CTI Form A

Path: Orders>Demand Documents>Certification of Terminal Illness
Path: Patient >Documents >Certification of Terminal Illness

You can generate the CTI form A for the first 90 days of the hospice period of care. The form A shows the basic patient information (from Patient>General>Basic), hospice benefit information (from Patient>General>Admissions & Status), and a brief narrative statement (entered using the B - CTI Brief Narrative Statement clinical note).

To preview the CTI form A, do the following:

1. Define the MD CTI in the Certification of Terminal Illness window.
2. Define the attending MD, who can be any hospice physician, in the Certification of Terminal Illness window.
3. Specify which physician signs the form first in the First send to field of the Certification of Terminal Illness window. After the form is signed by the first physician, it gets the interim status Signed by MD CTI only or Signed by Attending MD only; after the second physician signs the form, it gets the status Signed.

For more information on the workflow, refer to Certification of Terminal Illness workflow.

On the preview form, MD CTI and attending MD are displayed in the corresponding fields.

Note: If MD CTI and attending MD is the same physician, define this physician in both MD CTI ID and Attending MD ID fields. After this physician signs the form, it gets the status Signed.

Brief Narrative Statement

MD CTI or attending MD (any hospice physician) can enter a brief narrative statement. Name and signature of the entering physician, and the date when the note was provided are printed in the appropriate fields. If two physicians provided the B clinical note, both notes are printed on the form together with dates when they were provided, names, and signatures of both providing physicians.

If the B clinical note was signed in the Electronic Signature dialog of the Clinical Notes Window or entered through Physician Portal, Electronically Signed by  will be displayed on the form, where is the name of physician who signed the form.

If the B clinical note was not provided, then the Brief Narrative Statement section and the corresponding Date field is blank. If needed, the brief narrative statement can further be entered on the printed form.