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MedServices Patient Assistance Program

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1. Last Name NPI at Search by prescription info Rx Rx Date 3 Search Cancel lis Re Fill Script jg Duplicate Script _ wi Delete d Add b Save Click on M edServices Rx in the list of available modules to make the RX Module the Active M odule Click on the Search Prescription link in the Active M odule window to launch the Rx M odule in a New Tab Enter all or part of one Information Field s system value to search for the prescription record Example Enter jo in the First field to search for a first name of John Example Enter the full Patient Chart Press the Enter key on the keyboard or click on the Search button O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 36 M edServices will display a table of search results on the Search Results Tab The table can be sorted by clicking on the column headings Facility Home Page Rxit6 Doe John q el MedServices Rx Search Results 6 results Script Date Strength Patient Last Name Patient First Name Patient C 5 3 2009 4 45 Mobic John 1 1 2001 4 18 2009 9 5 Lipitor li hoe John 1 1 2001 3 16 2009 10 NexIUM John 1 1 2001 8 17 2009 9 5 Mabie John 1 1 2001 9 17 2009 Malic ID John 1 1 2001 3 18 2009 11 Lexapro Dos Jahn 1 1 2001 JA 2 Double click any row to select the record and load all scrip
2. Click on the OK button to return to the prescription record A PAP record already exists for this Script DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 19 Creatinga PAP Application Creating a PAP Application from the WinPAP module requires the user to enter the Patient Information Prescriber Information and Prescription Drug Details Users can save time by creating a PAP application from the Profile tab in the Patient s record or the Create PAP button in the Rx Module The Rx record for the patient already has the Patient Information Prescriber Information and Drug Details This information will be transferred to the PAP application From the WinPAP Module File Administration Tools Reporting Help Facility Home Page Fin PAP Modul Add New PAP j Search PAPs atch Reorder Order Date Po wy s Patient Information go Prescriber Information ID First Name DEA License Add Another Drug Pharm Co Program Status SIG 5 Diagnosis Open Instances Y WinPAPModue X Cancel LE Save Open Module Instances cmm T M a Bill Tracker 1 Click on MedServices WinPAP in the list of available modules to make the WinPAP Module the Active Module Click on the Add New PAP link in the Active Module window En
3. JataNet Solutions Inc 254 Broad Street SW e Cleveland TN 37311 e 423 479 6729 M edServices Patient Assistance Program User M anual Version 5 MedServices User Manual Version 5 Page 2 Table of Contents Table or CONtTeEntS asriar a tate at taa aaa a atan aa a l a e a anko a a a n CHEF RGB RP RID 2 SONS GUIS kew oi foot a ka ka ieee ati a ii kk tk E a a kk a a kk io e ET vni n a a Eo eka 3 LO OIG Trou ai l Oe e a te kak DOLO RW a a k OU e DAR DA ka D UR Yr OD D DOR f a e RD UR 4 Facility HOME PAGE iioii kiba mdi n a a n a n a a n n E IM oo TL ITI EINE iE 6 MedServices Patient Assistance Program eene 7 M edService Patient Assistance Program Screen Diagram eeeeeenee nnns 8 PAP MO FAN G08 Z P td 8 PARTETO 202 tt mi kak n la aka lay kk mi ak e e tp a e ti ere ga ke cere fo 9 Creating a PAP AppliCatiOn wiii kika kk kk a ER e e kk pk a E LR RE ER A A Ok EUR FRED FN ERE 10 From the Patient Record in the Patients M OdUIC cccssssccccsssssssessssseeeeeeessssssenseteeeeeeseessssesaeenes 11 From the Prescription Record in the Rx Module nnmm nnns 17 Frontone WINFARM VOU East ii ko enti ived ae ire rid Eon rta Pouf anie ape PUR Pea ac HG d RR URN 19 Opening an Existing PAP Record vision ian kosa o OO RECEDIT 20 Erom tne Patient F CON scere atis nu Eu ERI DEBA RE GR ERU ORNA a INR SCR CIPRO VER S GU TIR a n RETE HH RUD RR 20
4. 5 Double click on the Gray box in the first column of the Search Results table to load the record or select a record from the list and click on the OK button DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 24 Printing Applications PAP applications can be printed at any time 1 To print a single application use the Application button in the PAP record Prescription 2 Users have the option of printing a copy of the corresponding prescription with the application by checking the Print Prescription box in the Application Options Letter window If the application is a reorder users can check the Use a reorder form box to print the application on a reorder form if one has been made available by the Pharm Ca pharmaceutical company Only use the reorder form if you are certain the application is a reorder and not the initial application for the drug program Label Rev Meds it SC tio 1 Eligibility 2 Print Prescriptior Use a reorder form if available Show All Activity Print Later Print 3 Cancel Application Print Options With Preview Direct Print 3 Users can preview the application prior to printing by selecting With Preview from the Print drop down list The application will open in Adobe Reader and Choose Printer can be saved or printed using commands from n Adobe Reader
5. AE 39 PNN e e tt a a di kn kn TU a kn a a a a a a aa e ER a at a kk a UB Fia GA a FA ee ra ik ae 40 Prescription Label and Patient Education bwa a e aa a l ak tk ata aa ea n a be be ka b ted ia 40 Contact Information ke aie ii a ii ai ai ata ay ki a a atann E EF UD EFL NUR EFRON VR DER HDD A a A 41 DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 3 User s Guide All of the software features steps and system values are include in this manual but may not be available to every user The following Icons will be used throughout this and other M edServices manuals UNIVERSAL COMMAND A ALIN SHORT CUT This is a time saving tip or A command that will work in all H another way to do the same task tex teri modules or is a common operation Y in all modules DATABASE Information about the IM PORTANT Pay close attention to information stored in M edServices these directions DataNet Solutions is a custom software solution provider We value the input of our users and strive to constantly improve the software As a result the user manuals and guides are living documents and may not contain a current screen shot Please don t hesitate to send an email to sales datanetsolutions org and give us a friendly reminder Before you can login to M edServices you must have a User Name and Password Only users with Administr
6. Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 34 Recording an Activity 1 Click on the Activity PAP Activity button 2 Click on the Add button The date and time are d 5 11 19 2009 4 3 automatically recorded 3 Enter a short activity Description Enter the active Notes Click on the Save button Activity Date Time 11 19 2009 04 31 08 PM Description Click on the Exit button oes ko Iu ai Delete Add kel save Exit View and Edit an Activity 1 Click on the Activity button Select an Activity in the table at the top of the PAP Activity window to view the full notes Make any changes to the Description or Notes Click on the Save button Click on the Exit button Ron e er Click on the Save button at the bottom of the PAP Application tab to save changes made to the record O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Filling a Prescription MedServices Rx Add Prescription Search Prescriptions Unfilled Unreviewed Options Sy Mobic 9 17 s Open Instances Facility Home Page RxModule Version 5 A MedServices Rx Search s Search by patient ID First Chart DOB Page 35 Recert Date Status s Search by prescriber ID First Name DEA License
7. Script E Delete E Add I save Open Module Instances Re script Date Last Fill Date Drug Name strength Fills Remaining Available Oty i eo e b ann ODataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 18 Dialogue Boxes Create PAP From Script Are vou sure pou want to create a PAP from the selected script M edServices will prompt the user to confirm the di i action Click on the Yes button to continue or click on the No button to return to the prescription record M edServices will display a Success dialogue box Users have the option of printing the application at the time they are created or batch printing all the applications at a later time Click on the Yes button to print the No application Click on the No button to flag the Print Later box in the PAP record Do you want to print the application now Could not Create PAP YET If no drug program is available for the prescribed mediation M edServices will Drug is not available in PAP display a Could not Create PAP message Click on the OK button to return to the prescription record Could not Create PAP Ifan application has already been created for the same prescription M edServices will display a Could not Create PAP message
8. is uere Resend ie Vig nada Ghee ty Ohh YAN k teleped ya home Finit deta a HIPAA latae ou ned ae eek of youn oer Th abit cout celi De AD oer cll ume Pa Da ee co What Proof of Incoane Do I Need to Apply You ll need to provide ws with one of the following income document that show your total gross annual houschold income 8 Current pay check stub Federal Tax Rerum Form 1040 oz LOMOREZ for the prior tax year Wage and tax statements Wa forma Social Secaritr penson or railroad retirement statements SSA 1099 ar almilar m Statements af interest dividenda or other income 1089 TN T 1099 10499 DIV or other ferma If you do not bave any proof a income please call 66 706 24 0 for instructions Pim marra nr tance the Commection ta mt any tmr Cannacrlan Ci E RE ad Ble E arg eleme ar maet Re je Cies pout ec Farlapr Abimin Pirin DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 26 PATIENT APPLICATION it Please read all information on the separate Instructions sheet Print clearly in the shaded areas on the application CONNECTION TO CARE Paticnt Name Jake Berkley Patient Address 5050 Wimont Lane moe o DIE c Tetons 423 478 0728 2 Total Gross Annual Income 26400 00 Number of Persons in Houschold 5 facade yonzsel end rase yon ave financially respon bis for Do you have any insurance coverage f
9. with the Peor Connection to Cave patient eurichewco program Patient Na me For Lyrica and patients residing in Puerto Rico and U S Virgin Idands ONLY Prescription and over the counter medications NOT E Expedited enrollment fe available for the below noted products for the Eza fill of a new Connection to Care patient Geodon Eipraaidone ERC e Inspra Tikosyn dafeihde fnpismetprenriben onb e Zithromax anthroanycna Plenn call 866 705 2400 bor ad eurollxusst Instructions By signing below you the healthcare provider understands and agrees to the following Receive and secare patient s medication at your office tntil dispensed to your patient Comply with and abide by my State Practitioner Dispensing Laws for anthorized Healthcare Providers po dee yw e by Pitzer asa resale of this ordez form are for the ose of the patient named on this form tid shall not be seld weded bartered transferred returned for eredi or sulemitved vo airy third party rach en Medicare Medicaid ar other benefit provider for reimboraament e Pfxrr may cantect the patient directly to cumfirm moubt of medications e Pfleer may change ur cancel this program at axy time e The medicine will be provided emily to this sligidh and specific enrolled patient at no charge af any kind e fa patient a applying for a Hardship Exception I certify that this medication order ex attached comtralled suhstanca promonption is medically m
10. 1 24 2010 Berkley Jake Lipitor 10 MG s Open Instances os wj i Double click any row to select a record and load all scripts that are associated with it PaP mo Search Results si Delete d Asa Open Module Instances Bill Tracker Document Manager Donors amp Donations Drug Inventory MedServices Rx MedServices Schedule MedServices WinPAP Visits Volunteers amp Time Patient Module DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 21 Search for a PAP Record File Administration Tools Reporting Help m em ii TET ae eee EEE EE eee eee ets Add Mew PAP Batch Print Search PAPs Batch Reorder Recert Date Status First Mame Last Mame License MI PAP ID Drug Strength Pharm Cao x Order D ate Reorder Date f Search Cancel at Open Instances Y PAPInfo Search Results Search Ti Add Open Module Instances ll 2 M Dam Volunteers amp Time 1 Click on MedServices WinPAP in the list of available modules to make the WinPAP M odule the Active Module 2 Clickon the Search PAP s link in the Active M odule window to launch the WinPAP M odule in a new tab DataNet Solutions Inc 2009 e 254 Broad Street SW e Cle
11. 2009 Sent to Patient Revd From Patient x Reorder Date 04 23 2010 Lipitor Qty Reg 90 Refills 2 Qty Rcvd Take ane tablet daily Supply Days strength 10 00071015523 Each Awp 3 35 Total Awp 301 05 Each WAC 2 68 Total WAC 240 84 Rx The Rx will be populated if the PAP Application was created from the Rx Module Order Date This date reflects the date the application was mailed or processed The Reorder Date will be calculated using this date and the guidelines set by each pharmaceutical company M anually change this date to reflect the date the application was mailed to or phoned in to the pharmaceutical company Due Date This date field can be used to enter the expected due date of the medication Add Date The date the application was created Sent to Patient This date can be used to track the date the application was sent to the patient for them to sign Rcvd From Patient This date can be used to track the date the signed application was received back from the patient Reorder Date The Reorder Date will automatically be calculated using the Order Date and the guidelines set by each pharmaceutical company Qty Revd This field can be used to track the amount of medication actually received from the pharmaceutical company See the Rev Meds button below if the clinic will receive the PAP drugs into local inventory and dispense the PAP drugs by filling a prescription from the Rx Module when the patient comes to
12. AP record for each drug application The PAP record will be linked to the Patient Record M edServices will automatically display a Print Applications dialogue box e 10 27 2003 f ES Users have the option of printing the application s at the time they are aana created or batch printing all the applications at a later time mm Rev Meds Eligibility Print Applications a wAC 21 83 Show All Activity Do vau want to print these applications now Yes Moa Y Print Later 17 Click on the Yes button to print the application Click on the No button to flag the Print Later box in the new PAP record ka Re order Days 90 Payment Discontinued Date gi Delete Add Save O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 17 Creatinga PAP Application From the Prescription Record in the Rx M odule When a prescription is created in the Rx Module the provider can be directed to select from a list of medications imported into the clinic s local drug database inventory The Clinic Director can load medications that are frequently ordered through the PAP program into the local drug database to insure that providers prescribe these medications when it is possible The Rx Record for the patient already has the Patient Information Prescriber Information and Drug Details This information will be tr
13. Clicking on the Print button in the Application Options window or selecting Direct Print from the Print drop down list will bypass the print preview See a sample print out on the next page Cancel Ok 4 Select a printer from the list of installed printers and the application will be sent directly to the printer An internet connection is required Patient Assistance Program applications are updated daily Each time an application is created or printed M edServices retrieves the most up to date information available O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 25 Sample PAP Application INSTRUCTIONS ar FOR PATIENT APPLICATION PETIORT BERR NAM AN Pee Am I Ebgihle for Comnection fa Care You must meet the following criteria L You have been prescribed a Piza medicine Many Pfizer bondad madiciros are available For a lut of available Pfaeer madiciros please cali F amp 6 704 M00 or risit ranpa I fezorfislpiolAmnwarr com 2 You reside in the United States Puerto Rico or the U S Virgin klands 3 Your Total Gross Annual Household Income is at or below 2 times the Federal Poverty Level kee chart ae m Tertal Grona Didit peludea ih pin s fete ali eons ina the bousekold before tunes and Please visit waww aspe bhs gou pouertw for information on Federal Poverty Level ea F
14. Order Date Reorder Date PAP Info Search Results Search Last Name MPI 10 27 2009 01 25 2010 Ecv Meds Rcvd Eligibility 3l WAC Show All Activity Y Print Later Recert Date Status Strength Search Cancel F Add 1 Click on MedServices WinPAP in the list of available modules to make the WinPAP M odule the Active Module Click on the Batch Print link in the Active Module window to launch the Batch Applications window A Batch Print link is also available at the bottom of the PAP Info Tab DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 29 Users have the option of printinga copy of the corresponding prescription with the application by checking the Print Prescription box If the application is a reorder users can check the Use a reorder form box to print the application on a reorder form if one has been made available by the pharmaceutical company Only use the reorder form if you are certain that none of the applications included in the batch print are the initial application for the drug program Batch Applications If Batch Printing you can leave dates blank to Print all apps marked to Print Later If Batch Re Ordering you can leave dates blank ta Re Order all apps that are due from this date forward From Y E To Print Prescription Use a r
15. Print Later rur ow Pharmaceutical Company Astrazeneca AZ Ie Prescription Savings Program wio Insurance m AVAILABLE Until fe e Re order Days EE PAP ID Patient Charge Mm Reorder ID me Discontinued Discontinued Date EE ai T PAP M odule Reorder and Delete Add Save Tabs Print Options Buttons tini ao ola l m A 2 akt mu Te Services in Pi F e Patients n Active Module Patien ray n TE HH s DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 9 M edService Patient Assistance Program Screen Diagram PAP Info Tab 2 of 2 File Edit Administration Tools Reporting Help Open Instance of MedServices 4 gt Facility HomePage Pap ID i Doe Jonny PAP Module Add New PAP Search PAPs Application Patient Information pulled from Patient Record Prescription Letter T Pharm Ca PAP Application and Order Date Due Date Add Date 99 15 2009 Label n Prescription Drug sent ta Patient Rcvd From Patient Reorder Date M I Rev Meds Details Qty Rea Refills Qty Revd Eligibili Supply Days Strength pen Status of 3 Aga Each Awp Total Awp Saos Each WAC Total WAC AN Application Sici Diagnosis VIRAL PNEUMONIA 480 Y Print Later Prescriber Information p
16. Req Supply Days Each Awp Total Awp Application Status Diagnosis ae Prescriber Information am Pharmaceutical Company Information Pharmaceutical Company Program Status Rearder ID PAP Info Search Results T Required values display in Yellow Users will be prompted to complete these fields before moving to the next Add Date Reorder Date Refills Oty Rod Strength Each WAC Total WAC Re order Days Patient Charge Discontinued Date step Unavailable values display in Gray Using the Tab key on the keyboard will skip these fields If the Patient section of the record is Red the patient has been flagged by the clinic as Ineligible for Services DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 n MedServices User Manual Version 5 Page 13 5 Enter an Order Date for the Application If there is a delay in processing the application this date can be changed to the actual date the application was processed and sent Do not leave the Order Date blank HINT Press the letter t on the keyboard to enter today s date in the Order Date field Facility Home Page Patients IDs 27 William Ti Because the PAP application was launched from the Patient s Record the Patient Information section will already be populated with the geographical data from the Patient s Record The Patient s Recert Date Status an
17. SearcD or a PAP ROeCOLG anseres dtes sa been nts cbe dto i ite Bn eer Ru ern m pO 21 Printing Applications sinn a tik ak atak ak a a ja D n RERO a oa ERO EROR EORR EIER OECD 24 Sample FAP ADPIC O aestas kl at ks a Praten dread itta d pne tmb ed atre ro Pen ke f e E 25 BALE PINUNO f r nana ae 28 Update or Edit an Existing Application 11eeeeeeeeeeeeeneeennnnnnnn nennen nnn 31 PAP MONN A CON Se CL A patat kk ak tee sr ca crema ebd trn kf ta nota el be a e RR zb 32 DEUS SECH ON M ru E 32 Pharmaceutical COMPANY INTOMNAUON e a a ak ak pk kk Ra ask n on ke IE a e kak ia a kk aaa ew ki EDU b ia 32 PAP ADDIICaEION BUWONS cessant on c n l va e uci foc ak a bun Pl a e a pk ki e a ean ena 33 Entering PAP drugs into local MWEN CON Yet a tia tn ora i e kk Pete cian e e kap n ka e 33 K CONU N an A CM Y MT 34 VIGW ANRO EGU ACEI ii ka ka oak ab alates kte A e a tease A 34 ENING d PFESCN PLON kot ia at tat at n e a a ae ka ak dun n onc Da n enc b D v n ia fv 35 Search Prescriptions for the Patient s Prescription Record Error Bookmark not defined PRESChIDUOM LA B S k ae ve dal aa a klate e tea e n Echos Cra rcr di miS pa ko Ca vx da VICE aa Zen 38 PUNEO DYMO Label PEITIEGE ezite ka a a ge O kata dde a e a ake ka kn ducit e a kt a 38 Ordering Labels from DataNet SON UE N NS ei sinbol ai kn n ek i FERE FRU EN RE Re E ERR ur 38 Sa DI Preseruon LAD Cl io ti kit aka ek ak kk a a ea kk ak ke kk
18. ansferred to the PAP application 1 Open the Prescription Record in the Rx M odule See Prescriptions Rx M anual 2 Click on the Create PAP button File Administration Tools Reparting Help MedServices Rx 4 gt v Facility Home Page Rx 9 Doe John X Add Prescription 3j MedServices Rx Module Search Prescriptians Unreviewed Options amp 9 ETT a 10 8 2009 4 5 Warfarin Sodium 7 5 TABS 4 360 Drug Date pae 8 10 8 2009 4 4 Vasotec 2 5 TABS 340 6 9 13 2008 11 Lexapro 5 TABS 340 4 9 17 2009 9 5 9 18 2009 111 Mobic 7 5 TABS 270 i i Rx Summary IE 4 First John Last Doe Recert Date 04 02 2010 ax Review Status Chart 123444 DOE 01 01 1971 SSM 111 11 1111 Status Recurring Review Pending Last Filled rt Prescriber Information Pag ID 1 First Name Mary Last Name Smith Available DEAS 123456 License 123456 MFE 123456 Fills Qty 360 it Rx Information Completed Ruz 9 Drug Warfarin Sodium Strength 7 5 Dosage TABS Fills i SIG 1 take 1 tablet daily Sig 2 with food Prescribed Qty 80 0000 Supply Days 50 Prescribed Refills 3 Discontinued Py ence iiim pm Print Script Rx Date fio 8 2008 Stop Date fio 8 2010 Dispense As Written DAWO iit ad Ma Child Proofing Script Renewed Discontinued ies eru rs Instances Pharmacist Review Username Password Confirm Review Review Pending Qs ML Results Search iuis Re Fill Script as Duplicate
19. ative rights can set up new users and reset passwords l l DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 4 Logging In Updates M edServices automatically checks for updates each time the software is opened Checking for SQL updates Current Process Overall et into M edServices Click on the drop down arrow to display alistof E emre MedServices clinic names Logging into MedServices 2 Click on the desired clinic name to enter the clinic name into the Clinic text s Down Login Options Log In box Clinic Clinic 1 Md v Login to Medj Button Database Properties Data Sources 3 H it the TAB key on the onon a Cancel Login keyboard to move the mwen cursor to the User Name Field 4 TypeinaUser Name 5 Hitthe TAB key on the keyboard to move the cursor to the Password Field 6 Click on the Log In button l l User Names and Passwords are case sensitive Each user is assigned permission to Add View Edit or Delete data in each module Only users with Administrative rights can change these permissions I DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 5 Logging out of M edServices 1 Fromthe File menu select the Exit command or clic
20. ch Upset O cars 1 per day RPh before b rea kfast Ong Take The Med Elie With Fall D ONNSEE i ao RTHO Discard After Limit Abobo Use Wilk Taktig l The Drg Dalk Ure OT alco bal May be filled until Gy S May creare The REK OT bma oo Patient Cours eled By Accepted By Re ject ed Rx Fill Date Refills 3 KA Rx Refills 3 Hext Refill Due Fill D ate Qty 90 00 FOR John Doe Medication HD C Directions for Use 1 per day before breakfast 254 Broad Street Cleveland TH 1311 RECEIPT ik Prescriber Mary Smith RPh 555 422 1234 Bs NDC Fill Date AWP 409 0 Drug Meloxicam 75 MG Days Supply 36 Refills 3 DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 40 Printing Prescription Label and Patient Education After the Prescription has been filled and saved the Print button will appear next to the Delete button Select the desired printing option for the Prescription Label and Patient Education If the primary language of the patient is Spanish in the Patient Record s See Profile Il the education and label will print in Spanish Dispense As Written DAWO Supply Days 90 Exp Date 09718 2010 Fill Date 09 18 2009 01 11 PM Print Delete Label Printing Options With Preview Direct Print Patient Education Prescription Drug Education Misc Clear Prin
21. cv Meds Record receipt of the PAP drugs PAP drugs can be added into the local drug knes inventory PAP drugs added to the local drug inventory need to be dispensed by filling a prescription from the Rx M odule when the patient comes to pick them up in order to iii deduct the drugs from the local drug inventory Eligibility show All Activity Receiving PAP Drugs Into Local Inventory You may adjust the quanity received and the NDC in case the actual quanity or drug 1 Enter the Received Quantity and received was not the same as on the application Lot Number for the PAP drugs Bra Lab WIS Drug must be the same type and lab as was on the original application Click the OK button A Receive Drug Inventory window will open showing that the drugs Received Qt Hl have been received 4 Clickthe Close button to return to the PAP Application Received NDE 58394000101 BeneFIX 1000UMNITSOLR E OK Cancel Lot Number Eligibility Compares the information recorded in the Patient s Record with the selected Pharmaceutical Company s eligibility criteria Show All Displays a list of all PAP Records linked to the current Patient Record Activity Add an entry to the Activity journal Users can track any activity associated with the processing of the PAP Application A Time and date stamp is available Click on the Save button at the bottom of the PAP Application tab to save changes made to the record O DataNet Solutions
22. d Alerts follow the Patient into other modules Click on the Alerts button to review any patient alerts A number will appear next to the button indicating the number of Alert Records that have been linked to the Patient Record Facility Home Page Patients ID amp 27 William Ti WinPAP Module Order Date Patient Information ID 27 First William Last Tima Recert Date 4 12 2010 i bi DOE 5 21 1971 vi SSN 123 Status Recurring First Mame Last Mame License MFI Add Another Drug Program Status Pharm Ca SIG Sup Days Diagnosis DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 14 ege e OU 6 Enter all or part of one Prescriber Information Field s system value to search for the Prescriber Example Enter ma in the First field to search for a first name of Mary Click on the Reset button to clear the fields and reset the search criteria 7 Press the Enter key on the keyboard or click on the Search button to search for the Prescriber s Information If multiple records match the search a separate window will open with the Prescriber Search Results By default the search results table is sorted by Last Name The table can be sorted by clicking on the column headings at the top of the table 8 Double click on the Gray box in the firs
23. der Broad Street Clinic Contact Mary Smith at 423 479 6729 SU bject Line Label Order recurred SW Cleveland TN 37311 Name of Clinic Shiping Address n 1122 West Milton Cleveland TN 37311 Attention Jack Jones Clinic is only open 1 day a week ship to Jack Contact name and phone number a 22d pwe Billing address Shipping address and name of person who will be receiving the labels 6 Number of cases Please include the following information in the email 2 Cases St ooo psp DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Sample Prescription Label x Fill D ate John Doe Mary Smith zid Ergad Sie et Cele end TH 57311 555 d22 1234 1 e004 DES State 1 per daybetore breakta st RFK Written Refills 3 Discard CHUTON S T TE AHIA FEDERALLALY Pf OHETITS TASER OF THFEDR Lia PART FER SOM OTHER THAN FER SOM POR CHOMITUAE FRESCE EED Rx OOOO ate 3 182003 mafilg AMP Pt John Doe RPh Drug MebzkamTs MG PHARMACIST NOTES Printed 3 8 2008 Hx Written Fill Date Refik 3 RPh Patient Patient Phone Patient DOB Prescriber Mary Smith Prescriber Phone Prescriber DEA Drug lelo carm 7 5 MG Mfualah 410 RTHO Qty on Hand 210 00 Version 5 Page 39 May Cae Drowzhezi OF anni 26d Broad SieetCkuwbnd TH 423 479 6729 Rx Filled Take The Medblie With Sack Refills 3 Orsmal Meal tStoma
24. dicauad for this patient and I will ba supervising the patiant a trestmenis Te tha beat a my kenerwlaciga thia patient would not ba able to nbtain this medics without amictance fram Connection to Care for the reasons the patient has indicated in this application Connection to Care m part gf Fme Fanfa Aneqwers a j n program of Fme kan und the FP xxr Patient Ansictuson Fepndatign Piiz Connection to Care PO BOX 66505 5T LOUIS MO 63166 4585 Carem Service Phour 166 706 2400 DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Printing Applications Batch Printing Version 5 If the user chooses the print later option at the time a PAP application is created the Print Later box is automatically flagged on the PAP record The flagged records can be batch printed using the Batch Print link The applications will be sent to the printer as a single print job A header page will separate each application for easy sorting and processing File Administration Tools Reporting MedServices 34 Add Mew PAP Batch Print Search PAPs Open Module Instances Bill Tracker Document Manager Donors amp Donations Drug Inventory MedsServices Rx MedServices Schedule 1 Volunteers amp Time Facility Hame Page Help ID First Mame DEA License PAP ID Drug Pharm Ca
25. e full drug name and strength will be entered into the PAP NI application Double click on the drug in the list 13 Enter the Qty Quantity and number of Refills to automatically load the drug l l prescribed details into the PAP application Add Another Drug Drug Lipitar strength Qty 30 Refills 3 BB of Ya Program Status Pharm Co SIG Pfizer U S Connection to Care Program Pfizer U S Pfizer Piriends Welvista Patient Assistance Program 14 Select a participating program from the Pharm Co list NOTE No programs will appear on the drop down list if a Drug and Strength have not been supplied O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 16 Drug Lipitor Strength J Qty 90 Refills 3 Reorder 01 35 2010 Pharm Co Welvista Patient Assistance Program Program Status 15 SIG Sup Days Diagnosis m 15 Enter the SIG Sup Days Supply Days and select a Diagnosis When a patient has been prescribed multiple medications a PAP application can be Add Another Drug created for all the drugs at the same time Click on the Add Another Drug button and complete the steps for adding each additional drug A separate application will be created for each drug entered 16 Click on the Save button to create an application for each drug M edServices will bal save create a P
26. entory of prescription drugs 9 Confirm the Prescription Details 10 Click on the Save button DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 38 Prescription Labels Print to DYMO Label Printer The Clinic Administrator can set the prescription labels to print on a Dymo Label printer See Administrative Preferences M anual When the Use Dymo Label box is checked the prescription labels will be formatted to the Dymo label format Clinic Number 1 Serial Number Clinic Name Broad Street General Practice Website www BSGP org General Information Settings Patient Assistance Sliding Fees Prescriptions Clinic Users System Value Permissions Prescription Preferences When adding prescriptions check the patient s prescription card to see if it has expired Require Rx Review Use Dymo Label Ordering Labels from DataNet Solutions Prescription labels can be ordered through DataNet Solutions for 128 per case Call 423 479 6729 Ext 2 to confirm pricing There is no charge for shipping Each case contains 2 400 8 1 x 11 Rx labels Expect delivery in approximately 5 business days Label order Message HTML File Edit view Insert Format Tools Actions Help An order can be placed by sending an email to i Tahona support datanetsolutions org Maen LLL Geo Subject Label Or
27. eorder form if available 4 Click on the Process button 5 A Print Applications window will open automatically DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 30 Print Applications YELLOW A record highlighted Yellow indicates that the Patient has been flagged as Ineligible by the clinic Check the Patient s Profile tab in the Patient Record RED A record highlighted Red indicates the Patient s recertification date has passed Check the Patient s Profile tab in the Patient Record GRAY A record highlighted Gray indicates that required information is missing from the application like an accurate NDC number or Pharmaceutical Company Name Scroll to the right in the table and record the PAP App ID number Open the PAP Record and make the necessary corrections ProcessApp RearderDate OrderDate PatientMame TradeName Print Applications rellow Patient Ineligible Red Patient recert date past due Gray Missing Required Info DE Pharmc ReqUty E 3 25 2010 1 25 2010 Allen Tim Allegra 3 pi 3 25 2010 1 25 2010 Allen Tim Belladonna Alk ad 3 25 2010 1 25 2010 Allen Tim BeneFIX 30 1 31 25 2010 1 25 2010 Allen Tim Daypra 3n E 1 25 2010 1 25 2010 Allen Tim Lipitar a C 4 25 2010 1 25 2010 Allen Tim M exILh a inm 1 3 25 2010 1 25 2010 Allen Tim Sustiva 3 x f Select All U
28. ills and current PAP applications Required values display in Yellow Users will be prompted to complete these fields before moving to the next step Unavailable values display in Gray Using the Tab key on the keyboard will skip these fields If the Patient section of the record is RM the patient has been flagged by the clinic as Ineligible for Services Service eligibility is set on the Profile tab of the patient s record An internet connection is required Patient Assistance Program applications are updated daily Each time an application is created or printed M edServices retrieves the most up to date information available The drug database is automatically updated monthly O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 8 M edService Patient Assistance Program Screen Diagram PAP Info Tab 1 of 2 Other PAP Application Buttons Open Instance of PAP Module Links to open an instance of E mi 7 Order Date yoyo Due Date L hu Add Date ZE fr E the Active Sent to Patient Revd From Patient Reorder Date ED oua wem mka av poo new tab e E Eligibility SIG Supply Days w Strength 20 Rev Weds NDC 00186402001 Each Awp less Total Awp BESS Each WAC ls 16 Total WAC ru Show All Activity VIRALPNEUMONIA 480 W
29. k on the X button in the top right corner of the M edServices V5 Window e ui MedServices v5 Edit Administration Too Search Patients 2 Clickont a mtm MedServices Logging out of MedServices P Current Session User Name admin Clinic Clinic 1 Server MomOffice sqlexp Login Time 7 23 2009 3 14 11 PM Dab bee Maieniicne Logging Out Options Log Out Log Out Button Return Restart MedServices Restart M edServices will automatically lock the screen and require the user to log back in after 10 minutes of inactivity Session Lock Due to system inactivity your session has been locked in order to comply with certain privacy laws Medservices will shutdown 1 hour from the time the session was locked Please enter the username and password you original logged into MedServices with in order to resume your current session l l l l l l l l l l l l l l Thisisa system setting USS T eR dictated by HIPAA l l l l l l l l l l l l l l l Username Resume Session Exit MedServices requirements and cannot be changed by an Administrator Password DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 6 Facility Home Page M edServices opens with the M edServices Today page displayed on the Facility Home Page Tab Statistics from the current days activi
30. n be created during the batch reorder process Accurately tracking the Application status will help the clinic keep on top of the reorder process and insure there is not a shortage of medication for the patient Batch reordering allows the clinic to reorder applications within an eligibility window for the entire clinic without processing each patient individually An internet connection is required Patient Assistance Program details are updated daily Each time an application is created or printed M edServices retrieves the most up to date enrollment applications program guidelines and pharmaceutical company details from the PAP Application Database The Master Drug Database is automatically updated on a monthly basis and contributes the NDIC number Drug Pricing Duplicate Therapy Interaction Dosage and Patient Education details DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 11 Creating a PAP Application From the Patient Record in the Patients M odule When users create a PAP Application from the Patient s record the Patient s demographic information is transferred to the application File Edit Administration Tools Reporting Help Patients A how Facility Home Page Add New Patient j Patient Profile I for William Timer Search Patients Patient ID 27 Chart Sec ID Pei Fist Wiem M de Last Ter s
31. nse through Correction to Care Pfizer Patient Assistance Foundation PPAF understands yoar personal and health information is private The information you provide will only be used by PPAF and parties acting on its behall to send you the materials yon texjaexted and other helpfol information and updates ot the Connection to Care program L1 e burst as ripe iue n STR S E AR oo ir RT rit uae my information to develop or improve products and services or contact me puente ee f grs Connection to Care program or other health related topic Original Patient Si Parent or guardian i Amp 18 years of age Mizar Connection to Care PO BOX 66535 ST LOUIS MO 63166 6535 Cartomar Sarvica Phone 166 706 2400 More PHAStSLITT DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 27 HEALTHCARE PROVIDER SECTION Please read all information and print clearly in the shaded awas Physician Name Mary Smith our gee aa nl ar tele oe ae ee op Hee ae paa Lyrica pregablin and paienn residing ln Puerto Rico and U 5 Virgin lalande you MUST arrach your original prescription ped sheer Jake po Bis Patient Address Io CC MEE TN 37311 D O B Product Name Lipitor Strength 10 MG Qu L Dose 1689 One tablet de Product Name Strength Qty Dose Product Name L Strength Qty Dose Healthcare Provider Sig nature This ik anly veld for wee
32. nselect AI DO NOT PRINT apps that can be phoned in Continue Cancel 7 DO NOT PRINT appsthat can be phoned in Check this box to automatically create an Excel Spreadsheet listing all the details necessary to phone in applications Not all Pharmaceutical companies will allow applications to be phoned in Print App 8 Click on the Continue button would pou like to print these applications now Y es Mo 9 Click on the Yes button to send the selected applications to the printer M edServices will check for updated applications and then create a single PDF file in Adobe Reader containing all the applications A header page will separate each application for easy sorting and processing M S Excel will open automatically displaying the Phone In details if applicable O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 31 Update or Edit an Existing Application M edServices WinPAP Is designed to allow users to track the PAP Application through the order receive dispense reorder cycle Once the clinic has defined the PAP Application process Application Status codes can be entered in the Administrative Preferences M odule and used to track each applications progress Click on the Save button at the bottom of the PAP Application tab to save changes made to the record PAP Application Record 31 MedServices Patien
33. or a household greater than 5 or if you live in Alaska or Hawaii please call 866 706 2400 4 You bave no maurwu ce coverage or benefit for prescripaun medicines Pharmacy discount cards or drug company assistance programs are not insurance coverage 5 Our programs arc primarily designed for people without prescription drug coverage If you have drug iwancial preacriptiou coverage but are expecienomg hardship you may stil i u You meet the income requirement noted above Fleasr fill out Patient Hardship Exreption section on the Patient Application How Can I Apply L Fill out the patient sections on the Patent Application Form 2 Ask your doctor m fill pat the healthcare popriser sections an the Patient Application Farm 3 Place all required documents together in a stamped envelope O Original completed and signed Patient Application Form both Patient and Healthcare Provider sides O Original prescription if yon are applying for Lyrica pregabalin CO Original prescription for all medicines if yon are a resident of Puerto Rico or U S Virgm alanda LI Photocopies of proof ofdncome documenta please see Proof of Income section below Mail t PFIZER CONNECTION TO CARE PROGRAM PO BLIX 66585 ST LOUIS MO 63166 6555 For your information a Keep photocopies of your application and your origmal income docamentetion a Meet ads Contd dor a pa Annet Gade ea ee eee Tf pou are accepted medicines will be dispenaed at Meine Wa catia eating
34. or prescription drugs 7 Yes C No If no skip to section 4 tete Exception you responded ye nd and are facing financia hardahip and have peeacr ption drug coverage pleaae answer a eU Me X A C Medicare prescription drug C Medicald C Employer C Other 3 3 Insurance Company Provider Name Policy Number ID c Kf ang of the Pfizer medicines for which you arc requesting assistance arc not available through pour insurance plan please provide them here x LT By checking i bn T cere certify that significant financial hardship and I Iam hardahip I am currently to pay far the Pfizer medicine my doctor has prescribed Patient Declaration By aigning below I affirm that my answers and my prua u incoze documents are complete true and accurate to the beat af my knowledge I understand that Completing thia application farm does nat guarantee that I will qualify for Connection to Care Pizer may verify the eccurecy of the information I have provided and may ask for more financial and insurance information a Any medications suppied with the Connection to Care program shall not be acid traded bartered or tremalerred e P rer reserves the right to change oz cancel the Connection to Care program at any Gime The support provided in this program is not contingent on any future payor inchiding Medicare Part D plans for any costs of medications will notify my ingurance provider of the receipt of any merici
35. pick them up Status Section S status Application Status Diagnosis Codes for Application Status and Diagnosis can be loaded using the Administration Preferences M odule The Application Status field can be used to document the progress of the application process Pharmaceutical Company Information E Pharmaceutical Company Information Pharmaceutical Company Pfizer U S Connection to Care Program k Program Status AVAILABLE E c Re orderDays 90 Click on the E button to display the program eligibility details supplied by the pharmaceutical company Click on the C button to display any comments published by the pharmaceutical company The Re order Days are automatically provided by the pharmaceutical company Click on the Save button at the bottom of the PAP Application tab to save changes made to the record DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 33 PAP Application Buttons Application Print the PAP application Includes an option to print the prescription Application Prescription Print the prescription Prescription Letter Print Your medication has arrived letter with Patient s Name and Address Pharma Co Pharmaceutical Company contact information program eligibility details teen and comments if available Pharm Co Label Print a prescription drug bottle label R
36. t Assistance Program PAP go Patient Information Application First ware Last Serkis Recert Date 4 27 20 1 wl Prescription DOE ZAL El SSM 000 771 9995 status Recurring all amp 9 PAP Information Pharm Co Order Date 01 24 2010 Due Date Add Date 10 26 2009 Label Sent ta Patient Revd From Patient Reorder Date 04 24 2010 Rcv Meds Drug Lipitar Qty Reg 90 Refills 12 Oty Revd Eligibility IG Take one tablet daily Supply Days Strength 10 MDC 00071015523 Each Awp 3 35 Total Awp 301 05 Each WAC 2 68 Total WAC 240 84 ren ia Activity Application Status 3 Ordered agnosis TYPHOID FEVER 002 0 4 AF Print Later ID 1 First Name Mary Last Name Smith 18 DEA 123456 License 123456 NPI 123456 p Pharmaceutical Company Information Pharmaceutical Company zer U S Connection to Care Program Program Status AVAILABLE Automatically reordered from PAP 10 an 10 26 2009 1 07 32 PM Patient Charge Reorder ID M Discontinued Discontinued Date a 2AE Info NEUE l s Reorder ka Batch Reorder jy Batch Print gj Delete 3 Add p save DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 32 PAP Information Section 2 PAP Information Rx Order Date 01 23 2010 Due Date Add Date 10 26
37. t column of the Search Results table to load the Prescriber Record or select a Prescriber from the list and click on the OK button ESI Search Results e valunterid doclicense valfirst vollast vere Ld 1 123456 Mary Smith DE Cancel l The Prescriber Information fields will be populated with the information stored in the Prescriber s Volunteer Record Add Another Drug Drug 9 eon Gty m Refills Reorder Pharm co UU Program status SIG Sup Days Diagnosis 9 Enter all or part of the Drug name to search for the name of the drug that has been prescribed Example Enter Lip in the Drug field to search for a drug name of Lipitor Be sure to spell the name of the drug correctly or search by a partial drug name 10 Press the Enter key on the keyboard to open the Drug Search results window DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 15 Drugs shown on the list are available through a patience assistance program NOTE If the drug is not shown on the list there is no program available Be sure to spell the name of the drug correctly or search by a partial drug name ne Drug Selector Lipitar Lipitor Lipitor Lipitor 11 Select the prescribed drug from the list paying special attention to the Strength Dosage and Unit of M easure UOM 12 Click on the OK button Th
38. te 7 DOB 5 21 1971 38y 4m 3d SSN 123 45 6788 Street 1 jan 9 Clock Street Street 2 Apt B City Cleveland State Tennessee Zip Code 37311 County T Country O Home Phone 423 555 1212 Work Phone Ext Sex Male ka Pager Mobile Phone Race Email Ethnicity w Marital Status s Number of Children lo Number in Family lo Clinic Location Patient Type Active Patient Status Recuring H Employment Un employeed v Insurance Registration Date 8 24 2008 vi Last Recert Date Next Recert Date 4 12 2010 Veteran US Citizen US Resident Head of Household 7 Ineligible for Services Facesheet Profile I at Open Instances rare Documents Search Summary Profile Allergies Appointments Charge Exc j s PAP R y Visits yi Delete A Add be save Open Module Instances Patient Module 1 Open the Patient s Record in the Patient s M odule See Patient Records M anual 2 Click on the PAP button DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 12 3 MedServices will launch the WinPAP Module in a New Tab 4 Click on the Add button PEER T Boe n IDH Z7 William Ti amp Patient Information DOB 2158 55 gS PAP Information Order Date Due Date Sent to Patient Revd Fram Patient Oty
39. ter Settings O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 41 Contact Information M edServices Technical Support 423 479 6729 Ext 1 Support DataNetSolutions org Register for Check with a Tech CWAT Support DataNetSolutions or General Questions 423 479 6729 Ext 1 Info DataNetSolutions org DataNet Solutions Sales and Marketing 423 479 6729 Ext 2 Sales DataNetSolutions org DataNet Solutions Accounting 423 479 6729 Ext 3 DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729
40. ter the data for each section or use the Search feature Click on the Save button to create the application O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 20 Opening an Existing PAP Record From the Patient Record Every PAP Application is stored as a separate PAP Record The PAP Record is assigned a unique PAP App ID number The PAP Record is linked to the Patient s Record Clicking on the PAP button at the bottom of the Patient s Profile Tab in the Patient Record will open the WinPAP Module and displaya list of the PAP Records that have been created for the patient The user can double click on the record in theSearch Results table to open the PAP application in the PAP Info tab of the WinPAP M odule r Open Instances Open Madule Instances File Administration Tools Motes Documents ip Images Search Summary Profile Allergies Appointments lis PAP lis Scripts lis Visits ai Delete a Add k save Reporting Help Patients 4 w Facility Home Page WinPAP Module X Add New Patient Search Patients MedServices Patient Assistance Program PAP Search Results 2 records found Red Discontinued Gray Missing Required Information PAPAppld OrderDate ReorderDate PatientName TradeName Strength UOM 11 1 24 2010 4 24 2010 Berkley Jake Lipitor 10 MG 10 10 26 2009
41. ties are tracked on the M edServices Today page The Patient M odule is the default Active M odule Show Hide Module Navigation Bar Button M ODULE NAVIGATION BAR Available M odule Navigation Buttons ad MedServil File Edi A ati Reporting Help Patients ream Ter M enu Bar Add New Patient MedServices Today Search Patients Molly s Clinic S X 4 X Open Daily Clinical Activity Summarization mom Instance s Summarizatio M odule Appointments 0 Navigation Window Links to veas Buttons v T p 0 00 open an 0 00 Instance of Today 0 00 the Active M ificati D isi nity 0 odu e Recertificatons 0 Visit Activity D Scripts Filled Y T D 0 00 M T D 0 00 Today 0 00 Product Information List of O pen s Open Instances Y Mete n sta n ces of Scripts Written 0 User Licenses 10 the Active Users Logged In 1 Module Data Medservices2 Bill Tracker List of Donors amp Donations Available Drug Inventory Modules aee MedServices Schedule Active Madsenin Visits M 0 d U e Volunteers amp Time Patient Module The Clinic s Database automatically refreshes every 3 5 minutes When making a change to the system like entering a new patient or scheduling an appointment other users will be able to see the update within 3 5 minutes Users can manually refresh their system by using the Refresh B
42. ts that are associated with the selected patient Prescriptions A DESEE LL ls Re Fill Script jj Duplicate Script id Delete Add Lj Save 5 Double Click on the Rx to open the prescription record 6 Clickon the Re Fill Script button 7 Click on the Add button M edServices will notify the user if the Patient xj has been flagged as Ineligible For Services This prescription does not have any Fills remaining M edServices will notify the user if there are No Refills remaining on the prescription DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 37 a Prescription Re Fills d monn for Doe John ko Yi Select Drugs From Local Drug Inventory Local Inventory MDC 00071015540 Manufacturer PFIZER U S Drug Name Lipitor Strength 10 gt UOM MG Doseage TABS ri Pkg ize 100 000 Pkg Qty 1 Bill Unit EA Lot Dispensed Qty 90 0000 AWP Price 316 09 WAC Price 252 87 Direct Price 252 87 Gigil 1 per day Sigz at bed time Pharmacist Dispense As Written DAWO Supply Days 90 Pharmacy Outside Pharmacy Exp Date 054 a0 Prescription Assistance Fill Date 084 B 2008 10 47 AM Patient Charge 8 Check the Select Drugs from Local Inventory box if the PAP drugs were received into the Local Drug Inventory and will be dispensed from the clinic s local inv
43. ulled from Prescriber s Volunteer Record First Mame Last Name License MPI Pharm Co details E Eligibility C Comments w Open Instances Y PAP ID Patient Charge Pharmaceutical Company Astrazeneca AZMe Prescription Savings Program w o Insurance m Program Status AWA ae Until E C Re arder Days Reorder ID Discontinued Discontinued Date order g Batch Reorder fa Batch Print Patient Discontinued Charge and Notes PAP Record ID Application Payment including PAP ReOrder Details Button Re Order Record ID Date and Time Patient Assistance Program DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 10 Creating a PAP Application The PAP Application is similar to a prescription with refills Creating the initial application sets up an account with the pharmaceutical company A supply of drugs can be sent to the doctor s office or clinic and can be re ordered based on the pharmaceutical company s guidelines The Physician s Record Database contributes the information necessary complete the Physician s portion of the application Some pharmaceutical companies require a different application form for reorders while others allow the reorder to be faxed or called in by the clinic A soreadsheet showing applications that can be called in with all the necessary details ca
44. utton Manually Refresh Database O DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 7 M edServices Patient Assistance Program The Patient Assistance Program WinPAP or PAP was created to streamline the application process for ordering free medication directly from participating pharmaceutical companies Each pharmaceutical company sets their own enrollment guidelines Some require complete financial information while others allow reorders to be called in by phone The PAP database is continually updated with the most current enrollment applications program guidelines and pharmaceutical company details M edServices Users can process a PAP application with the click of a few buttons as long as the Patient Record and Prescription Record have been created and the User was able to record the necessary patient and drug information The PAP M odule allows for eligibility confirmation batch printing batch reordering status tracking patient charge tracking the receipt and dispensing of the medication when received from the Pharm Co and much more Each time a PAP application is added M edServices creates a PAP Record with a unique ID number This PAP Record is linked to the Patient Record If a Patient is flagged as ineligible for services M edServices will automatically prompt the user to discontinue any remaining prescription ref
45. veland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 22 Users can search for a PAP record using any of the fields displayed on the Search tab 3 Enter all or part of the search criteria into the field and click on the Search button Example Enter B in the First field to search for a first name of Billy Click on the Reset button to clear the fields and reset the search criteria Press the Enter key on the keyboard or click on the Search button to search for the PAP Record Facility Home Page WinP P Module X e MedsServices Patient Assistance Program PAP Search amp 9 Patient Information Last Name First Name MFE License PAP ID Drug Strength Pharm Co Hu Order Date Reorder Date ji Search Cancel A i i d 1 j EAP e A search Results LN s Add T DataNet Solutions Inc 2009 e 254 Broad Street SW e Cleveland TN 37311 e www DataNetSolutions org e 423 479 6729 MedServices User Manual Version 5 Page 23 If multiple records match the search criteria a separate window will open with the Search Results The table can be sorted by clicking on the column headings at the top of each column Patient Social Recertification Date of M TER ue Last Mame First Mame Chart Patient Status Secum pu Birth Jones 333 Bb h454 3 28 2010 Techno Willams 572171955 23 1372

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