Question Types

The following question types can be used in forms, visit note templates, care plan templates, document templates, and quizzes. Note that some question types are specific to certain templates (e.g., "Setup Payment" is exclusive to forms).

Common Toggles

These are some common toggles that are available in all/most question types:

  • Required: Whether a response to this question is required
  • Add to Summary Card: (Only applies to visit note templates, care plan templates, and document templates) Whether this question and its' response should show up on the summary card when an organization member is scanning a patient's chart
  • Add to Patient Chart: (Only applicable to some question types) Whether to sync the response from this question to the patient panel that's located on the left-hand side in the patient's chart

Types of Questions

Multiple Choice

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Multiple choices that are listed vertically that the form responder can select one or more options from (depending on if "Multiple Selection" toggle is turned off or on). Each option can be assigned a score. The total score for the form is calculated by adding together the scores for all the options that were selected.

The following toggles are available:

  • Image: Whether to show an image with each option
  • Multiple Selection: Whether to allow the form responder to select multiple options
  • Horizontal Alignment: Whether to align the options horizontally instead of vertically
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Multiple choices that are listed in a dropdown format that the form responder can select one option from. Each option can be assigned a score. The total score for the form is calculated by adding together the scores for all the options that were selected.

The following toggles are available:

  • Dropdown: Whether to include a description with each option and it's name
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Short Answer

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

One line for the form responder to type in their answer. Add a placeholder where it says "type your placeholder here" so form responders can see an example or guidance on what to input in the field.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Grid

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Click "Add row" to add a row to the grid. Type the name of the row where it says "Row 1", etc. Click "Add column" to add a column to the grid. Type the name of the column where it says "Column 1", etc. At the intersection of the row and column, type the number of points that are assigned to selecting this option. The total score for the form is calculated by adding together the scores for all the options that were selected.

The following toggles are available:

  • Required
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Multiple Selection: Whether to allow the form responder to select multiple options per row

Number

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

One line for the form responder to type in their numerical answer. Add a placeholder where it says "type your placeholder here" so form responders can see an example or guidance on what to input in the field.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Paragraph

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Multiple lines for the form responder to type in their answer. Add a placeholder where it says "type your placeholder here" so form responders can see an example or guidance on what to input in the field.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Date

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Space for the form responder to type in a date.

The following toggles are available:

  • Add to Patient Chart: Whether to sync this date to the date of birth field in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Time

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Space for the form responder to type in a time.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Picture

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Space for the form responder to upload a picture.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

File

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Space for the form responder to upload a file.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Statement

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Type a statement for the form responder to read.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Type in the policies that you want the form responder to agree to. To consent to the policies, the form responder will type in their full name, add an electronic signature, and set today's date,

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

SSN

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Space for the form responder to type in the patient's SSN number. Add a placeholder where it says "type your placeholder here" so form responders can see an example or guidance on what to input in the field.

The following toggles are available:

  • Add to Patient Chart: Whether to sync this SSN to the SSN field in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Address

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Space for the form responder to type in an address.

The following toggles are available:

  • Add to Patient Chart: Whether to sync this address to the address field in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Allergy

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

All the allergies that are on file for the patient will be automatically added as responses to this question. The form responder can modify these allergies, add new allergies, or delete allergies. If the "Add to Patient Chart" toggle, these modifications, additions, and deletions will also apply to allergies in the patient's chart and be synced to DoseSpot.

The following toggles are available:

  • Add to Patient Chart: Whether to sync these allergies back to the allergies field in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Medication

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

All the medications that are on file for the patient will be automatically added as responses to this question. The form responder can modify these medications, add new medications, or delete medications. If the "Add to Patient Chart" toggle, these modifications, additions, and deletions will also apply to medications in the patient's chart and be synced to DoseSpot.

The following toggles are available:

  • Add to Patient Chart: Whether to sync these medications back to the medications field in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Condition

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

All the conditions that are on file for the patient will be automatically added as responses to this question. The form responder can modify these conditions, add new conditions, or delete conditions. If the "Add to Patient Chart" toggle is turned on, these modifications, additions, and deletions will also apply to conditions in the patient's chart. These conditions will also automatically be synced to the diagnoses section of the insurance claim.

The following toggles are available:

  • Add to Patient Chart: Whether to sync these conditions back to the conditions field in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Vitals

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Space for the form responder to add the patient's vitals.

The following toggles are available:

  • Add to Patient Chart: Whether to sync these vitals back to the vitals section in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

PDF Upload

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Upload a PDF for the form responder to view.

Editor

Available for: forms, visit note templates, care plan templates, document templates, and quizzes

Pre-set default text. Insert variables for information that should be populated with the appropriate patient's information at run-time; for example, “{{patient.first_name}} {{patient.last_name}} is born on {{patient.date_of_birth}} and prefers to speak {{patient.preferred_language}}.”

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Setup Payment

Available for: forms

Space for the form responder to add in the patient's credit card information.

The following toggles are available:

  • Required

Insurance

Available for: forms

Space for the form responder to add in the patient's insurance information.

The following toggles are available:

  • Add to Patient Chart: Whether to sync this insurance information to the insurance section in the patient's chart.
  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

Preferred Pharmacy

Available for: forms

Space for the form responder to select their preferred pharmacy location. This location will automatically be synced to DoseSpot.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

ICD Codes

Available for: visit note templates, care plan templates, document templates, and quizzes

Set default ICD codes that the form responder can add to or delete from. These ICD codes will be automatically synced to the diagnoses section of the insurance claim.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required

CPT Codes

Available for: visit note templates, care plan templates, document templates, and quizzes

Set default CPT codes and modifiers that the form responder can add to or delete from. These CPT codes will be automatically synced to the billing items section of the insurance claim.

The following toggles are available:

  • Add to Summary Card: (Only available in visit note templates, care plan templates, and document templates)
  • Required
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