to add this form field to your form:

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Appointment Reminder Preferences

This field collects approvals from patients regarding sending email and text messages for appointment reminders. You may edit the text of the questions, but the default should suffice.

The only options for this component are Destination, where you select where it will appear (iPad, Online, or both), and whether the field buttons appear in English or Spanish.

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Checkboxes

This is used as a list of values where the patient can check one or more values from the list. An example of checkboxes is “how long has it been since your last visit? (i.e., 3 months, 6 months, 1 year, more than 1 year).

The available options for this component are:

	Question	The checkbox question.
	Has border	Creates a border around your checkboxes.
	Small font	Makes your font smaller.
	Columns	Organizes your answers into columns. You can have up to 3 columns.
	Has other option	Adds an extra check box called “Other” and if it’s selected a single-line field will appear for you to fill in.
	Use YN button	Replaces checkboxes with YN selection icons. It is advised not to use this option as it appears very small on the iPad screen hence very hard to read.
	Single selection is required	Makes the field mandatory for the patient to select a single answer to proceed (for iPad only).
	Selection Option	Contains the checkboxes values. Write each value on a separate line.
	Destination	Choosing a destination determines where the checkboxes will be displayed. You can choose between “iPad”, “Online” or “Both”.

The animation below shows you how to add this form field to your form:

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Data Row

The Data Row field works differently from other form fields. This field allows you to include more than one element in single row. You can add Label, Text, List, Checkbox, Yes/No, and Image elements.

To add a Data Row:

1. Select the Add button from the Document Builder main menu.

The Select Question Type dialog box will open.

2. Select Data Row from the drop down then click on the Add.

The Data Row dialog box will open.

3. Click on the Add button to add your first element.

The Add dialog box will open.

4. Select the element type you would like to add to your data row from the Type list item and type in the element label in the Text field. You can also adjust the element width from the Width field and element alignment from the Alignment list item.

The available Types are as follows:

• Label
• Text
• List
• Checkbox
• Yes/No
• Image

5. Click on the OK button when you’re finished. The data row element will be added to the data row list box.

Repeat steps 3-5 until you’ve added all your data row elements.

6. If you need to, adjust the spacing between your elements by clicking on the Spacing field.

7. When you’re done click on the OK button. The new Data Row should be added to the Question Area.

Filler

This component adds empty space for a better aesthetic layout. The only available option is to set the height, in pixels, of the Filler object.

NOTE: This field does not display any visible elements.

The animation below shows you how to add this form component to your form:

Headers

This is the title of the form being created or modified that appears at the top of any form. Common examples are “Dental History” or “HIPAA Notice of Privacy Practices.”

The available options for this component are:

	Header Text	The text that appears in the header.
	Text Size	You can choose from Default, x-small, small, large, and x-large.
	Alignment	Choose from Left, Center, and Right.
	Text Color	The color of the text. Double-click to open the color picker.
	Background Color	The color of the background behind the text. If Transparent is turned on, this option will be disabled. Double-click to open the color picker.
	Destination	The Header component can work in both iPad and Online modes.
	Transparent	Disables the Background Color setting. If you use this option, select a dark Text Color to properly contrast the white background of the application.

NOTE: For longer header names, use a smaller text size and left-align your text. Otherwise, center-align the text. Also avoid using all caps headers.

The animation below shows you how to add this component to your form:

Images

The Image field allows you to add an image to your form.

The available options for this component are:

	Image URL	Insert the URL to your image.
	Action Script	Insert any Javascript to be performed when the image is loaded. By default, leave this field empty.
	Logo	Click this button to insert the image you have set as your logo.
	Destination	Determines if the field will appear on the iPad, online, or on both.
	Width	Defines the width of the image, in pixels.
	Height	Defines the height of the image, in pixels. NOTE: The default height is 0px (zero). If you do not change this, the image will not appear.
	X-offset	Defines the horizontal positioning of the image, in pixels. This value sets the left-most margin as zero ("0").
	Show	Loads the defined image in your default browser.

Labels

Use the Label component to mark logical sections or groups of questions.

The available options for this component are:

	Label Text	This is the text of the label as it appears on the form.
	Text Size	Your options are Default, x-small, small, large, and x-large.
	Destination	This components work for both iPad and Online modes.
	Text Color	Your options are Black, Red, or Blue.

The animation below shows you how to add this form component to your form:

Lists

This is used as a drop-down list where the patient can select only one value from the list. Examples of lists are gender, marital status and employment status.

The available options for this component are:

	Question	The List question.
	Inline	Indents your List.  When you click on this checkbox a Width drop down appears. You can choose your width or leave the default value.
	Answer is required	Makes the field mandatory for the patient to select an answer from the list to proceed.
	Has border	Creates a border around your List.
	Selection Option	Contains the list values. Write each value on a separate line.
	Destination	Choosing a destination determines where the Label will be displayed. You can choose between “iPad”, “Online” or “Both”.

The animation below shows you how to add this form field to your form:

Medical Conditions

This field allows the patient to select pre-existing conditions.

You can choose from a selection of pre-defined titles or write your own. In addition, you have the option to add an "I checked all that apply" checkbox to the bottom of the form.

 The animation below shows you how to add this form field to your form:

Multi-Line Text

Used for text input for an explanation that requires more than one line such as list of conditions, list of medications and comments.

Available Multi-line Text options are:

	Question	The multi-line text question.
	Answer is required	Makes the field mandatory for the patient to fill in to proceed.
	Has Border	Creates a border around your multi-line text.

The animation below shows you how to add this form field to your form: 

Page Break

Adding this field will divide your form into pages, but it is only designed to work on iPad forms. This page break will not have any effect on the online version of the form.

NOTE: Do NOT use the Page Break with a Scrollable Single-Page form.  This will break your form by adding a Save button instead of Next and Back buttons on the page that will prevent you from moving between pages and causes you to close your form.

 The animation below shows you how to add this form field to your form:

Page Break Online

Adding this field will divide your form into pages but only for online forms. This page break will not have any effect on the iPad version of the form. 

The animation below shows you how to add this form component to your form:

Paragraph

This is used for the majority of larger body texts that contain several paragraphs of text. A common example is the main text body for consent forms.

The available options are:

	Paragraph	Area to write your text.
	Spell Check	Use this to check your spelling. If you click on this button all misspelled words will change color to red.
	Vertical adjustment	Adjusts the vertical position of your text
	Text Color	Changes the text color.
	Destination	Choosing a destination determines where the paragraph will be displayed. You can choose between “iPad”, “Online” or “Both”.
	Has HTML	Checking this box allows you to use HTML code to format your text. If you include HTML and don’t check this check box your code will appear along with the paragraph text instead of the formatting applied to the text.

The animation below shows you how to add this form component to your form:

Patient Address

This field collects address information for patients.

The available options for this field are:

	Question	The label for the street address line 1 (displayed online only).
	Answer is required	The patient(s) must include this information to complete the form.
	Read Only	The field only displays information and does not collect it.
	Has Border	Applies a simple border around this field.
	Empty	UNCHECKED: Existing patient address information stored in your PMS is displayed. CHECKED: Makes the fields empty each time the form is loaded. Use Empty for New Patient forms, as you do not already have address information to display.
	Add Phone	Adds a field for a phone number.
	Add Email, Mobile Phone	Adds a field for an email address and a mobile phone number.
	Add Work Phone	Adds a field for a work phone number.
	Add 'Same Address for Entire Family' Checkbox	Adds a checkbox where the patient can indicate if the same address should be applied to all family members. For use with Family Mode only.

NOTE: You can only use one Patient Address field per form.

In addition, you have the option to add an "I checked all that apply" checkbox to the bottom of the form.

The animation below shows you how to add this form field to your form:

Patient Birthdate, Weight, Age

This field is a combination field used to collect patient birthday, age, and optional weight values.

Aside from making the answer required, the options available are to include a border and to choose English or Spanish language versions. 

 The animation below shows you how to add this form field to your form:

Patient Name

Selecting this field creates the First Name and Last Name fields. You can also choose to display a field for a patient's birthday.

NOTE: Including this component as the first field or after the form header in your form is considered a Best Practice. All patient documentation must include identifying elements in order to ensure proper routing, display, and security.

Referred By

This field is a simple text field for collecting the name of the doctor who referred the patient to your practice. By default, the tag is automatically selected. The only option is if you would like for this field to be required.

By default, the tag is automatically selected. The only option is if you would like for this field to be required. 

The animation below shows you how to add this form field to your form:

Segmented

This is used as a list where the patient can select only one of the values visible as buttons next to each other on the form.

The available options for this component are:

	Question	The segmented question.
	Inline	Indents your List.
	Answer is required	Makes the field mandatory for the patient to select an answer to proceed.
	Has Border	Creates a border around your segmented.
	Small	Makes your font smaller.
	Selection Option	Contains the segmented values. Write each value on a separate line.

The animation below shows you how to add this form field to your form:

NOTE: This form field will appear as a drop down menu when viewed online.

Separator

A separator is a horizontal line across your form.

The only options for this component are Color and Height (in pixels). To change the color of the separator, double-click the color box. 

NOTE: This form field is for iPad forms ONLY.

Signature

The signature should be used by default on every form created unless you choose otherwise. It is usually the last field on your form. Alongside the patient signature, you can add a doctor or witness signature.

The Is required checkbox makes it mandatory for the patient/doctor to sign the form before it is saved. The Add name checkbox displays a field for the patient to enter their name under the signature line. Add “Doctor” or “Witness” to the Footer field if the signature you are creating is for a doctor or a witness.

Single-Line Text

This is used for text input such as name, phone number, and email.

Available Single-line Text options are:

	Question	The single-line text question.
	Inline	Indents your single-line text. When you click on this checkbox a Width drop down appears. You can choose your width or leave the default value.
	Answer is required	Makes the field mandatory for the patient to fill in to proceed.
	Has Border	Creates a border around your single-line text.
	Input Type	Formats your field to the type of data you want to enter in the field.
	Placeholder	Adds grey text in the field that can be a further explanation of the formatting expected or provides an example of what to input. As soon as you start typing the placeholder text goes away.

The animation below shows you how to add this form field to your form:

Student Status

This field asks the patient about their student status.

The available options for this field type are:

	Question	The Student Status question.
	Options	Contains the list values. Write each value on a separate line.
	Required	Makes the field mandatory for the patient to select an answer from the list to proceed.
	Include School Name question	Adds School Name field.

Web Popup

This is used to add a hyperlink on your form that links and opens a webpage or a local HTML file.

Type the text that will be displayed on your form in the Title field then the URL in the Location field.  You also need to specify the source of the link by selecting Local or Internet from the Location radio group.

NOTE: Make sure to include the complete URL. This will include the HTTP:// or HTTPS://

The animation below shows you how to add this form component to your form:

Yes/No Question

Used for answering questions that have “Yes” or “No” answers. Examples are “Do you smoke?”. It can also be used for conditional questions like “Do you like your smile, if no why?”

The available options for this field type are:

	Question	The Yes/No question.
	Yes & No	The text that will be displayed for a positive/negative answer.
	Inline	Indents your Yes/No.
	Answer is required	Makes the field mandatory for the patient to fill in to proceed.
	Has Border	Creates a border around your Yes/No element.
	Small	Makes text smaller. This can be used for long questions.
	Required	Makes the Yes/No conditional; meaning if you choose an answer the element will prompt you to explain your answer further.
	When Yes/ When No	Specifies when the element will display a single line text field to explain your answer. The Required checkbox has to be checked to enable this option.
	Placeholder	The answer prompt that provides different default options or allows you to type in a custom prompt.

NOTE: Avoid making the question too long or a filler will be required to ensure proper spacing.

 The animation below shows you how to add this form field to your form: