Research Registration Instructions for Registration Personnel

• SMS information
• IDX information

SMS CLINICAL TRIALS REGISTRATION INFORMATION

Please note that red text indicates information different from your normal registration procedures.

1. Patient Arrives:
   1. Registration staff asks, “what is the reason for your visit.” If the patient says they are part of a clinical trial or research study, ask for the “Clinical Trials ID card”.
   2. If the patient does not have their Clinical Trials ID card, do not proceed with registration. Contact the CTO by phone or pager. If someone from the CTO does not approve registration of the patient, do not proceed with registration, the patient must contact the department doing the clinical trial and reschedule.
   3. If the “Clinical Trials ID Card” is hot pink, please ask for insurance information (card). If the patient refuses to render insurance information please contact the clinical trials office by phone or pager before proceeding with registration. Please copy both cards. If the patient is already in the system, their insurance information will become secondary.
   4. If the “Clinical Trials ID Card” is lime green, DO NOT ask for insurance information. Please copy the card. If the patient is already in the system, their insurance information will become secondary.
   5. Verify that at the bottom of the “Clinical Trials ID Card” that the card has not expired. If the card has expired please contact the CTO at the numbers listed below.
      
      
2. Patient Demographic Screen:
   Use the admit patient pathway.
   Enter information on the patient.
   Do not enter hospital information as a substitute.
   
   
3. HDX Screen:
   Bypass this screen using Function Key 13.
   
   
4. Patient Employer Screen:
   Enter patient information. If patient refuses to give info enter “9”- unknown.
   
   
5. Guarantor Screen:
   Enter the hospital department responsible for the research study as the guarantor. This information will be found on the patients study ID card.
   1. Relationship to patient: Enter “O” for other.
   2. Sex: Enter “M” for male.
   3. Birth Date: Enter 01/01/1901
   4. Name, Address and Work telephone number: Enter “GUH” in the last name field and the name of the department in the first name field. Enter the department’s address and telephone number of the coordinator in the address and home telephone fields.
      
      
6. Guarantor Employer Screen:
   Enter the value “9” (unknown) in the employment status field.
   
   
7. Emergency Contact Screen:
   Press enter to skip screen. No required fields.
   
   
8. Insurance Availability Screen:
   Enter a “Y” (yes) to indicate that a grant is available for the account.
   
   
9. Insurance Review Screen:
   Enter “G90” in plan 1 field.
   
   
10. Insurance 1 Plan Data Screen.
    Enter information ON THE GRANT as follows.
    1. Insurance plan code and name: Information will default for plan code G90.
    2. Verify flag: Enter the flag as “Y”.
    3. COB Priority: Enter “1”. Group number and name fields. Based on the grant you select, the grant number and name will default.
    4. Policy Number: Enter the RX number that is indicated on the study ID card or the letter that the patient presents.
    5. Insurance Company Name, address and telephone number: Enter the name, address and telephone number of the hospital department responsible for the grant. This can be obtained from the study ID card or the letter the patient presents.
       
       
11. Subscriber Information Screen:
    1. Relationship to patient: Enter “R” for self. The departments (guarantor) information will default into the subscriber name, address and telephone fields.
    2. Employment status: Enter “U” for unknown.
    3. Social security Number/ Reason code field: Enter “U” for unable to obtain. 
       
       
12. Final Registration Screen:
    Outpatient Pathway Only (If inpatient please proceed to #15):
    1. Patient type: Enter “W” for grants/special contracts.
    2. Hospital service: Enter the hospital service responsible for the grant.
    3. Attending Doctor: Enter doctor listed on card or letter.
    4. Order referring doctor: Enter doctor listed on card or letter.
    5. Chief complaint: If unknown, enter clinical study patient.
       
       
13. Diagnosis Information Screen:
    Enter “OD” in the type field. Enter “Clinical Research Patient” in the description field.
    
    
14. Case Data:
    1. Admitting doctor: Enter doctor on card or letter.
    2. Attending doctor: Enter doctor on card or letter.
    3. Referring doctor: Enter doctor on card or letter.
    4. Admission priority: Enter “R” routine.
    5. Admission source: Ask patient who is admitting them.
       
       
15. Final Admit Data:
    1. Nurse Station
    2. Room and Bed
    3. Admission, Date and Time
    4. Patient Type. Inpatient research, enter “I”.
    5. Symptom diagnosis. Clinical Research Patient.
       
       
16. Admission facesheet and plate will be created.
    

Please contact Shirleeta Beck at x77589 with questions regarding the SMS system.

Please contact the CTO with any questions regarding the above procedures.

IDX CLINICAL TRIALS REGISTRATION INFORMATION

1. Patient Arrives:
   1. GPG Registration staff asks, “what is the reason for your visit?” If the patient says they are part of a clinical trial or study, ask for the Clinical Trials ID Card.
   2. If the patient does not have their Clinical Trials ID card, do not proceed with registration. Contact the CTO by phone or pager. If someone from the CTO does not approve registration of the patient, do not proceed with registration, the patient must contact the study coordinator conducting the clinical trial and reschedule the visit.
   3. If the Clinical Trials Card is:
      • Hot Pink and the Patient already exists in the IDX System, verify and correct as necessary the demographic and health insurance information.
      • Hot Pink and the Patient does not exist in the IDX System, register the patient to include demographic and health insurance information.
      • Lime Green and the Patient already exists in the IDX System and the patient will continue to seek services at the GPG for non-Clinical Trials related care, verify demographic and health insurance information and correct as necessary.
      • Lime Green and the Patient does not exist in the IDX System, perform a complete registration to include demographic information only.
      • Verify that the Clinical Trials Card has not expired. If the card has expired please contact the CRS at the numbers listed above. If unable to reach the CRS or coordinator, do not register the patient. The patient must contact the trial coordinator to reschedule the appointment.
        
        
2. General Comments Screen
   1. Edit General Comments- If the patient has presented a Clinical Trials Card, type a “Y” to enter comments.
   2. In the General Comments Function - Press help (ALT & F5) to list options.
   3. Type “E” to edit. The cursor will drop to the comments section. (The date and time must precede all comments. Use the function key F7 & “D”.
   4. Type the words: “Patient in Clinical Trial”.
   5. Type the RX # of the Clinical Trial.
   6. Type the Clinical Trials Coordinator’s Name and Telephone Extension.
   7. File and Save the General Comment, by using the Function Key “F10”.
      
      
3. GPG Physician Fee Slip Preparation (Done either by registration personnel in GPG, research nurse, or PI)

   1. The FSC for Clinical Trials, (otherwise known as Grants,) is not a REGISTRATION Level FSC in the IDX System. Correctly filling out the encounter form for charges that need to be directed to the grant is critical, but simple:
      

      1. Write the word “GRANT” in the FSC Box C
      2. Write the RX # (grant number) in the REFERRAL/AUTH Box on the Fee Slip.
      3. Continue to follow batching instructions as required by UBS. UBS will ensure that the charge is directed to the Clinical Trial by changing the FSC to Grant at the INVOICE Level. 
         
         
   2. If a patient visit includes both a “GRANT” related service and a “Health Insurance” related service, then TWO fee slips should be prepared for the visit, marking each slip accordingly.
      
   3. For departments who enter charges directly into the IDX System, the “GRANT” charges must be entered by overriding the health insurance FSC at the INVOICE Level prompt. Please do not corrupt the Registration data in IDX!

Please contact Linda Pearson or Shirleeta Beck in the UBS Training Dept. if you have questions regarding the GPG Fee Slip Preparation process.

• Linda Pearson x 42880
• Shirleeta Beck x 77589