Dashboard

Licenses Custom Form

Create license View

Instructions

This form will allow users to submit multiple healthcare licenses. The type, state of issue, license no and expiration date will be recorded.

The user will get a reminder when license is about to expire.

If a user does not have a license, completing the select question will mark them as compliant

If user marks yes they will have to submit at least 1 license to be marked as compliant by the system.


User Input View

Submission Status:

Not Submitted

Messages: From: Sue Smith date/time

This is a message

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Instructions:
Submission:

File Name  

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  • Question and answer portion of the form is dynamic
  • If response to "Do you have a healthcare license?" is no the request for license info will not appear.

Reviewer View

Submission Status:

Not Submitted

Messages: From: Sue Smith date/time

This is a message

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Save  
  • Reviewer should be able to change the expiration date if user entered it incorrectly
  • If rejected force reviewer to send a message