1. Electronic Consents and Signatures For Newborn Nursery and NICU

2. Swivel Always turn screen for Legal Representative to see what they are signing Topaz Always ‘ctrl + ‘click to sign’ This allows Legal Representative control of the form

3. 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 Patient 2.Select Enter Data 3.Select Forms 4.Select appropriate form bundle (English or Spanish) 1.Neonatal Admitting Forms 5.Select radio button identifying entry point (Inpatient) 2 1

4. Completing Consents ADD Row is only used if Consent can not be obtained Select Inpatient Red Tab Indicates Form to be completed

5. 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

6. 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

7. 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.”

8. 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

9. 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.”

10. 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**

11. 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****

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

13. 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 to 2.Which forms were completed that need to be moved 3.Date it occurred Medical Information Services Management must make the corrections

14. What To Do If Patient/family Can Not Come to Nursery to Sign Consents Process has not changed 1.Go to EDOCS 2.Print out forms that are needed Consent to Treat HIPPA Payment form 3.Stamp with baby card 4.Take to mother/family to sign 5.Place signed copy in chart 6.Provide copy if requested