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Do you require immediate assistance with OutSmart? You can reach us at:
Monday to Friday, from 8:00am to 8:00pm Eastern Standard Time.
Your Sharing PIN allows other practitioners using OutSmart to share their charts with you. Please keep this PIN private and only give it to other practitioners that you know.
This PIN will not allow anyone to access your account or your information. It simply allows them to identify you in the OutSmart Community, and safely share items with you.
You can provide your Sharing PIN to any practitioner that wants to share their charts with you.
Select a patient whose information is being requested through this form. You can then also further authorize other patients to fill up this form on their behalf.
Do you want the patient to fill out this form on a recurring basis? If so, please indicate details below:
*You can still manually repeat this form again from the Patient Submissions page.
Provide patient with repeat instructions:
Assign patients who are authorized to fill out this form. You may only assign people who are in your patient list. If the person you want to authorize is not in this list, you must first add them as a patient, and then return here to send the form. This section will only add assignments, not remove them - so patients authorizations cannot be revoked from here.
*Note: Smart Form codes are currently sent by e-mail. Assigned patients who do not have an e-mail on file will not receive any reminders or notifications of this form. The assigned patient will also not be able to fill the form without first creating a patient portal account. See here for instructions on how your patients can create a patient portal account.
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Select Document Attachments To Include:
Total Attachment Size: 0 KBReminders are currently not compatible with recurring events. In order to set reminders for an event, you must first save the event, and then edit the event to add reminders.
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Sending To:
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Message:
Additional Information:
You are about to cancel your appointment with at with the following reason:
Are you sure you want to continue?
You will receive an e-mail shortly confirming your cancellation.
No further action is required.
Please contact your clinic if you need to reschedule this appointment.
Current Inventory: 5
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