School / Physical Forms

Presentation on Adding
School/Physical Forms
School / Physical Forms
Adding school / physical forms to eCW is a special process. This process optimizes
an existing module in eCW and modifies it to fit the pediatric office needs for
automated school / physical forms.
The forms are created and updated by a CIQN EMR Coach / Community User in
MS Word. During development of the forms, the community user communicated
with local school districts to notify of the automated capabilities and obtain
approval to utilize the EMR generated physical forms in place of hand filled in
forms throughout the region. The forms have been in use in VA, MD, and DC
since 2009. If you have problems with any school accepting the computer
generated forms, please talk with the local school district.
The process was developed to utilize the EMR in a meaningful way, prevent
transcription errors, and to improve turn around times for parents.
Information in this presentation only applies to the uploading of
school/physical forms.
The Process
If you do not already have existing physical forms you will need
to put in a ticket to eCW.
Ticket Information that can be copied and pasted into the ticket
for submission to eCW.
(Office Name) is going to begin using the immunization form
section for school physical forms. In order for the forms to work
we need eCW to set the following preventive medicine CPT E&M
codes to immunization forms so that the form will pull the form
data from the child’s most recent well child visit.
• New Patient – 99381, 99382, 99383, 99384, 99385
• Established Patient – 99391, 99392, 99393, 99394, 99395
If you have questions, please email Sheryl at [email protected]
First Step
• Close out all MS Word
documents that are
open on your
• Click on EMR,
This can also be found anywhere that there
is a immunization form link.
Second Step
• Select the state you
want to use.
(Not all states have a form loaded into it, so
you may have to search through the states
to find one that brings up an existing form in
MS Word.)
• If there is not a form,
you cannot change or
upload into that state
on the user end.
Third Step
Click on Edit Template.
click anything else on the
eCW Window.
Fourth Step
At the bottom of the
screen you should see an
name)” form in MS Word.
Fifth Step
You will begin to delete bits
and pieces of the form. Do
this in small amounts and
save and repeat the
Once the form is empty,
open the form you want to
upload and begin copying
and pasting into this empty
only use the save ICON. Do
not save to your computer.
Sixth Step
“X” out of MS Word.
Ensure that you do not
have any other MS Word
documents up.
Seventh Step
Now click ok on the
“Ok” button in the eCW
Immunization Window
that is open.
Eighth Step
You should get a window
that looks like this.
Now click “Ok.”
Ninth Step
• Click on add.
• For a form that
does not have
immunizations on
it, you can add
just one random
Tenth Step
• Enter in any tag name.
(Case sensitive to form only when pulling in a vaccine.)
• Select at least one vaccine and move it to the right
• Enter in the number “1” or any other number and
See the next slide
Screenshot of Tenth Step
Eleventh Step
Testing the Form
• Contact Sheryl at [email protected]
• At this point the form has to have special customization
specific to the practice.
• You will need help testing and trouble shooting the form, if this
is the first physical form to be uploaded into your system.
• There can be errors and problems depending upon how your
system is set up. Once one physical form is in the system and
working, you can then follow the same process and the office
specific customizations Sheryl assists you with for all other forms
and updates to the form in the future.
Sheryl will send out updated forms to CIQN when the state
education departments make changes.
Form Information
• The forms are created from the most recent
released VA, VHSL, DC, Maryland, and Boy Scout
• When a form has a released change, it is updated
by the CIQN EMR Coach and will be published to
the CIQN Website.
• Offices can then download the current form and
upload the current form to their system.
• Offices will need to perform the customizations
needed in the form “merge tags” to match their
system so that the form will pull the data.
Non-Physical Forms
There are other forms that can be
utilized through the same process.
• An existing form for parents that lists the infant /
child’s vitals and percentiles. Additionally, the form
has the entire immunization record.
• Infant check-up sheets that lists anticipatory
guidance, weight, height, head circumference,
percentiles, and the vaccines received at the visit.
• There are many more possibilities that exist with this

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