MPSC WIC MIS SystemCS 5 Nutrition Ed – Care Plan – BF Equipment Screens

MPSC WIC MIS System

Detailed Functional Design Document

CS 5 Nutrition Ed – Care Plan – BF Equipment Screens

Revision Date: March 23, 2017

Maintained by:

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Document Revisions

Revision Date / Updated By / Requested By / Description of Revision
5/4/2013 / Ciber Team / MPSC / Amendment 7 Updates
12/28/2015 / Ciber Team / MP User Group / Release 5.3 Updates
1/20/2017 / Ciber Team / MP User Group / Release 5.07 Updates
3/23/17 / CDP Team / MP User Group / Cover page, header, and footer mods for new M&E contractor

Table of Contents

1Education and Care

1.1Referrals – Participant

1.1.1Signature Capture – Release of Information Pop-Up (from Referrals – Participant)

1.1.2Choose Referral Output Pop-Up

1.1.3BLANK – Referral from the WIC Program (Dynamic)

1.1.4Specific – Referral from the WIC Program (Dynamic)

1.1.5Listing of Organizations (Static)

1.2Referrals – Family

1.2.1Signature Capture – Release of Information Pop-Up (from Referrals – Family)

1.2.2Choose Referral Output Pop-up

1.2.3BLANK – Referral from the WIC Program (Dynamic)

1.2.4Specific – Referral from the WIC Program (Dynamic)

1.2.5Listing of Organizations (Static)

1.3Nutrition Education

1.3.1Copy Nutrition Education Pop-Up

1.4Care Plan - Participant

1.4.1Care Plan Print Pop-Up

1.4.2Printed Participant Care Plan (Static)

1.4.3Copy Goals Pop-Up

1.5Care Plan – Family

1.5.1Care Plan Print Pop-Up

1.5.2Printed Family Care Plan (Static)

1.6BF Equipment

1.6.1Signature Capture – BF Equipment Release Pop-Up

March 23, 2017Table of ContentsPage 1 of 79

MPSC WIC MIS SystemCS 5 Nutrition Ed – Care Plan – BF Equipment Screens

1Education and Care

The Education and Care branch node of the Clinic Services navigation tree offers options for recording nutrition education for participants, as well as creating participant and family referrals and care plans.

1.1Referrals – Participant

The Referrals – Participant screenshows referrals that WIC staff have suggested or made for an individual participant. Verbal or written referrals can be recorded on this screen. A participant may be referred to a type of organization or to a specific organization. One or many referrals may be identified on the same date. Participant referral data may be updated at a later date, for example, to record follow-up information (i.e. did the family actually enroll?). A care plan may also be used to record follow-up information since it may be more involved than the list box choices allow.

Note: Referrals - Family and Referrals - Participant are kept in separate data tables, therefore separate screens are needed for the different types of referrals.

> Family/Intake > Referrals – Participant

<Family Header (See CS Overview)>

<Participant Sub-Header (See CS Overview)>

Control / Description
Add Row / Clicking the Add Row button adds a row to the Referred To – Participant Referrals from WIC grid. Each row represents a separate participant referral. The Add Row button is always enabled.
Type / Command Button
Hot Key / Alt + A
Remove Row / Clicking the Remove Row button removes the selected row from the Referred To – Participant Referrals from WIC grid. This button is enabled when there are rows in the grid that can be removed.
Type / Command Button
Hot Key / Alt + R
Signature / Clicking the Signature button causes a signature to be automatically requested for the specific highlighted referral. The signature pad display is activated and text is displayed. A pop-up is seen by the WIC user that also displays the text shown on the signature pad. See Signature Capture – Release of Information Pop-Up for details.
Type / Command Button
Hot Key / Alt + I
Print / Clicking the Print button brings up the Choose Referral Output pop-up. From this pop-up, the user can choose to print
  • a BLANK-Referral from the WIC Program,
  • a Specific - Referral from the WIC Program, or
  • a Listing of Organizations of a particular Organization Type in the service area.

Type / Command Button
Hot Key / Alt + P
Referred To – Participant Referrals from WIC / The Referred To – Participant Referrals from WIC grid shows by date all participant based referrals and any follow-up status that has been recorded.
Type / Editable Data Grid
Display / No
Date / This is the date that a Participant Referral is recorded. This date defaults to today’s date. It cannot be updated by the user.
Type / Date Picker
Required / NA
Display Only / Yes / Calculated / No
DB Column / ParticipantReferral.RecordedDt
Organization Type / Identifies the general category or type of external organization that the participant was referred to by the WIC Program.
Type / List Box
Required / Yes
Length / 30, Display length 18
DB Column / ParticipantReferral.TypeCd
Code ID / Organization Type
Organization / Identifies a specific external organization or agency that WIC referred the family to. The drop-down list is filtered by Organization Type and clinic.
Type / List Box
Required / No
Length / 30, Display length 18
DB Column / ParticipantReferral.Org_ID
Code ID / Organization table lookup (only those with Organization.WICUseCd = WIC Refers To or Outreach and Refers To)
Staff Member / This is the concatenated first and last name of the staff member who last updated the row.
Type / Text Box
Required / NA
Length / 60, Display length 18
Validation / Mask of ‘firstnamelastname’
DB Column / ParticipantReferral.Stfp_ID
Follow-up / Identifies the result of a referral, for example, did the participant enroll in the program or not. It is normally updated during a clinic visit subsequent to the referral.
Type / List Box
Required / No
Length / 18
DB Column / ParticipantReferral.FollowupCd
Code ID / Rfrl Follow-up
<Last Modified By User and Date> / In the lower right-hand corner, the user and the date of the last update of the referral record are displayed.
Type / Text Box
Required / NA
Length / NA
Validation / Mask of ‘firstnamelastname mm/dd/yyyy’
Display Only / Yes / Calculated / No
DB Column / ParticipantReferral.ModifyStfpID +
ParticipantReferral.ModifyDt
Business Rules
Participant Header Rule
  1. Display the Participant Sub-Header at the top of this screen.
General Business Rules
  1. Organization is a filtered list based on Organization Type and Clinic.
  2. Display warning message if user selects an Organization and does not capture a signature for Release of Information.
  3. It is necessary for the user to return to this screen to indicate follow-up status.
  4. If the user attempts to move away from this family (go search for another family, go issue benefits for another family, etc.), the user is prompted with a Save confirmation message if any family data has been updated. Required fields are validated.
  5. Disable the Remove Row button for a particular row if a signature has been captured for that referral.
  6. Disable Organization Type field if a signature has been captured for that specific referral.
  7. Disable Organization field if a signature has been captured for that specific referral.
  8. Enable the Signature command button if the highlighted referral does not yet have a signature capture completed and has an organization selected.
  9. The print button is enabled whenever there is a record in the grid.

1.1.1Signature Capture – Release of Information Pop-Up (from Referrals – Participant)

A Signature button is on the Referrals – Participant screen to allow staff to collect a signature when a participant referral is made.

Note: The BLANK – Referral From the WIC Program and the Specific – Referral From the WIC Program documents also provide signature lines on the printed form for the WIC staff and the participant/endorser. A signature captured in the data system is not seen on these printed documents.

The first screen is an example of what is displayed on the signature pad display screen. The pop-up “Signature Capture to User” is displayed to the WIC system user so that they know what is on the signature pad display screen and then when a signature is captured, it can be reviewed here to determine if adequate or if another capture is required. For full details about this system component, see the Signature Capture section of the Clinic Services Overview DFDD.

1.1.2Choose Referral Output Pop-Up

From this pop-up, the user can choose to print

  • a BLANK-Referral from the WIC Program,
  • a Referral from the WIC Program addressed to a specific organization, or
  • a Listing of Organizations of a particular Organization Type and associated with the clinic of the family.

(With a specific referral organization)

(No referral organization specified)

Control / Description
OK / Clicking the OK command button allows the user to print the highlighted document.
Type / Command Button
Hot Key / Alt + O
Cancel / Clicking the Cancel command button allows the user to go back to the Referrals – Family or Referrals - Participant screen (where the user was just previously) without printing a document.
Type / Command Button
Hot Key / Alt + L
Business Rules
  1. Always include List of Organizations in the list of UI outputs to select from.
  2. If the user is positioned on a row in the Referred To – Participant Referrals From WIC grid where an Organization has not been selected, then include BLANK-Referral from the WIC Program in the list of UI outputs to select from.
  3. If the user is positioned on a row in the Referred To – Participant Referrals From WIC grid where an Organization has been selected, then include the name of the specific organization in the list of UI outputs to select from.
  4. Sort the list of available UI outputs alphabetically.

1.1.3BLANK – Referral from the WIC Program (Dynamic)

This is a Referral letter from the WIC Program to an organization that is not in the WIC data system. This may be an organization that is rarely used by this local agency. The printed letter allows space for staff to write in the organization’s name and address and the reason for the referral. The release of information is included in this letter. A staff signature and date is needed on the actual physical form. Often this letter is handed to the Endorser and they hand deliver it to the organization, but it could also be mailed.

Note: The participant signature is captured for the general release of information in the system and is not reflected on the printed letter.

1.1.3.1Language: Both

The main body of the BLANK-Referral from the WIC Program is in English only. The release of information is in English and Spanish.

1.1.3.2BLANK – Referral from the WIC Program Mockup

WIC Program - Referral from the WIC Program

11/22/2006

To

From

River City Agency

700 E. University Ave

Dennis, CO 55555

(777) 555-5555

Regarding

Melissa Smith

Reason

______

______

______

Please send any follow-up communication regarding this referral to the WIC agency at the address listed above.

AuthorizationforRelease of Information / Autorización para La Divulgación de Información

I give permission to the WIC Program to release confidential information from my WIC record to the person or agency named above. I understand that the information is needed for this referral.

Yo doy permiso al Programa WIC para solicitor la información mencionada arriba de la persona o agencia nombrada arriba. Yo entiendo que esta información le ayudara al Programa WIC a ayudarme con mis necesidades de salud y nutrición especificas.

______

Signature of participant or parentStaff signatureDate

Firma de la participante/padreFirma del Personal de WICFecha

Authorization for Release of Information Protected by State or Federal Law

Autorización para La Divulgación de Información Protegida por la ley estatal o federal

I specifically give permission to release information relating to:

Yo especificmente doy permiso a divulgar información relacionada con:

__ Substance abuse (alcohol/drug abuse)

__ HIV-related information (AIDS-related testing)

__ Mental health (including psychological testing)

__ Abuso de las sustancias (alcohol/drogadicción)

__ Información relacionada con la VIH (analisis relacionados con la SIDA)

__ Salud mental (incluyendo examenes psicológicos)

______

Signature of participant or parentStaff signatureDate

Firma de la participante/padreFirma del Personal de WICFecha

Business Rules
  1. The date of the referral is today’s date. Format as mm/dd/yyyy.
  2. The From information source is based on the value of system parameter ClinicServices.UIOutputContactSource:
  3. If ClinicServices.UIOutputContactSource = “Local Agency”, the From information is the local agency’s <agency name>, <address>, <phone number>, and <e-mail address>.
  4. The agency name is LocalAgency.Name.
  5. The address is
  6. LocalAgency.StreetAddrLine1
  7. LocalAgency.StreetAddrLine2
  8. LocalAgency.Suite, LocalAgency.POBox
  9. LocalAgency.City, LocalAgency.State LocalAgency.ZipCode+ LocalAgency.ZipPlus4
  10. The phone number is LocalAgency.BusinessAreaCode+ LocalAgency.BusinessPhoneNr
  11. The e-mail address is LocalAgency.EmailAddress
  12. If ClinicServices.UIOutputContactSource = “Clinic”, the From information is the clinic’s <clinic name>, <address>, <phone number>, and <e-mail address>.
  13. The clinic name is Clinic.Name.
  14. The address is
  15. Clinic.StreetAddrLine1
  16. Clinic.StreetAddrLine2
  17. Clinic.Suite
  18. Clinic.City, Clinic.State Clinic.ZipCode + Clinic.ZipPlus4
  19. The phone number is Clinic.PhonseAreaCode+ Clinic.PhoneNr
  20. The e-mail address is Clinic.EmailAddress
  21. Do not include a blank line in the From section of the document for any contact information that is empty such as a blank address line 2, phone number, or e-mail address.
  22. When printed from the Referral – Family screen, the Regarding information is the full name of the <Endorser>.
  23. The endorser name is FamilyMember.FirstName+FamilyMember.MiddleName+FamilyMember.LastName where FamilyMember.ParentGuardianIn = “Y”
  24. When printed from the Referral – Participant screen, the Regarding information is the full name of the participant in the record selector.
  25. The participant name is FamilyMember.FirstName+FamilyMember.MiddleName+FamilyMember.LastName.
  26. The clinic services breastfeeding message image appears in the footer-middle of the output.
  27. The clinic services header image appears in the header-left of the output.
  28. Page numbering in the output appears in the footer-right in the format "Page x of y".
  29. This UI output is portrait.

1.1.4Specific – Referral from the WIC Program (Dynamic)

This is a letter of Referral from the WIC Program to an organization that is in the WIC data system. The printed letter has the organization name and address to which the referral is being made. This appears on the letter in a location to allow for sending this letter in a left justified window envelope. The reason for the referral is entered by hand on the printed copy. The release of information is included in this letter. A staff signature and date is needed on the actual physical form. Often this letter is handed to the Endorser and they hand deliver it to the organization, but it could also be mailed.

Note: The participant signature is captured for the general release of information in the system and is not reflected on the printed letter.

1.1.4.1Language: Both

The main body of the Specific Referral from the WIC Program is in English only. The release of information is in English and Spanish.

1.1.4.2Specific – Referral from the WIC Program Mockup

WIC Program - Referral from the WIC Program

11/22/2006

To

Milton Child Health Specialty Clinic

234 Rosemont Drive

Winnie, CO 77777

(555) 666-7777

From

River City Agency

700 E. University Ave

Dennis, CO 55555

(777) 555-5555

Regarding

Melissa Smith

Reason

______

______

______

Please send any follow-up communication regarding this referral to the WIC agency at the address listed above.

AuthorizationforRelease of Information / Autorización para La Divulgación de Información

I give permission to the WIC Program to release confidential information from my WIC record to the person or agency named above. I understand that the information is needed for this referral.

Yo doy permiso al Programa WIC para solicitor la información mencionada arriba de la persona o agencia nombrada arriba. Yo entiendo que esta información le ayudara al Programa WIC a ayudarme con mis necesidades de salud y nutrición especificas.

______

Signature of participant or parentStaff signatureDate

Firma de la participante/padreFirma del Personal de WICFecha

Authorization for Release of Information Protected by State or Federal Law

Autorización para La Divulgación de Información Protegida por la ley estatal o federal

I specifically give permission to release information relating to:

Yo especificmente doy permiso a divulgar información relacionada con:

__ Substance abuse (alcohol/drug abuse)

__ HIV-related information (AIDS-related testing)

__ Mental health (including psychological testing)

__ Abuso de las sustancias (alcohol/drogadicción)

__ Información relacionada con la VIH (analisis relacionados con la SIDA)

__ Salud mental (incluyendo examenes psicológicos)

______

Signature of participant or parentStaff signatureDate

Firma de la participante/padreFirma del Personal de WICFecha

Business Rules
  1. The date of the referral is today’s date. Format as mm/dd/yyyy.
  2. The To information is the selected <referral agency name> and <address>.
  3. The referral agency name is Organization.Name.
  4. The referral agency address is
Organization.StreetAddrLine1
Organization.StreetAddrLine2
Organization.Suite, Organization.POBox
Organization.City, Organization.State Organization.Zipcode+ Organization.ZipPlus4
Organization.BusinessAreaCode+Organization.BusinessPhoneNr
  1. The From information source is based on the value of system parameter ClinicServices.UIOutputContactSource:
  1. If ClinicServices.UIOutputContactSource = “Local Agency”, the From information is the local agency’s <agency name>, <address>, <phone number>, and <e-mail address>.
  2. The agency name is LocalAgency.Name.
  3. The address is
  4. LocalAgency.StreetAddrLine1
  5. LocalAgency.StreetAddrLine2
  6. LocalAgency.Suite, LocalAgency.POBox
  7. LocalAgency.City, LocalAgency.State LocalAgency.ZipCode+ LocalAgency.ZipPlus4
  8. The phone number is LocalAgency.BusinessAreaCode+ LocalAgency.BusinessPhoneNr
  9. The e-mail address is LocalAgency.EmailAddress
  10. If ClinicServices.UIOutputContactSource = “Clinic”, the From information is the clinic’s <clinic name>, <address>, <phone number>, and <e-mail address>.
  1. The clinic name is Clinic.Name.
  2. The address is
  3. Clinic.StreetAddrLine1
  4. Clinic.StreetAddrLine2
  5. Clinic.Suite
  6. Clinic.City, Clinic.State Clinic.ZipCode + Clinic.ZipPlus4
  7. The phone number is Clinic.PhonseAreaCode+ Clinic.PhoneNr
  8. The e-mail address is Clinic.EmailAddress
  1. Do not include a blank line in the From section of the document for any contact information that is empty such as a blank address line 2, phone number, or e-mail address.
  2. When printed from the Referral – Family screen, the Regarding is the full name of the Endorser.
  3. The endorser name is FamilyMember.FirstName+FamilyMember.MiddleName+FamilyMember.LastName whereFamilyMember.ParentGuardianIn = “Y”
  4. When printed from the Referral – Participant screen, the Regarding information is the full name of the participant in the record selector.
  5. The participant name is FamilyMember.FirstName+FamilyMember.MiddleName+FamilyMember.LastName.
  6. The clinic services breastfeeding message image appears in the footer-middle of the output.
  7. The clinic services header image appears in the header-left of the output.
  8. Page numbering in the output appears in the footer-right in the format "Page x of y".
  9. This UI output is portrait.

1.1.5Listing of Organizations (Static)

This is a Listing of Organizations of a particular Organization Type and associated with the clinic of the family. When the user sees a need to provide the participant with a list of all providers associated with the clinic within the organization type, then this UI is printed. Example: Listing of all of the lactation consultants associated with the clinic of the family.