Functionality Name Acknowledgment of Health Insurance Portability and Allow for unknown patient Accountability Act (HIPAA) names notice delivered Allow for Hospital patient Acknowledgment of HIPAA numbers for unidentified notice signed patients Reason for lack of patient Address signature for HIPAA notice Phone delivery. Social Security Number Acknowledgment of billing Date of Birth (DOB) consent signed Allow for estimated age Reason for lack of billing value if DOB unknown consent signature. Height Family relative information Weight Physician information Provider and patient Guarantor information signatures, where Insurance information applicable. The system shall flag and track Billing Information, which includes: Basic Mileages Loaded miles fee Mandatory Functionality Fee code Total charges Mileage rates The system shall flag and track Patient Assessment, which includes: Chief complaint Blood pressure Onset date and time Temperature Secondary complaint ECG PTA (prior to arrival) vital signs. Reason field if ECG not done/collected Vitals signs (multiple) 12 lead EKG Performing medic Reason field if EKG not Date and time Basic Mandatory done/collected PCO2 device Functionality Broselow scale PCO2 reading Thrombolytic checklist. PO2 Glasgow comma scale, Pain index multiple instances (i.e. initial Stroke scale score, secondary scores for Level of response using AVPU critical patients or change of scale status) Pulse Trauma Score Respiration rate Basic The system shall track Physician Assessment for multiple patients Mandatory Functionality Basic Physician Assessment record shall include, but is not limited to: Mandatory
Functionality Name Allow for unknown patient names Allow for Hospital patient numbers for unidentified patients Address Phone Social Security Number Date of Birth (DOB) Allow for estimated age value if DOB unknown Height Weight Provider and patient signatures, where applicable. Acknowledgment of Health Insurance Portability and Accountability Act (HIPAA) notice delivered Acknowledgment of HIPAA notice signed Reason for lack of patient signature for HIPAA notice delivery. Acknowledgment of billing consent signed Reason for lack of billing consent signature. Family relative information Physician information Guarantor information Insurance information Basic Functionality The system shall flag and track Billing Information, which includes: Mandatory Mileages Fee code Mileage rates Loaded miles fee Total charges Basic Functionality The system shall flag and track Patient Assessment, which includes: Mandatory Chief complaint Onset date and time Secondary complaint PTA (prior to arrival) vital signs. Vitals signs (multiple) Performing medic Date and time PCO2 device PCO2 reading PO2 Pain index Stroke scale Level of response using AVPU scale Pulse Respiration rate Blood pressure Temperature ECG Reason field if ECG not done/collected 12 lead EKG Reason field if EKG not done/collected Broselow scale Thrombolytic checklist. Glasgow comma scale, multiple instances (i.e. initial score, secondary scores for critical patients or change of status) Trauma Score Basic Functionality The system shall track Physician Assessment for multiple patients Mandatory Basic Physician Assessment record shall include, but is not limited to: Mandatory
EXHIBITB-CAD-RMSTechnicalRequirementsMatrixFillIn.docx