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pdf Non-visible Questions
Label
PDF Name
(step)
Location
Response
Input Item
Visibility Trigger
Other
Date of Death
Peer Review Below "Is this
Organization person
(1)
deceased?"
Text Entry The field is displayed
if the user selects
the "Yes" radio
button for "Is this
person deceased?"
Organization
Description
Peer Review Below
Organization Organization
(1)
Type
Text Entry The field is displayed
if the user selects an
organization type
that requires a
description.
Name of
Occupation
Peer Review Beside Profession Text entry The field is displayed
Organization or Field of
if the user selects a
(1)
Licensure
profession or field of
licensure that does
not require
information for a
specialty.
“Specialty” is
displayed in place
of “Name of
Occupation” if the
selected profession
or field of
licensure requires
specialty
information.
Specialty
Peer Review Beside Profession Drop List
Organization or Field of
(1)
Licensure
The field is displayed
if the user selects a
profession or field of
licensure that
requires information
for specialty.
“Name of
Occupation” is
displayed in place
of “Specialty” if the
selected profession
or field of licensure
does not require
information for a
specialty.
FEIN (Federal
Employer
Identification
Number)
Peer Review Below checkbox Text Entry
Organization "Does the subject
(1)
have an FEIN, or
UPIN
identification
number?"
The field is displayed
if the user selects
the checkbox
for "Does the subject
have an FEIN, or
UPIN identification
number?"
Selecting the
checkbox displays
FEIN and UPIN text
entry fields.
UPIN (Unique
Physician
Identification
Numbers)
Peer Review Below FEIN text
Organization entry
(1)
Text Entry The field is displayed
if the user selects
the checkbox for
"Does the subject
have an FEIN, or
UPIN identification
number?"
Selecting the
checkbox displays
FEIN and UPIN text
entry fields.
Type of
Affiliation
Peer Review Below "Is the
Organization practitioner
(1)
affiliated with a
health care
entity?"
checkbox
Drop List
The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries.
Entity Name
Peer Review Below Type of
Organization Affiliation
(1)
Text Entry The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries.
Country
Peer Review Below "Is the
Organization practitioner
(1)
affiliated with a
health care
entity?"
checkbox
Drop List
The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries. United
States is the default
selection.
Address
Peer Review Below Country
Organization
(1)
Text Entry The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries.
Address Line 2
Peer Review Below Address
Organization
(1)
Text Entry The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries.
City
Peer Review Below Address
Organization Line 2
(1)
Text Entry The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries.
State
Peer Review Below City
Organization
(1)
Drop List
The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries.
ZIP
Peer Review Below State
Organization
(1)
Text Entry The field is displayed
if the user selects
the "Is the
practitioner
affiliated with a
health care entity?"
checkbox.
Selecting the
checkbox displays
Type of Affiliation,
Entity Name,
Country, Address,
Address Line 2, City,
State, and ZIP
entries.
Description
Peer Review Below an a
Organization finding requiring
(2)
a description
Text Entry The field is displayed
if the user selects a
finding that requires
a description.
Description
Peer Review Below Basis of
Organization Finding(s)
(2)
Text Entry The field is displayed
if the user selects a
basis of finding that
requires a
description.
State Changes
Label
PDF Name
Item Type
Trigger
Public Burden
Statement
Peer Review
Organization
Modal
When the user selects the Public Burden Statement
link the modal is displayed.
Select a
Profession or
Field of
Licensure
Peer Review
Organization
Modal
When the user sets focus on the Profession or Field of
Licensure text entry, the modal to select a profession
is displayed and focus is set on the Search text
entry. The user can enter text in the Search text box
to find a specific profession or select a profession
from the list without searching. The modal is hidden
once the user selects a profession from the list. The
user's selection populates the Profession or Field of
Licensure text entry.
Name of
Occupation
Peer Review
Organization
Text Entry
Text entry is disabled if the user does not select a
profession or field of licensure requiring a
description.
License
Number
Peer Review
Organization
Text Entry
Text entry is disabled if the user selects the "No/ Not
sure" option for "Does the subject have a license for
the selected profession or field of licensure?"
Select a Basis
for Finding
Peer Review
Organization
Modal
When the user sets focus on the Basis for Finding(s)
text entry, the modal to select an act is displayed and
focus is set on the Search text entry. The user can
enter text in the Search text box to find a
specific finding or select an finding from the list
without searching. The modal is hidden once the user
selects a finding from the list. The user's selection
populates the Basis for Finding(s) text entry.
| File Type | application/pdf |
| File Modified | 2017-11-09 |
| File Created | 2017-09-12 |