CTI Form B

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

You can generate the CTI form B for the second 90 days of the hospice period of care. Form B 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 B, define the MD CTI in the Certification of Terminal Illness window.

Optionally, in the Certification of Terminal Illness window, you can define the attending MD, who can be any hospice physician. Then you must specify which physician signs the form first in the First send to field. On the preview form, MD CTI and attending MD are displayed in the corresponding fields. 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.

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

Depending on the defined workflow, the MD CTI or attending MD can enter the 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 the 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.