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1. 00 To Maverick Charette From Contact Number Subject Prescription Refill Request Dear Dr Maverick Charette 1 would like a refill for the following medication s Amoxapine 100 MG Oral Tablet Amoxicillin 100 MG Oral Tablet Please type any additional info below ED mr 25 Page Contact Us info patientally com 888 747 4255 PatientAlly Na e eelog Home Profile Healthcare Requests Test Results My Providers Resources Laboratory View Vitals A Welcome Located Using this menu you reach each individual page Below quick links to some of the more commonly used features Thanks for using Patient Ally Your membership is important to us if you have any questions or suggestions please use our Feedback Form Update Personal Information Send Provider Messages Add a Family Member Submit Health Forms Please fill out our Survey here Patient Ally Survey Make an Appointment Request Prescription Refills 1 LABORATORY View Lab Results that your Provider has sent to you You will receive an email indicating a Lab Result is available to be viewed in Patient Ally Any Labs sent to you will display the date the result was sent the name of the result and any comments from your Provider To view the result click on the VIEW button h Dc Date Name Comments 03 23 2012 Lab Result Lab was done with referring Provider 2 VIEW VITALS View vital signs that your Provider has sent
2. Thee uae rite be hac ieee urh Dern T onn Ri Dien Dae F and saben To log into your Patient Ally account you will need to enter in your Username and Password that was created during your registration process Keep in mind that your Login is case sensitive After entering in your Username and Password click LOGIN If you are having Login issues please contact Patient Ally PatientAlly Home AboutUs Features ContactUs Help SignUp Welcome to Patient Ally Patient Ally is your FREE internet based Personal Health Record management system that enables you to manage Members Login your medical records and communicate with your healthcare providers MM Username Save time and avoid frustration utilizing Patient Ally s secure state of the art software Schedule appoint prescription refills maintain health records for your entire family even communicate online with your pr Password Forgot Password Forgot Username Sign Up Now to get started Blue Shield Member Micit nur Dina hinld Natinnt Alh Cita 7 Page Contact Us info patientally com 888 747 4255 Logging into Blue Shield of California s Patient Ally Homepage blue amp of california Welcome Blue Shield of California Providers and Members Blue Shield and Office Ally are offering this easy to use secure web based patient health record communication tool that allows providers and members to co
3. m m Skating uni Do you consume alcohol v Do you think that you suffer from stress vi Swimming Pp Tennis Racquetball Do you have difficulty falling or staying asleep V S SES e 7 Walking Do you have irritability or outbursts of anger V F Volleyball Do you have difficulty concentrating m v __ 71 Weightlifting Yoga Do you feel you are on guard Are you easily startled mm How many servings of the following foods do you eat in a typical day Have you missed work school or other activities because of stress vj No of Servings No of Have you experienced any of the following in the recent past Servings Yes No 71 Bread Cereal Pasta or Fats Oils Sweets Death or serious illness of a family member or close friend Vj Rice Divorce i V Fruits Fruit Juices rea Group meat poultry Separation from a spouse or significant other 7 V Milk Products cheese tee Beans Eggs or Nuts rt et Conflict with family member s riv yogurt etc Loss of home E iv Vegetable Group Loss of job i V Serine accident rm T Intake Documents Click INTAKE DOCUMENTS and then click SELECT next to your Provider General Insurance Pharmacies Forms Visit Summary Prospect Data Intake Documents Allergies Charette Megan Medical History __ Family Histo Social History Intake Documents You will see any documents your Prov
4. Microsoft Internet Explorer 7 0 or greater with 128 bit SSL Encryption Mac Mac OS X Mozilla Firefox 3 0 or greater with 128 bit SSL encryption Required Connection Speed High speed internet service for optimal performance DSL Cable Modem etc For Technical Assistance please email us at info patientally com or call 888 747 4255 Question Who can use Patient Ally Answer Patient Ally offers free services to any patient in the country Anyone with a computer and internet connection can use Patient Ally Question What is Patient Ally Answer Patient Ally is your FREE internet based Personal Health Record Management System that enables you to manage your medical records and communicate with your Healthcare Providers 32 Page Contact Us info patientally com 888 747 4255 Question How dol enroll sign up for Patient Ally Answer Visit www patientally com and click SIGN UP NOW You will create your own Username and then we will email you a link to create your own Password Question Do I need to have high speed internet Answer High speed internet is recommended either DSL or cable modem Question Can I use any browser for Patient Ally Answer This website is best viewed with Internet Explorer 7 0 or Mozilla Firefox 3 0 and above Question What information do I need to fill out Answer Basic demographic information is the only requirement however you may also include insurance information and complete forms containin
5. Recipient List Address Book State Zip Phone Source Status Maverick Charette Family Practice 16703 SE Mill Plain Blvd Vancouver WA 98684 EHR PM Confirmed Select Checked Add External Contact 18 Page Contact Us info patientally com 888 747 4255 JA 1 2 3 Inbox Drafts 4 Search Sender Name Starts With 8 Archived 5 Sent 6 From To Subject Date Autorefresh off 7 F Megan Charette Bo Bice Re Request Adding Provider 5 25 2012 F Megan Charette Bo Bice Added New Patient with Megan Charette 5 25 2012 Megan Charette Bo Bice Re Request an Appointment 5 04 2012 Bo Bice Re Request Adding Provider 5 04 2012 E Megan Charette Bo Bice Added New Patient with Megan Charette 5 04 2012 2 Archive Selected Select the checkmark box for the messages you would like to archive from your Inbox Click on ARCHIVE SELECTED and they will be removed from your Inbox To view them later click on ARCHIVED 3 Delete Selected Select the checkmark box for the messages you would like to delete from your Inbox Click on DELETE SELECTED They will be permanently deleted from your Patient Ally account 4 Drafts View messages saved to your Drafts folder To open and view the message click on the icon Drafts Search Sender Name Starts With Archived Sent From To
6. Document Tithe Visit Summary Information from your Provider regarding your office visit such as Diagnoses Allergies Current and Prescribed Medications Immunizations and Procedures Note You will only have access to view information if your Provider has enabled this feature General Insurance Pharmacies Forms visit summary Prospect Data Diagnoses Visit Date Description Provider 08 16 2012 ABDOMINAL PAIN UNSPEC SITE Megan Charette Allergies Visit Date Description Status ProviderName 08 16 2012 Milk Products 0 Megan Charette 08 16 2012 Wheat Flour 0 Megan Charette Medications PatientMedicationDrugName PatientMedicationQty PatientMedicationRefill Status ProviderName CurrentType StatusID 08 16 2012 amoxicillin 125 mg Chewable Tab 0 Active Megan Charette 2 immunizations History Date Given Description Provider 03 15 2012 Influenza high dose seasonal Megan Charette Procedures Visit Date Description Provider 08 16 2012 OFFICE OUTPATIENT VISIT Megan Charette Prospect Data COMING SOON General Insurance Pharmacies Forms Visits A Prospect Data Medications Labs Referrals 2 MY FAMILY Gives you access to additional family member profiles You can view edit as well as transfer information to a separate Patient Ally account Also you will have the ability to add a new family member from this page Hry 0 0 0 0 0 1 1 1111 1 1 19 1 1
7. Information Patient Demographics Employer Information V Contact Information Emergency Contact V Employer Information Insurance V Emergency Contact FINI Secondary Insurance Insurance Forms Primary Insurance Medications V Secondary Insurance lt Allergies Bl Forms Surgical History V Medications a Immunizations Allergies Family History V Surgical History Social History V Medical History Pharmacies V Immunizations V Family History V Social History Please select the format s you would like to Pharmacies export V Pharmacies PDF lt Example of Medical History Print Preview TestP Account NA 8 4 2012 PatientAlly Gender F DOB 1986 05 05 Patient Demographics SSN 123 453 6789 Blood Type 0 61 173 Marital Status M Emp Status Employed Couniry LSA Professional T itle TSS Ethnicity White af Children 1 Contact Information Address 123 West Main Ciy Vancouver State WA Zim JESAS Hame Phone Work Phone 360 999 9999 Work Ext 1 Cell Phone 360 666 6f Fax 380 111 1111 Email emaili amp ernail com Employer Information Name Office Ally Phone 866 575 4120 Occupation Suppor Address 16703 SE McGillivray Blvd Suie 200 Ciy Vancouver State WA Zi Emergeney Contact Contact Name Sample Account Relation in Patient Spouse Address 123 West Main Cky Vancou
8. PM EHR 16703 SE Mill Plain Blvd Vancouver WA 98684 Family Practice Confirmed View Edit Check All Delete Provider s To establish a secure HIPAA connection between you and your Provider you will need a Patient Security Code If you do not have a code please contact your Provider directly to receive one If you have already been issued a code please proceed with the next steps Click ADD NEW PROVIDER pamm m Check All Add New Provider gt Delete Provider s 27 Contact Us info patientally com 888 747 4255 Now you will need to search for your Provider After using the search filter to find your Provider click SEARCH Providers Add Providers To find your Provider in the Patient Ally Network fill in the fields below Note At least one field is required to search If you are unable to locate your Provider in the Patient Ally Network Click Here to add a Provider manually Note Manually added Providers are for recording purposes only and are excluded from electronic communications Providers added from the Patient Ally Network will receive a request to be linked message Once your Provider has confirmed your request to be linked you will receive a confirmation message in your Patient Ally inbox Note You will not be able to communicate with your Provider until they confirm your request City Name State Zip Code 1 er Last Name First Name Once your Pr
9. Subject Date Autorefresh off Bo Bice Message for Doctor 5 Archived View messages saved to your Archived folder open and view the message click on the icon Archived Subject Re Request an Appointment Autorefresh off 8 17 2012 6 Sent View messages you have sent through Patient Ally To open and view the message click on the sit icon If you have previously viewed the message the icon will be instead Date From Subject Bo Bice Autorefresh off Megan Charette 5 17 2012 Request Adding Provider 7 Autorefresh Can setup an autorefresh interval so you don t have to manually click the 3 icon 8 Search Can search for messages Enter in what you are searching for and click SEARCH Messages Archive Selected Delete Selected 5 Inbox Drafts Subject x Contains Appointment Archived Sent Subject Date Autorefresh off 7 A Megan Charette Bo Bice 5 04 2012 19 Page Contact Us info patientally com 888 747 4255 2 EVISITS Allows you to have an online consultation with your Provider for a set fee You will complete a series of questions based on your symptoms and your Provider will be able to respond You will be prompted to pay prior to viewing any responses from your Provider Fees are set by your Provider You can view recent eVisits you have created that are pending a response from your Pro
10. your Password Uppercase Letter A through Z Lowercase Letter a through z Number 0 9 Punctuation or Character OQ 96 amp lt gt Hecover Password System requirements for a valid password 1 Contains 8 characters or more 2 Contains characters from three of the following four character classes English uppercase characters A through 2 English lowercase characters a through z Numeric i e 0 9 Punctuation and other characters e g 4 lt gt I 3 New password can not be any of the previous 3 passwords New Password Confirm New Password Once you are done creating your new Password click CHANGE PASSWORD to finish You will now be able to log into Patient Ally with your Username and new Password PatientAlly Home AboutUs Features ContactUs Help Sign Up Patient Ally is your FREE internet based Personal Health Record management system that enables you to manage your medical records and communicate with your healthcare providers Username Save time and avoid frustration utilizing Patient Ally s secure state of the art software Schedule appointments order prescription refil health records for your entire family even communicate online with your provider Password Forgot Password Forgot Username gt SIGN UP NOW Sign Up Now to get started Blue Shield Member Visit our Blue Shield Patient Ally Site Patie
11. 00 PM 82 0 180 0 253 0 120 05 05 1974 Edit Go back to Vitals Summary Select Unselect All Fill out any vitals you would like to record and click SAVE If needed you can always edit or delete any vitals you have previously recorded Go back to User Vitals Add Vitals Common Vitals Weight kg Height cm Heart Rate Pulse Learn How Respiratory Rate Learn How Blood Pressure Systolic Learn How Diastolic Learn How Cholesterol HDL LDL Triglyceride Date Vitals were Taken Date of Measurement Time of Measurement Date of Birth mccum Go back to User Vitals Current Profile x Messages 1 e eVisits 0 e e Log Out PatientAlly Home Profile Healthcare Requests Test Results My Providers Resources Manage Providers Submit Health Forms FJ Welcome Located above is the navigation menu Using this menu you can reach each individual page Below are quick links to some of the more commonly used features Thanks for using Patient Ally Your membership is important to us if you have any questions or suggestions please use our Feedback Form Update Personal Information Send Provider Messages A Add a Family Member Submit Health Forms Please fill out our Survey here Patient Ally Survey Make an Appointment Request Prescription Refills 1 MANAGE PROVIDERS Connect and keep track of your Providers in Patient Ally Contact Charette Maverick
12. 0000000000 0 Patient Survey Blue Shield Member O Fam not a Blue Shield Member Insurance Name 1 On a scale of 1 to 10 where 1 represents Extremely Dissatisfied and 10 represents Extremely Satisfied how would you rate your level of overall satisfaction with Patient Ally N A D1 52 63 O4 55 66 67 99 10 2 During your most recent experience which feature s did you use eVisit Request Appointment Request Communicating with Provider C Storing medical Records for personal use Document Center 3 Thinking about your most recent experience with eVisits On a scale of 1 to 10 where 1 represents Extremely Dissatisfied and 10 represents Extremely Satisfied how would you rate your level of overall satisfaction O N A O 1 22 O3 O4 55 08 O9 10 When finished with the Survey click SEND 4 Thinking about your most recent experience with Appointment Requests On a scale of 1 to 10 where 1 represents Extremely Dissatisfied and 10 represents Extremely Satisfied how would you rate your level of overall satisfaction 1 2 63 24 65 26 67 59 10 5 Thinking about your most recent experience with communicating with your provider On a scale of 1 to 10 where 1 represents Extremely Dissatisfied and 10 represents Extremely Satisfied how would you rate your level of overall satisfaction N A 61 62 63 54 65 59 10 6 Think
13. 11 8 8 d pared Fi arry Marre IEEE MILI Fide B 1389 Adam Assen 1965 TT Teenie 05 05 1965 Terie 15 Page Contact Us info patientally com 888 747 4255 Birth Gender and click ADD FAMILY MEMBER 3 ADD FAMILY MEMBER Ability to add family members to Patient Ally Enter in First and Last Name Date of main account holds To add a new profile please enter the name that you would like to appear on the profile First Name Last Name Date of Birth Gender Male You are allowed to add as many additional profiles to be managed along with your main account These profiles do not have administrative access such as login but retain the other functionalities that the ad e g mm dd yyyy m 4 Add Family Member gt 4 PRINT MEDICAL HISTORY Option to print Demographics Insurance History and Pharmacy Information Select or unselect the information you would like to print and click NEXT Confirm your selections and click PREVIEW when you are ready to print Click BACK if you would like to add or remove any selections info patientally com 888 747 4255 Export Medical History 1 1 11 Export Medical History Check the sections you would like to be exported Please take a moment to confirm your selection General d 2 ee Patient Demographics eneral Contact
14. 6f Family Member Submit Health Forms Please fill out our Survey here Patient Ally Survey b an Appointment Request Prescription Refills 1 MESSAGES Allows you to compose view and reply to messages You will automatically be in the INBOX when you select Messages The Inbox will list most recent messages first You will see who the message is from who the message is sent to YOU the subject and the date the message was sent To open a message simply click on the envelope icon Messages 1 2 3 Inbox Drafts 4 Search Sender Name _ v Starts With v 8 Archived 5 Sent 6 From To Subject Date Autorefresh off Megan Charette Bo Bice Re Request Adding Provider 5 25 2012 peg Megan Charette Bo Bice Added New Patient with Megan Charette 5 25 2012 f Megan Charette Bo Bice Re Request an Appointment 5 04 2012 1 f9 Megan Charette Bo Bice Re Request Adding Provider 5 04 2012 A Megan Charette Bo Bice Added New Patient with Megan Charette 5 04 2012 Unread Messages e Head Messages 3 Refresh 1 Compose New Click ADD CHANGE RECIPIENT or click ADDRESS BOOK select your Provider and then click SELECT CHECKED Enter in a Contact Number Subject and Message Click SEND when finished or if you are not ready to send the message click SAVE DRAFT Messages Address Book To Add Change Recipients eel From Contact Number Subject
15. Patient Ally BLUE SHIELD OF CA Register with Patient Ally as a Blue Shield of California Member 9 USERNAME amp PASSWORD Enter Login for Patient Ally 10 FORGOT PASSWORD amp FORGOT USERNAME Password and Username retrieval links 11 LOGIN Log into your Patient Ally account 12 SIGN UP NOW Register with Patient Ally 13 KEY FEATURES Details about services you can utilize in Patient Ally 14 FLU GOV Helpful information about the Flu 15 EHNAC Access to EHNAC s website 16 HOME Brings you back to the Patient Ally Homepage 17 TERMS AND CONDITIONS View Patient Ally s Terms and Conditions 18 PRIVACY View Patient Ally s Privacy Policy 19 CONTACT US Patient Ally s address phone and email information Oo Sie SI um 3 Page Contact Us info patientally com 888 747 4255 Click SIGN UP NOW to get started with your registration PatientAlly Home AboutUs Features ContactUs Help Sign Up Welcome to Patient Ally Patient Ally is your FREE internet based Personal Health Record management system that enables you to manage your medical records and Members Login communicate with your healthcare providers mm mu Username Save time and avoid frustration utilizing Patient Ally s secure state of the art software Schedule appointments order prescription refills maintain health records for your entire family even communicate online with your provider Passw
16. VICES CONTAINED ON THIS WEBSITE ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND EXPRESS OR IMPLIED Welcome to eVisit IN USING THIS WEB SITE I UNDERSTAND AND AGREE A THAT Patient Ally IS NOT RESPONSIBLE FOR THE NEGLIGENT OR INTENTIONAL ACTS OR OMISSIONS OF ANY HEALTH CARE PROVIDER OR SUPPLIER THAT IT MAY BE LINKED WITH OR FOR If this is an urgent situation p ANY ACTION OR INACTION TAKEN BY ME IN RELIANCE UPON THE INFORMATION COMMUNICATED TO ME VIA THIS WEB emergency room or call 911 4 i SITE B THAT THE TOTAL LIABILITY OF Patient Ally AND ITS AFFILIATES IF ANY ARISING FROM OR RELATED NEN N INTERACTIONS I HAVE WITH OR THROUGH THIS WEB SITE WHETHER THE CLAIM IS CONTRACT TORT WARRANTY Your provider charge 30 fg each Electronic Visit eVisit You will be required to pay for the eVisit before you can view your NEGLIGENCE MALPRACTICE FRAUD OR OTHERWISE IS LIMITED TO THE PURCHASE PRICE OF ANY PRODUCTS AND OR THE provider s response to ti eVisit To complete this eVisit you must have an established provider relationship with one of the COST OF AN OFFICE VISIT IN ANY RELEVANT TRANSACTION AND C THAT Patient Ally SHALL NOT BE LIABLE FOR ANY providers who handles eVisits Your eVisit is taken as seriously as a normal office visit All consideration will be made to treat you DIRECT INDIRECT SPECIAL INCIDENTAL CONSEQUENTIAL OR PUNITIVE DAMAGES EVEN IF INFORMED OF THE as if you were visiting the doctor in the
17. ase characters a through z Numeric i e 0 9 Punctuation and other characters e g amp lt gt User Name Date of Birth Lal New Password Confirm New Password Security Question In what city were you born Security Answer When you have finished click COMPLETE REGISTRATION You will receive a confirmation message when you have successfully created your Patient Ally account Next you should automatically be directed to the Patient Ally Homepage If you are not automatically directed click on the link provided to be brought to the Homepage where you can log into your Patient Ally account Complete registration Congratulations Y ou have completed registration with PatientAlly You will be redirected to the login page in a few seconds If you are not redirected please click here to go to the Patient Ally login paga Tb cite be hr ied ab barmak T oen Dien Dae F amd Lea For Blue Shield of California Members ONLY If you are a Blue Shield of California Member please click on the link provided on the Homepage to be redirected before registering Home AboutUs Features ContactUs Help Sign Up Welcome to Patient Ally Patient Ally is your FREE internet based Personal Health Record management system that enables you to manage your medical records and Members Login communicate with your healthcare providers ne ay wn Username Save time and avoid fru
18. atienvza4zsll Secure Access 24 7 5365 to Your Personal Health Records User Manual Patient Ally is sponsored by Office Ally Office Ally 16703 SE McGillivray Blvd Suite 200 Vancouver WA 98683 For questions and feedback please email us at info patientally com Phone 888 PHR 4ALL 1 Page Contact Us info patientally com 888 747 4255 TABLE OF CONTENTS Patient Ally Homepage Registering Blue Shield of California Member Logging In Forgot Password Forgot Username Home Profile Patient Profile My Family Add Family Member Print Medical Records Settings Healthcare Requests Messages eVisits Appointments Document Center Submit Health Forms Prescription Refills Test Results Laboratory View Vitals Add or Edit Vitals My Providers Manage Providers Connecting with your Provider Submit Health Forms Resources News Updates Feedback Contact Us Help Survey Blood Sugar Log System Requirements FAQ Contact Us info patientally com 888 747 4255 2 Page 1 2 3 4 5 6 PatientAlly 2 Home AboutUs Features ContactUs Help SignUp Welcome to Patient Ally Patient Ally is your FREE internet based Personal Health Record management system that enables you to manage your medical records and communicate Members Login with your healthcare providers Username Save time and avoid frustration utilizing Patient Ally s secure state of the art software Schedule appointments order prescription r
19. been added 24 Page Contact Us info patientally com 888 747 4255 5 SUBMIT HEALTH FORMS This section allows you to send Allergy History and Immunization information to your Provider Just like a message click ADD CHANGE RECIPIENT or click ADDRESS BOOK select your Provider and then click SELECT CHECKED Entering in a Contact Number Subject and Message is optional Check the boxes for the information you would like to send to your Provider Allergies Immunizations and History Once you are done selecting click SEND Messages Erb OR From Contact Number Subject Attachments Add Attachments Immunizations i i Medications L Social Histo E DrOWSe 6 PRESCRIPTION REFILLS You can request refills for any medications your Provider has prescribed or listed as a current medication in your patient chart Click on the SELECT button next to your Provider s name to request a refill Prescription Refill Request Refer to your Sent folder under Messages for previously requested prescription refills Back to Providers Refill Medication Sig Provider Amoxapine 100 MG Oral Tablet prea Amoxicillin 100 MG Oral Tablet Maverick Charette Check All Uncheck All Continue Add any additional comments to your Prescription Refill request and click SEND Prescription Refill Request
20. both the copyright notice identified below and this permission notice appear in the Materials 2 the use of such Materials is solely for personal non commercial and informational use and will not be copied or posted on any networked P Providers may make improvements and or changes in the products services programs and prices described in this Web Site at any time without notice Patient Ally may periodically make changes to the Web Site California law and controlling U S federal law will govern any action related to these Terms No choice of law rules of any jurisdiction will apply These Terms represent the entire understanding relating to the use of the Web Site and prevail over any prior or contemporaneous conflicting or additional communications Patient Ally has the right to revise these Terms at any time without notice by updating this posting Any rights not expressly granted herein are reserved by Patient Ally INTELLECTUAL PROPERTY NOTICES Elements of the Web Site are protected by trade dress and other laws and may not be copied or imitated in whole or in part No logo graphic sound or image from the Web Site may be copied or retransmitted unless expressly permitted by Patient Ally Patient Ally the Patient Ally logo and or other Patient Ally products referenced herein are trademarks of Patient Ally and may be registered in certain jurisdictions All other product names company names marks logos and symbols may be the tra
21. d my account due to numerous failed Login attempts Answer Click UNLOCK MY ACCOUNT and then the RESET PASSWORD button Patient Ally will automatically email you a link to set up a new Password If you do not receive this email please contact Patient Ally for assistance Username Password Forgot Password Forgot Usemame Your account has been locked How Do Unlock My Account If you attempt to log in with an incorrect password 3 times in a row your account will be automatically locked If you choose to reset your password Patient Ally will delete your old password and send you a temporary password to the email you registered the account with Reset Password Close PatientAlly For questions and feedback please contact us at Email info patientally com Phone 888 PHR 4ALL Copyright 2012 Patient Ally All rights reserved 34 Page Contact Us info patientally com 888 747 4255
22. demarks of their respective owners Copyright 2012 Patient Ally All rights reserved LEGAL CONTACT INFORMATION If you have any questions about these Terms or if you would like to request permission to use any Materials please contact Patient Ally Legal at 949 290 6866 checking this box I have agreed that I have thoroughly reviewed the Terms and Conditions stated in this Agreement No I do not agree 5 Contact Us info atientally com 888 747 4255 You will receive a confirmation message when you have successfully added your Provider Click OK to finish Provider Agreement x Your Provider has been added successfully A request to be linked message has been sent to your Provider Once your Provider has confirmed your request to be linked you will receive a confirmation message in your Patient Ally inbox Note You will not be able to communicate with your Provider until they confirm your OK Once you have added your Provider you can view what features they have enabled with Patient Ally Click the VIEW EDIT button located to the right of your Provider Combet 666 575 4120 Confirmed 16703 SE Mill Plain Blvd Vancouver WA 98684 Fari Practice on PAVEHR Charetie Megan Your Provider can choose to Share Vitals Share Labs Allow eVisits Allow Appointments and Share Chart Information If there is a Yes next to any options you will have the abilit
23. dual page Below are quick Thanks for using Patient Ally Your membership is important to us if you have any questions or suggestions please use our Feedback Form Update Personal Information Survey ovider Messages Add a Family Member ealth Forms Please fill out our Survey here Patient Ally Survey Make an Appointment Blood Sugar Log Prescription Refills 1 NEWS UPDATES Access to news enhancements and changes regarding Patient Ally Patient Ally Has Been Updated 12 09 2009 Thank you for your patience We have rolled out the new Patient Ally Please continue to give us feedback to help us improve the site Thank you Thank you Patient Ally Team Feedback 10 21 2009 Your feedback is very important to us It will help us to continue improving Patient Ally to meet our users needs Shortly we will release a feedback screen for you to comment on any enhancements or issues We may also contact you through the patient ally inbox if our system detects that you are experiencing errors Thanks again for choosing Patient Ally Thank you Patient Ally Team Patient Ally is Live 10 20 2009 Thank you for signing up for Patient Ally We hope we can continue to serve you and make your PHR personal health record experience a great one Thank you Patient Ally Team 2 FEEDBACK Submit feedback to Patient Ally Enter in a Subject select from the Page or Section dropdown add comments and then click PREVIEW Patient Ally w
24. efills maintain health records for your entire family even communicate online with your provider 7 Sign Up Now to get started 10 Visit our Blue Shield Patient Ally Site 8 14 Password EHNAC Accredited Safe and Secure a Keep track of your medical records for free m L U OV Schedule cancel change appointments with your physicians s online UE Communicate with your physicians s online Know what to do Request medication prescription refills about the flu Store medical documents Request View Lab Results SHARETHIS WIDGET EHNAC represents a wide range of stakeholders in its peer driven effort to advance healthcare through electronic transaction standards To learn more visit the EHNAC site Patient Ally is part of Office Ally an accredited EHNAC organization EHNAC ACCREDITED HNAP EHN This web site is best viewed with Internet Explorer 7 or Mozilla FireFox 3 and above Home Terms and Conditions Privacy Contact Us 16 17 18 19 From the Patient Ally Homepage you can use quick links to access certain parts of the website HOME Brings you back to the Patient Ally Homepage ABOUT US Information about Patient Ally FEATURES Details about services you can utilize in Patient Ally CONTACT US Patient Ally s address phone and email information HELP Access to Guides and Manuals SIGN UP Register with Patient Ally SIGN UP NOW Register with
25. el Re type New Password Change Email Address Click on the CHANGE EMAIL link Enter your current Password and click UPDATE When you have entered in your new email address click UPDATE to save Email Address Password Verification Enter Current Password to Proceed New Email Address Current Password Re type New Email Address Cancel d Update jp Change Security Question and Answer Click on the CHANGE SECURITY QUESTION AND ANSWER link Enter your current Password and click UPDATE Select your Security Question from the drop down list and then enter in your Answer Click UPDATE to save Security Question and Answer Password Verification x Enter Current Password to Proceed Security Question In what city were you born I Current Password Answer E Update p 17 Page Contact Us info patientally com 888 747 4255 PatteniA Ih j Current Profile x Messages 1 e eVisits 0 e e Log Out Home Healthcare Requests Test Results My Providers Messages eVisits 2 Welcome Appointments is the navigation menu Using this menu you reach each individual page Below quick paien 4 e of the more commonly used features Resources Thanks for using Patient Ally Your membership is important to us if you have any questions or suggestions please use our Feedback Form cis iis tire 5 hte Send Provider Messages Prescription Refills
26. elcomes your feedback Please help by sending us comments suggestions or issues that you have with Patient Ally We appreciate encouraging feedback too PageorSecion Add New Profle E q Preview gt Wit ell You can review your feedback before you send it If you would like to add or change anything click the GO BACK button If you are ready to submit click SEND FEEDBACK To Patient Ally Team Subject Feedback Page or Section Other Screen Comments Patient Ally is great Send Feedback Go Back Ne el You will receive a confirmation that your feedback was sent to Patient Ally successfully Thank you for your feedback We will use your feedback to help us improve Patient Ally If it is a bug you may receive a message in your inbox to notify you that it s fixed 30 Page Contact Us info patientally com 888 747 4255 3 CONTACT US Patient Ally s address phone number and email address To Contact Patient Ally 16703 SE McGillivray Blvd Suite 200 Vancouver WA 98683 Phone 888 PHR 4ALL Email info amp npatientally com 4 HELP Access to Guides and Manuals You can view these using Adobe Reader and print if needed Help Manuals e Patient Ally FAQ Bau s Patient Ally User Guide meVisits Guide n Temporary Password Instructions 5 SURVEY Complete a short survey to let us know how Patient Ally is working for you Survey 00 0 0 0 0 000
27. ent Ally Your membership is important to us if questions or suggestions please use our Feedback Form Settings 5 Update Personal Information Send Provider Messages 11 Page Contact Us info patientally com 888 747 4255 1 PATIENT PROFILE You can store Demographics Insurance Pharmacy and History Information in your Patient Profile Intake Documents are available under the Forms tab and Visit Information is listed under the Visit Summary tab General Fill out your demographic information and click SAVE General Insurance Pharmacies Forms Visit Summary Prospect Data Patient Information Last Name Required First Name DOB Required Gender Blood Type a Weight kg Marital Status iy Emp Status Country v Ethnicity Contact Information Address City State Home Phone Work Phone Cell Phone Fax Employer Information Name Phone Address City State Emergency Contact Contact Name Address City State Home Phone Work Phone Required x x Iz Zip Email x Zip du Work Ext Occupation MI SSN Height cm Professional Title No of Children Relation to Patient Zip Cell Phone Suffix Insurance Fill out your Insurance information and click SAVE General Insurance Pharmacies Forms Visit Summary Prospect Data Primary Insurance Ins Name Group No Patient Relationship To Primary In
28. ent types of documents your Provider has sent to you as well as view documents you have completed or uploaded in Patient Ally To view the document click on the icon on the right side of the page next to the document Different types of icons indicate different types of files If you would like to remove any documents check the box next to the document and then click DELETE Keep in mind that this will permanently delete these documents from your Patient Ally account Document C ente View All gt Upload Documents belect Unselect All File Name Description Date Added View Edit LabResult 2 5 HEXANEDIONE URINE UNHYDROLYZED 08 24 2012 LabResult 2 5 HEXANEDIONE URINE UNHYDROLYZED 05 31 2012 1005747942 Sample Lab Report 2 txt Lab 03 23 2012 Allergies This is the form you have filled out under profile 03 22 2012 g Medications This is the form you have filled out under profile 03 22 2012 f View All v Select Unselect 2 Word Document A Text File l na Registration Form You can upload any documents to store in your Patient Ally account by clicking UPLOAD DOCUMENTS Select the Category Type click BROWSE and search for files Click UPLOAD when you are finished Upload Documents Category Type Labs Help 1 Select the category type to upload the files under 2 Select as many files for upload as desired 3 Glick the Upload button when all files have
29. ers Email First Name Last Name Date of Birth ES e g mm dd yyyy Gender Male P XAJ 3 G du Captcha Enter the code shown have thoroughly read and accept the Terms of Use and Agreement Create Account You will be sent a separate email from info patientally com to complete your registration If you do not receive this email please contact Patient Ally Once you receive the email example below click the HERE link or copy and paste the web address provided From info patientally com mailto info patientally com Sent To Subject Patient Ally Registration Confirmation Congratulations You have successfully created a new account with Patient Ally To finish your registration please here Yis link is only good for 72 hours If you are not able to click on the link above copy the following https www patientally com CompleteRegistration aspx user a016206e 1061 40c2 S9ea d0fd1d322aae amp r ves and paste into your browsers address bar If you have any questions email us at info patientally com or call us at 888 PHR 4ALL Click here to print the full instructions or go to www patientally com Help aspx and download the Registration Instructions Thanks and welcome aboard the Patient Ally Community The Patient Ally Team 6 Page Contact Us info patientally com 888 747 4255 The link will bring you to Patient Ally where you will create your own Password You will need to confirm your Username you
30. ess 123 w City Vancouver Name John Doe Address 123 w City Vancouver Zip Code esea2 Zip Code 98632 Account Number Washington ons Card Number CCV Routing Number fm Expires january 2012 7 itm Amount 30 00 Amount 20 00 Comments Comments CT next gt gt gt CT next gt gt ji Below is an example of what your eVisit response will look like from your Provider You will be able to reply until the eVisit has been marked Complete by your Provider Go Back Provider Office Aly Technical Support Reason for Visit Back pain Messages From Dr Office Ally Technical Support t 1 21 2010 3 33 04 PM Sending second reply from provider From Nancy Willis 1 21 2010 3 23 08 PM sending a reply From Dr Office Ally Technical Supporto 1 21 2010 3 21 44 If symptoms persist past 1 week please contact us for an appomtment Send a From Dr Office Ally Technical Support 1 20 2010 1 28 13 lf symptoms persist past 1 week please contact us for an appointment 22 Page Contact Us info patientally com 888 747 4255 3 APPOINTMENTS You will have the ability to request appointments based off your Providers schedule Your Provider will need to approve the appointment before it is confirmed To request an appointment click SCHEDULE AN APPOINTMENT No appointments pending in the naxt 90 days To pull up your Provider s sc
31. g medical information This information may then be transmitted to your Provider though secure communication Question Is it safe for me to enter all my personal information Answer Yes your information is stored on our secure servers and our website boasts 128 bit encryption Redundant equipment with firewalls load balancing and failover are used to ensure continuous operation of our website Question Are you HIPAA compliant Answer Yes we are certified HIPAA compliant The Privacy Policy details the procedures we follow to protect your private health information as well as the security measures used to ensure privacy Our parent company Office Ally LLC is also EHNAC accredited which represents the highest standards in HIPAA compliance Question Can add delete family members in my account Answer Yes you may add family member profiles to your account and manage them within Patient Ally Question How I print out the forms complete Answer Use the Profile link to access Print Medical History and select the documents you wish to print Confirm your selection s and preview the document Click the PRINT button at the top or bottom of the screen Question How tell if my Provider is set up for Patient Ally Answer Once you have established a Patient Ally account you may search for your Provider in the Patient Ally Network using the My Providers link in the navigation tool bar Select Manage Providers and then click o
32. hedule first select their name on the right side of the Appointment Calendar window and then select their Office Close Calendar Providers Maverick Charette Family Maverick Charette Family Practice Practice Megan Charette Family Practice The schedule should now refresh with the Provider s office hours Any time slots that are grey or show as Heserved are not available All white time slots are available Click on a day and time you would like to request for your appointment o Megan Charte Charette Medica Grow x 2 1 i gt B J P LI E A E n r When you click on a specific day and time you will be prompted to enter in your Contact Number Reason for Visit and any additional comments Click OK when finished You will now see your appointment request on the Appointment Calendar It will remain red until your Provider has confirmed the appointment Appointment Calendar Request an Appointment You are requesting an Appointment on 8 24 2012 8 00 00 AM with Megan Charette Charette Medical Group Contact Number Reason for Visit Close Calendar Megan Charette Charette Medical Group o Mon 08 20 2012 08 21 2012 Wed 08 22 2012 Thu 08 23 2012 Fri 08 24 2012 08 25 2012 Ethan J s Providers Megan Charette Family Practice Charette Medical Sun 08 26 2012 Comments Contact Us inf
33. ider has made available to you under the Retrieve tab Click on the document that you would like to open and complete General Insurance Pharmacies Forms Visit Summary Prospect Data Intake Documents Go Back Providers Retrieve submit Intake Form Intake Documents mmc ON BLUE LINK TO OPEN Insurance Card HIPAA Patients Rights Form HIPAA Consent Form Financial Form You will receive a pop up asking if you would like to Open or Save the file select either option Depending on the file type you may be able to save it on your computer and fill it out without having to print If you do not have an option to type on the document you will need to print it Do you want to open or save Gbad4ef15 50e6 4323 ad35 91e598b ebbe PDF from www patientally com Open Save Cancel x 14 Page Contact Us info patientally com 888 747 4255 To be able to send the document back to your Provider electronically click on the Submit tab You will need to browse for the document on your computer and then select the file Next enter in the Document Title select the File Type and then click Upload The document should be displayed once uploaded You can repeat the steps to add multiple documents if needed When ready click SUBMIT to send any attached documents to your Provider Intake Documents Document upoaded File to upioad Browse Document titie Upload Clear File Type Intake Forms
34. ing about your most recent experience with storing medical records i e Document Center On a scale of 1 to 10 where 1 represents Extremely Dissatisfied and 10 represents Extremely Satisfied how would you rate your level of overall satisfaction N A 61 62 63 4 6 67 9 10 T If Applicable On a scale of 1 to 10 where 1 represents Extremely Dissatisfied and 10 represents Extremely Satisfied how would you rate your level of overall satisfaction with Patient Ally Customer Service 1 2 54 5 26 67 O8 29 2 10 31 Page Contact Us info patientally com 888 747 4255 6 BLOOD SUGAR LOG Keep track of your Blood Sugar levels in your Patient Ally account First you will need to enter in your Blood Sugar Target Ranges Then click ADD LOG ENTRY to enter in levels for the day you are recording Click ADD when finished Blood Sugar Log My target blood sugar ranges are Belongs to Before meals mg dL from 100 Healthcare Professional Before meals mg dL to 100 Phone After meals mg dL from 100 My A1c Level is 100 After meals mg dL to 100 My A1c Goal is 100 Save Target Values Blood Sugar Log Entry x Date Bi eg mm adwyy Add Log Entry Time of Day Blood Sugar Insulin Dose Breakfast Mid Morning Lunch Mid Afternoon Evening Bedtime 2 3 AM Comments Patient Ally works best with the following systems PC Windows 7 Windows Vista or Windows XP
35. mmunicate online This tool Member Login helps eliminate the paperwork and telephone time it typically takes for daily tasks such as scheduling appointments filling out provider intake forms requesting refills and more When Blue Shield members use the tool they can securely access their medical profile anytime anywhere and engage their provider online All of this can be accomplished when wp convenient for Blue Shield members and their providers Password Not yet registered Register to create a username and password Forgot Password Forgot Username Are you a provider Get more information Questions comments or suggestions Contact Patient Ally If you cannot remember your Password click the FORGOT PASSWORD link Members Login Username Password Log In orgot Username Step 1 You will be prompted to enter in your email This email needs to match what you already have on file with Patient Ally Forgot Your Password Enter your Email to receive your password Email Step 2 Next you will be prompted to answer your Security Question In order to confirm your identity please answer the following security question Upon successful entry you will be sent a link to set up a new password via email to youremail address com Security Question In what city were you born Answer Step 3 After answering your Security Question you will be sent an email containing a link to crea
36. n the ADD NEW PROVIDER button An example of the Add Providers screen is displayed below Patients may add a Provider not in the Patient Ally Network Keep in mind that manually added Providers are for recording purposes only and are excluded from electronic communications Providers Add Providers To find your Provider in the Patient Ally Network fill in the fields below Note At least one field is required to search If you are unable to locate your Provider in the Patient Ally Network Click Here to add a Provider manually Note Manually added Providers are for recording purposes only and are excluded from electronic communications Providers added from the Patient Ally Network will receive a request to be linked message Once your Provider has confirmed your request to be linked you will receive a confirmation message in your Patient Ally inbox Note You will not be able to communicate with your Provider until they confirm your request City Name State AL Zip Code Last Name First Name 33 Page Contact Us info patientally com 888 747 4255 Question What I do if can t remember my Username or Password Answer If you cannot remember your Username or Password click the FORGOT PASSWORD or FORGOT USERNAME link displayed on the Login screen You will be emailed either a link to create a new Password or an email containing your Username Username Password Question What do do if locke
37. nt Ally is part of Office Ally an accredited EHNAC organization d EHNAC represents a wide range of stakeholders in its peer FLU cov Keep track of your medical records for free Schedule cancel change appointments with your physicians s online Communicate with your physicians s online Know what to do Request medication prescription refills about the flu Store medical documents driven effort to advance healthcare through electronic EHNAC transaction standards To learn more visit the EHNAC site Request View Lab Results VISIT FLU GOV SHARE THIS WIDGET ACCREDITED HNAP EHN This web site is best viewed with Internet Explorer 7 or Mozilla FireFox 3 and above Home Terms and Conditions Privacy Contact Us Copyright 2012 Patient Ally All Rights Reserved Server 86075 WEBO2 9 Page Contact Us info patientally com 888 747 4255 If you cannot remember your Username please click on the FORGOT USERNAME link Username Password Forgot Password Forgot Username Step 1 You will be prompted to enter in your email This email needs to match what you already have on file with Patient Ally Enter the email address below that you used to create your account on Patient Ally Your user name will be sent to this email address If you have forgotten both your user name and email address associated with Patient Ally please contact us at 666 575 4120 Email Step 2 Next you will be promp
38. o patientally com 888 747 4255 You will receive 2 notifications when your Provider has confirmed your appointment One notification will be sent to the email address you have on file in Patient Ally The second notification will be a new message in your Patient Ally Inbox If you need to reschedule or cancel an appointment click RESCHEDULE or CANCEL next to your upcoming appointment Reschedule Cancel Friday August 24 2012 at 8 00 00 AM with Provider Megan Charette at Charette Medical Group If you are requesting to reschedule an appointment the Appointment Calendar will pop up for you to select a new day and time Select your new appointment update your request Contact Number Heason for Visit or comments and then click OK when finished If you are requesting to cancel you will receive a pop up with your option to add a Contact Number and Comments Click OK when finished Reschedule an Appointment Original Appointment 8 24 2012 at 8 00 00 AM with Megan Charette at Charette Medical Group New Appointment Date 8 24 2012 10 00 00 AM with Megan Charette Charette Medical Group Contact Number 1 Cancel an Appointment You are requesting xl appointment on 8 24 2012 8 00 00 AM with Megan Charette Charette Medical Group Contact Number Reason for Visit Blood Test Comments Comments l Cancel DOCUMENT CENTER You can view differ
39. office The information you enter in this eVisit is confidential and housed in a secure POSSSIBILITY AHEAD OF TIME format This information will be delivered directly to your provider s office and routed to your provider After you complete this eVisit a provider or nurse will respond to you via your Patient Ally account IN ACCORDANCE WITH THE ABOVE UNDERSTANDING I AGREE TO RELEASE Patient Ally AND ANY OF ITS RELATED ENTITIES PARTIES FROM ANY AND ALL LIABILITY ASSOCIATED WITH OR ARISING FROM THE PHYSICIAN CONSULTATION OR FROM THE Note It is your responsibility to know if your health insurance covers eVisits and your financial responsibility for MEDICAL PHYSICAL BEHAVIORAL OR OTHER EFFECTS OF ANY MEDICATION THAT MAY BE ORDERED PRESCRIBED OR this service If your insurance does not cover the service you will be billed the enti 30 by the provider office PURCHASED AS A RESULT OF THE PHYSICIAN CONSULTATION Office Ally LLC Patient Ally LLC will charge a service fee of 15 00 for any check returned by your bank as NSF or Stopped Payment IF ANY PROVISION OF THIS ABOVE AGREEMENT IS HELD TO BE VOID UNENFORCEABLE OR ILLEGAL THEN I AGREE THAT E T THE AGREEMENT WILL BE CHANGED OR LIMITED ONLY TO THE EXTENT NECESSARY TO ENABLE THE REMAINING Waiver of Liability and Informed Consent to Release Medical Records FEE PROVISIONS TO BE OF FULL FORCE AND EFFECT I understand and agree that Iam using this tool because I have an existing and proper pa
40. ord z Forgot Password Forgot Username Sign Up Now to get started Blue Shield Member Visit our Blue Shield Patient Ally Site gt Keep track of your medical records for free L U G OV Patient Ally is part of Office Ally an accredited EHNAC Schedule cancel change appointments with your physicians s online organization Communicate with your physicians s online Know what to do Complete all fields on the registration form You will need to create your own Username with minimum of 6 characters aloha numeric Enter in your Email Address First and Last Name Date of Birth mm dd yyyy Gender Captcha alpha numeric code and then check that you have read the Terms of Use and Agreement Once you have completed the form click CREATE ACCOUNT Note All fields are required Username min 6 characters Email First Name Last Name Date of Birth ES eg mm dd yyyy Gender Male Enter the code shown have thoroughly read and accept the Terms of Use and Agreement Create Account You will be sent a separate email from info patientally com to complete your registration If you do not receive this email please contact Patient Ally Once you receive the email example below click the HERE link or copy and paste the web address provided From info patientally com mailto info patientally com Sent To Subject Patient Ally Registration Confirma
41. ovider is displayed click the SELECT button next to their name Add Providers communications City Name State WA 5 Zip Code Last Name cha First Name providers that match your search criteria 16703 SE Mill Plain Blvd Vancouver WA 98684 Select J Megan Charette Providers To find your Provider in the Patient Ally Network fill in the fields below Note At least one field is required to search If you are unable to locate your Provider in the Patient Ally Network Click Here to add a Provider manually Note Manually added Providers are for recording purposes only and are excluded from electronic Providers added from the Patient Ally Network will receive a request to be linked message Once your Provider has confirmed your request to be linked you will receive a confirmation message in your Patient Ally inbox Note You will not be able to communicate with your Provider until they confirm your request Address Contact 866 575 4120 Specialty Family Practice You will be prompted to add the Patient Security Code that you should have received via email example of email below After entering the code click SUBMIT to proceed If you do not have a Patient Security Code please contact your Provider directly Note Itis recommended to copy and paste the Patient Security Code from your email instead of attempting to re type it Megan Charette wants you to
42. r Date of Birth mm dd yyyy and then create your Password and Security Question and Answer The Password needs to contain a minimum of 8 characters You must have at least 3 of the 4 requirements in your Password Uppercase Letter A through Z Lowercase Letter a through z Number 0 9 Punctuation or Character 95 amp lt gt Complete Registration System requirements for a valid password 1 Contains 8 characters or more 2 Contains characters from three of the following four character classes English uppercase characters A through Z English lowercase characters a through z Numeric i e 0 9 Punctuation and other characters e g amp lt gt User Name Date of Birth Lal New Password Confirm New Password Security Question In what city were you born Complete Registration When you have finished click COMPLETE REGISTRATION You will receive a confirmation message when you have successfully created your Patient Ally account Next you should automatically be directed to the Patient Ally Homepage If you are not automatically directed click on the link provided to be brought to the Homepage where you can log into your Patient Ally account Security Answer Congratulations Y ou have completed registration with PatientAlly Y ou will be redirected to the login page in a few seconds If you are not redirected please click here to go to the Patient Ally login page
43. rd Party Providers and are the copyrighted work of Patient Ally and or its Third Party Providers Except as stated herein none of the Materials may be copied reproduced distributed republished downloaded displayed posted or transmitted in any form or by any means including but not limited to electronic mechanical photocopying recording or other means without the prior express written permission of Patient Ally or the Third Party Provider Also you may not mirror any Materials contained on this Web Site on any other server without Patient Ally s prior express written permission Except where expressly provided otherwise by Patient Ally nothing on this Web Site shall be construed to confer any license under any of Patient Ally s or any Third Party Provider s intellectual property rights whether by estoppel implication or otherwise You acknowledge sole responsibility for obtaining any such licenses See the Legal Contact Information below if you have any questions about obtaining such licenses Materials provided by Third Party Providers have not been independently reviewed tested certified or authenticated in whole or in part by Patient Ally Patient Ally does not provide sell license or lease any of the Materials other than those specifically identified as being provided by Patient Ally Patient Ally hereby grants you permission to display copy distribute and download Patient Ally s Materials on this Web Site provided that 1
44. s if you have any questions or suggestions please use ou Feedback Form Form 1 5 MALADE Add a Family Member Submit Health Forms Please fill out our Survey here Patient Patient Ally Survey Survey 2 Make an Appointment 6 e Request Prescription Refills You have 2 unread messages Monday September 17 2012 at 10 00 00 AM with Provider Megan Charette at Charette Medical Group eschedule Cance You have filled out 46 of your Patient Demographics Don t remind me again Monday September 24 2012 at 10 00 00 AM with Provider Megan Charette at Charette Medical Group Reschedule Cancel Monday October 1 2012 at 10 00 00 AM with Provider Megan Charette at Charette Medical Group Monday October 8 2012 at 10 00 00 AM with Provider Megan Charette at Charette Medical Group Monday October 15 2012 at 10 00 00 AM with Provider Megan Charette at Charette Medical Group Monday October 22 2012 at 10 00 00 AM with Provider Megan Charette at Charette Medical Group Monday October 29 2012 at 10 00 00 AM with Provider Megan Charette at Charette Medical Group Reschedule Cancel Reschedule Cancel Reschedule Cancel Reschedule Cancel Reschedule Cancel From Home you can use quick links to access certain parts of your Patient Ally account Feedback Form Can send suggestions comments or questions regarding Patient Ally Patient Ally Survey Can complete a shor
45. stration utilizing Patient Ally s secure state of the art software Schedule appointments order prescription refills maintain health records for your entire family even communicate online with your provider Password Forgot Password Forgot Username Sign Up Now to get started Blue Shield Member Visit our Blue Shield Patient Ally Site PSTN Now 5 Page Contact Us info patientally com 888 747 4255 From the Blue Shield of California page click REGISTER to get started blue amp of california Welcome Blue Shield of California Providers and Members Blue Shield and Offic are offering this easy to use secure web based pat paperwork and telep it typically takes for daily tasks such as schedulir securely access thair ical profile anytime anywhere and engage their provic Not yet registeret Register amp reate a username and password Are you a provider Get more information Questions comments or suggestions Contact Patient Ally Complete all fields on the registration form You will need to create your own Username with a minimum of 6 characters aloha numeric Enter in your Email Address First and Last Name Date of Birth mm dd yyyy Gender Captcha alpha numeric code and then check that you have read the Terms of Use and Agreement Once you have completed the form click CREATE ACCOUNT Note All fields are required Username amp charact
46. sured Secondary Insurance Ins Name Group No Patient Relationship To Primary Insured Subscriber ID Plan Name Note If Other than Self Please Fill out Primary Insured Section Subscriber ID Plan Name e Note If Other than Self Please Fill out Secondary Insured Section Pharmacies You can add your Pharmacies by clicking on ADD NEW Enter Pharmacy information and click UPDATE Insurance Pharmacies Forms Visit Summary Pharmacies Prospect Data Add Pharmacy Add Pharmacy Pharmacies Name Address State Phone Number Fax Number x Update Cancel Contact Us info atientally com 888 747 4255 Pharmacy Type Zip 12 Page Forms You can populate Medications Allergies and History as well as have access to any Intake Documents your Provider has made available Adding Medications Click ADD You will get a pop up to search for your medication ELLE ETIAM When you start typing in the Search bar you will receive a list of suggestions for medications Select your medication and then click ADD Medications Add Item Cancel ADVIL MULTI SYMPTOM COLD Advil Multi Symptom Cold BENYLIN MULTI SYMPTOM Benylin Multi Symptom BENYLIN MULTI SYMPTOM COUGH Benylin Multi Symptom Cough CHILD TYLENOL COLD MULTI SYMPTOM PLUS COUGH Child Tylenol Cold Multi S
47. t survey to let us know how Patient Ally is working for you Reminders Can see reminders for Messages Appointments as well as a reminder to complete your Profile Update Personal Information Can add to and edit your Patient Profile Add Family Member Can add additional family members to Patient Ally Note Patient information is kept separate but only one login is needed for all family members and you can change between profiles Make an Appointment Can request to schedule reschedule and cancel appointments Send Provider Messages Can view and compose messages to your Provider 8 Submit Health Forms Can send information to your Provider such as Allergies Family History Immunizations Medical History Social History and Surgical History 9 Request Prescription Refills Can request refills for medications your Provider has prescribed 10 Upcoming Appointments Can view all upcoming appointments You can also choose to reschedule or cancel an existing appointment oS IY oO Current Profile v Messages 1 e eVisits 0 e e Log Out PatientAlly Profile Healthcare Requests Test Results My Providers Resources Patient Profile cl Jome My Family F3 Welcome Add Family Member ES Print Medical History E Located above is the navigation menu Using this menu you can reach each individual page Below are quick links to some of the more commonly used features Thanks for using Pati
48. te your new Password Please allow up to 15 minutes to receive this email An email has been sent to the email address that you have provided Depending on your internet service provider it may take up to 15 minutes to receive Once received please follow the instructions in the email to reset your password Once you receive the email example below click the HERE link or copy and paste the web address provided This link is only good for 72 hours after receipt If it has expired you will need to repeat steps 1 3 under Forgot Password Page 8 From info gPatientAlly com To Cc Subject Patient Ally Password Recovery You are receiving this email because you have forgotten your password To reset your password gm link is only good for 72 hours s www patientallv com PasswordR ecoverv aspx If you are not able to click on the link above copy the following h user 3d5fS8ec0fce3489185870d80c57bb92f amp fp ves and paste into your browsers address bar If you have any questions email us at info patientally com or call us at 888 PHR 4ALL Thanks and welcome aboard the Patient Ally Community The Patient Ally Team 8 Page Contact Us info patientally com 888 747 4255 The link will bring you to Patient Ally where you will create your new Password The Password needs to contain a minimum of 8 characters Note Your new password cannot be any of the previous 3 passwords You must have at least 3 of the 4 requirements in
49. ted to answer your Security Question In order to confirm your identity please answer the following security question Upon successful entry your user name will be sent via email to youremail address com security Question In what city were you born Answer Step 3 After answering your Security Question you will be sent an email containing your Username Please allow up to 15 minutes to receive this email Your user name has been sent to the email address that you have provided Depending on your internet service provider it may take up to 15 minutes to receive Once received please log into Patient Ally using the user name that was sent to you Continue Once you receive the email containing your Username example below you can click on the attached link to direct you to the Login screen where you can now log in Example From info PatentAlly com To Cc Subject Patient Ally UserName Recovery 10 Page Contact Us info patientally com 888 747 4255 Once you have logged in you will be on the Home screen of your account te A Current Profile Pat entA I Messages 2 e eVisits 0 e e Log Out Profile Healthcare Requests Test Results My Providers Resources Welcome Located above is the navigation menu Using this menu you can reach each individual page Below are quick links to some of the more commonly used features Thanks for using Patient Ally Your membership is important to u
50. tient physician relationship with the physician healthcare team My Physician team My Physician team uses their independent medical judgment to develop my treatment plan No one directs controls or influences the treatment decisions made by My Physician team with respect to my care or my request and only My Physician team is liable for any negligent act or omission of My Physician team Agree Not Agree My medical record becomes the property of my physician team and it will reside on the Patient Ally server I understand N 20 Page Contact Us info patientally com 888 747 4255 Next a list of reasons for the eVisit will be displayed Scroll through to find your reason If you do not see a reason close to your symptoms manually type in your reason Click NEXT to proceed Examples of what the questions will look like are listed below eVisit Messages Create New eVisits Please answer the following question Cancel Do you have a cough Enter the Reason for Your Visit Please select the reason for your visit from the list below Abdominal or Stomach Pain Adult Routine Medical Exam Chest Pain Child Medical Exam Cough m OR enter the reason for your visit e g cough headache chest pain depression Help Skip this question Please answer the following question How long have you had a cough Between 3 weeks and 2 months Between 2 months and 1
51. tion Congratulations You have successfully created a new account with Patient Ally To finish your registration please Yis link is only good for 72 hours If you are not able to click on the link above copy the following https www patientally com CompleteRegistration aspx user a 016206e 1061 40c2 S9ea d0fd1d322aae amp r yes and paste into your browsers address bar If you have any questions email us at info patientally com or call us at 888 PHR 4ALL Click here to print the full instructions or go to www patientally com Help aspx and download the Registration Instructions Thanks and welcome aboard the Patient Ally Community The Patient Ally Team 4 Page Contact Us info patientally com 888 747 4255 The link will bring you to Patient Ally where you will create your own Password You will need to confirm the Username you created your Date of Birth mm dd yyyy and then create your Password and Security Question and Answer The Password needs to contain a minimum of 8 characters You must have at least 3 of the 4 requirements in your Password Uppercase Letter A through Z Lowercase Letter a through z Number 0 9 Punctuation or Character amp lt gt Complete Registration System requirements for a valid password 1 Contains 8 characters or more 2 Contains characters from three of the following four character classes English uppercase characters A through Z English lowerc
52. to you To view your vitals click on the PROVIDER SUMMARY link Any vitals that your Provider has sent to you will be displayed User Vitals Summary Systolic Blood Pressure Provider Ideal 100 90 Provider Summary deal Life Summa Id poo g 203545 Example of Provider Summary Systolic Blood Pressure 154 140 Ideal Life Summary User Summary Your Systolic Blood Pressure has f increased by 0 mmHg since your last reading Your Average Systolic Blood Pressure has decreased by 20 mmHg during this period Your Most Recent Systolic Blood Pressure reading is normal at 120 mmHg poo g 2104545 View Details Diastolic Blood Pressure I Em Ideal User Ideal Life Summary User Summary Your Diastolic Blood Pressure has t increased by 0 mmHg since your last reading Your Average Diastolic Blood Pressure has decreased by 13 8 mmHg during this period Your Most Recent Diastolic Blood Pressure reading is normal at 70 mmHg poo g 21075810 View Details 8 15 8 7 8 6 25 717 712 711 a5 7 3 6 29 26 Page Contact Us info patientally com 888 747 4255 3 ADD OR EDIT VITALS Add and keep track of your own vital signs in Patient Ally To add your vitals click ADD NEW a Go back to Vitals Summary Add new l 0725737277 77 Select Unselect All Weight kg Height cm BMI Systolic BP Diastolic BP HDL LDL Tri Heart Rate Respirate 1 1 1900 2 41
53. ub Can ums oru enter amy additional comments you have and click Next Cancel Interview Complete You have finished your questionnaire Click Next to continue Search Provider Created Date 8 8 2012 1 57 32 PM Reason For Visit Message Type Reason for visit Message from provider Message from patient 21 Page Contact Us info patientally com 888 747 4255 You will now be prompted to pay for the eVisit either by Credit Card or Check It will also specify your Providers charge for the eVisit Select your method of payment and click NEXT eVisit Messages Create New eVisits Back to messages Per the eVisit Terms and Conditions your provider charged 30 Jor each eVisit To view your provider s response please choose a payment method O Checks Regardless of payment method some of your demographics will automatically populate if the information has been saved in your Patient Ally account Name Adaress City State and Zip Enter your Account Routing Number if you are paying by Check or enter in your Card Number CCV Code and Expiration Date if you are paying by Credit Card Click NEXT to verify and complete payment Checking Transaction credit Card Transaction Card Transaction Checking Transaction Required Fleis Credit Card Transaction Required Fields Name John Doe Addr
54. use Patient Ally info patientally com to me 4 15 PM 32 minutes ago Hello Your request to add Megan Charette As a Patient Ally Provider has been approved Your Patient Security Code is Please visit http locate your provider Search for Megan Charette and when prompted enter the patient security code above If you have any questions please e ail us at info patientally com or call us at 888 PHR 4ALL Please enter your Patient Security Code If you do not have a Patient Security Code please contact your Provider to obtain one Once your Patient Security Code has been validated you will be able to retrieve intake forms Patient Security Code To add a provider you must have read and agree to the following terms Patient Ally Legal Terms and Notices Welcome to the Patient Ally web site Please review the following terms and conditions concerning your use of the Web Site By accessing using or downloading any materials from the Web Site you agree to follow and be bound by these terms and conditions the Terms If you do not agree with these Terms please do not use this Web Site GENERAL USE PROVISIONS All materials provided on this Web Site including but not limited to information documents products logos graphics sounds images software and services Materials are provided either by Patient Ally or by their respective third party manufacturers authors developers and vendors Thi
55. ver State WA Tir PETETA Hame Phone 350 666 6666 Work Phone 360 666 6656 Cell Phone 360 Primary Insurance Ins Name Subscriber ID Patient Relationship To Primary Insured Self Secondary Insurance Ins Name Subscriber ID Patient Relationship To Primary Insured Self Walgreens 123 Now Vancouver WA 95683 360 8RR RRER 360 777 TTTI Primary 16 Page Contact Us 5 SETTINGS Allows you to change your Password Email or Security Question and Answer Password Change Password Email Address Change Email Address mcdemo4 oa com Security Question and Answer Change Security Question and Answer Change Password Click on the CHANGE PASSWORD link Enter your current Password and click UPDATE You will need to follow the system requirements for changing your Password to avoid receiving an error Click UPDATE to save Password System requirements for a valid password 1 Contains 8 characters or more 2 Contains characters from three of the following four character classes English uppercase characters A through Z English lowercase characters a through z Numeric i e 0 9 Punctuation and other characters e g amp lt gt 3 New password can not be any of the previous 3 passwords Password Verification Enter Current Password to Proceed Security Question In what city were you born Security Answer Current Password New Password Updat E Canc
56. vider as well as view eVisits that your Provider has already responded to eVisit Messages Create New eVisits Search Provider Name Starts With gt Reason For Visit Created Date well child 8 8 2012 1 57 32 PM 6 11 2012 2 11 16 PM Message Type X Reason for visit Message from provider Message from patient To start a new eVisit click the CREATE NEW EVISITS tab You will see your Provider displayed if they accept Visits Click START CONSULTATION eVisit Messages Create New eVisits Provider Start Consultation Megan Charette PM EHR 16703 SE Mill Plain Blvd Vancouver WA 98684 Family Practice Next select what type of Insurance you have If you a Blue Shield of California Member click BLUE SHIELD OF CALIFORNIA It will automatically check eligibility for you before you proceed For all other patients click PRIVATE PAY eVisit Messages Create New eVisits Cancel Select Provider Select insurance type Blue Shield of California Private Pay After you have selected Private Pay you will receive a Terms and Conditions Agreement that you will want to review regarding your eVisit You will see the fee your Provider is charging in 2 places Scroll through the agreement and check the box indicating you have read and agree to the terms then click AGREE to proceed Terms and Conditions Terms and Conditions OF ALL INFORMATION ITEMS AND SER
57. y to use these features If there isa No next to any options your Provider has not enabled these features at this time Providers 0 00 00000000000 Provider Information Network PM EHR Last Name Charette First Name Megan Middle Name Specialty Family Practice Contact Information 16703 SE Mill Plain Blvd Address Vancouver WA 96684 City Vancouver State Zip 98684 Phone 866 575 4120 Share Vitals Yes Share Labs Yes Allow eVisit Yes Allow Appointments Yes Share Chart Information Yes 2 SUBMIT HEALTH FORMS Another section for you to send your Allergy History and Immunization information to your Provider Click ADD CHANGE RECIPIENT or click ADDRESS BOOK select your Provider and then click SELECT CHECKED Entering in a Contact Number Subject and Message is optional Check the boxes for the information you would like to send to your Provider Allergies Immunizations and History Once you are done selecting click SEND Messages Save Draft To Add Change Recipients From Contact Number Subject Attachments Add Attachments 29 Page Contact Us info patientally com 888 747 4255 Current Profile Messa 1 e eVisits 0 e e Log Out PatientAlly Home Profile Healthcare Requests Test Results My Providers Resources News Updates Feedback Welcome Located above is the navigation menu Using 5 links to some of the more commonly used fea ach indivi
58. year More than 1 year Once you have completed the questionnaire you will be able to review all of your answers and change any if needed When you are satisfied with your answers click SAVE ANSWERS at the bottom of the page LO you smoke cigarettes Skip this question EE E PE ME ee EAA Erker gee headaches severe or unbearable Skip this question z Review Your Answers Da yau have a cough Hoe ku hene you had a omg Sop a ves had a cold flu er cough within Ie Least month Tab seres b impasse aea Een vecrmen Tam Do you all duy long Drs pour cough sometimes maler you up at night TH Dos pour cough seem to occur in spasms oc episcdes of multiple coughs Tm When you cough are you bringing up any sputum or phlegm Prom deep in As part of your current illness do you have neck stiffness where you cannot bend your neck forward associated with your headache Yes z Do you have severe neck pain with difficulty touching your chin to your chest Skip this question PCIE UM M ORI EN Pd a c CMS NM Yes Rong itu NEUEN 20204 Skip this question x S HORE mU DE ee z Skip this question T Undo Changes If you would like to include any additional comments for your Provider to read add comments and click NEXT You have now completed your eVisit Click NEXT again to finish q
59. ymptom Plus Cough CHILDRENS MULTI SYMPTOM PLUS UGH Childrens Multi symptom Plus Cough Your medication has now been added successfully Repeat steps if you have additional medications pm EC Forms ETT Med icotions Decret ic Pul Dabe Aided View Edit Delete ova a o4 15 2012 DONE Em TET ERST TEES Social History miik heumen You will repeat the same steps to add your Allergies Surgical History Medical History Immunizations and Family History General Insurance Pharmacies Forms Visit Summary Prospect Data Medications Family Histo Social History Intake Documents 13 Page Contact Us info patientally com 888 747 4255 Social History Complete form by marking Yes No and checking off activities and food servings Click SAVE when finished Social History Social History E nits rtc veer Week E lod modd r 1Basketball Please answer the following F Aerobics Yes No Dancing Have you ever smoked cigarettes mw 7 Bicycling Currently do you smoke cigarettes V Golf Gardening Do you smoke cigars or a pipe m v Do you chew tobacco rj i F Horseback Riding r Running Jogging Do you use any recreational or other drugs that not prescribed by a doctor _15 5

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