1. Pre-registration Referral Tracking This presentation includes the screen layout and functional flow of the referral tracking module. Details are given in the notes section of the slides.

2. Referral Case notes (system generated case notes) Pre-Registration Referral Tracking Sitemap Referral Search Results Referral Entry / Edit Registration SAR Correspondence

3. Search - Referrals Quick Search Options Pending Referrals Date Range Referral Received Begin Date : mm/dd/yyyy Advanced Search Options Add Referral Referral Criteria Referral Tracking Nr: Referral Type : Referral Source : Provider/Plan Nr: Find Referral Status : Provider/Plan Name: Referral Received End Date : mm/dd/yyyy Find By Client Search Referral Reset Pre-registration Referral Tracking

4. SelectReferral Tracking Number Referral Received Date Case Number Patient Name Patient Date of Birth Referral Source Referral Status Provider Name / NPI / Plan Nr 12345607/01/20121000000 First name Last name 01/01/2000Provider Completed Registration CCS Provider MD 1234567890 23456707/01/2012 First name Last name 01/01/2002 Healthy Families Accepted for Registration HF Plan name H000 34567807/01/2012 First name Last name 01/01/2012 Managed Care Plan Rejected as Inappropriate MGD Care 333 45678907/01/20121000000 First name Last name 01/01/2008Provider Received / Waiting for review CCS Provider MD 1234567890 56789007/01/20121000000 First name Last name 01/01/2012Provider Accepted for Service CCS Provider MD 1234567890 Referral Search Results View / Edit Referral Continue to Registration BackContinue to SAR Pre-registration Referral Tracking Add Referral

5. Pre-registration Referral Tracking Tracking Number : Referral Received On : Referral Type : Referral Source : Referral Entered On : Referral Status : Legal County : Provider / Plan Nr : Find Provider / Plan Name : Referral Information for Firstname Middle Lastname Tracking Number: 123456 Referral Information Display only mm/dd/yyyy Find Provider / Plan Address : City : display State: display Zip: Find Phone : Ext: Fax: Email : Suspected Diagnosis Same screen continued on next slide ICD CodeDescriptionDiagnostic / Treatment RemovePriority X ICD Code: Description: Find

6. Service CodeTypeDescriptionUnitsQuantityRemove X X X Return Request Reason Multiple selection list Free Text area (if Other is chosen) Number of characters left 25 Free Text area for Comments Last Updated By: user’s first name last nameLast Updated On: MM/DD/YYYY HH:MM AM/PM BackSaveSave and Continue to RegistrationSave and Continue to SARPreviousNext Requested Services Add Services Inappropriate Referral Information Comments Number of characters left 15000 Add Duplicate

7. Diagnosis CodeDescriptionTreatment / DiagnosisRemove X X Pre-registration Referral Tracking Tracking Number : Referral Received On : Referral Type : Referral Source : Referral Entered On : Referral Status : Legal County : Provider / Plan Nr : Find Provider / Plan Name : Referral Information Display only mm/dd/yyyy Find Provider / Plan Address : City : display State: display Zip: Find Phone : Ext: Fax: Email : Suspected Diagnosis Add Diagnosis Same screen continued on next slide Patient Name : LastFirst App Middle Date of Birth: mm/dd/yyyy Gender : SSN:

8. Service CodeTypeDescriptionUnitsQuantityRemove X X X Return Request Reason Multiple selection list Free Text area (if Other is chosen) Number of characters left 25 Free Text area for Comments Last Updated By: user’s first name last nameLast Updated On: MM/DD/YYYY HH:MM AM/PM BackSaveSave and Continue to RegistrationSave and Continue to SAR Submit to add reason to list PreviousNext Requested Services Add Services Inappropriate Referral Information Comments Number of characters left 15000

9. Provider / Plan NameProvider /Plan NumberProvider /Plan TypeRemove X Provider /Plan Number: Provider / Plan Name: Find Referral Criteria Referral Report (will change based on the report selection to the name of the report) Run Report County: Referral Status: Date Referral Received From: Date Referral Received To: Mm/dd/yyyy Provider/Plan search