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pdf Non-visible Questions and State Changes - Self-Query - Individual
Non-visible Questions
Label
PDF Name
(step)
Location
Response
Input Item
Visibility Trigger
Other
Organization Self-Query on Below Home
Name
an Individual and Work
(1)
radio buttons
for Type of
Address
Text Entry
The field is
displayed if the user
selects Work radio
button for Type of
Address.
Organization Self-Query on Below
Type
an Individual Organization
(1)
Name text
entry
Drop list
Organization Self-Query on Below
Description an Individual Organization
(1)
Type
Text Entry
The field is
displayed if the user
selects an
organization type
that requires a
description.
Specific
Name of
Occupation
Self-Query on Beside
an Individual Profession or
(1)
Field of
Licensure
Text Entry
The field is
displayed if the user
selects a profession
or field of licensure
that requires a
description.
“Specialty” is
displayed in place of
“Specific Name of
Occupation” if the
selected profession
or field of
licensure requires
specialty
information.
Specialty
Self-Query on Beside
an Individual Profession or
(1)
Field of
Licensure
Drop List
The field is
displayed if the user
selects a profession
or field of licensure
that requires
information for
specialty.
“Specific Name of
Occupation” is
displayed in place of
“Specialty” if the
selected profession
or field of licensure
does not require
information for
specialty.
DEA (Drug
Self-Query on Below
Enforcement an Individual checkbox "Do
Agency)
(1)
you have a
DEA, FEIN, or
UPIN
identification
number?"
Text Entry
Field is displayed if
user selects the
checkbox for "Do
you have a DEA,
FEIN, or UPIN
identification
number?"
Selecting the
checkbox displays
DEA, FEIN and UPIN
text entry fields.
FEIN (Federal Self-Query on Below DEA
Employer
an Individual text entry.
Identification (1)
Number)
Text Entry
The field is
displayed if the user
selects the
checkbox for "Do
you have a DEA,
FEIN, or UPIN
identification
number?"
Selecting the
checkbox displays
DEA, FEIN and UPIN
text entry fields.
UPIN
Self-Query on Below FEIN
(Unique
an Individual text entry
Physician
(1)
Identification
Numbers)
Text Entry
The field is
displayed if the user
selects the
checkbox for "Do
you have a DEA,
FEIN, or UPIN
identification
number?"
Selecting the
checkbox displays
DEA, FEIN and UPIN
text entry fields.
Mobile
Phone
Self-Query on Below
Text Entry
an Individual checkbox
(1)
"Send a sign-in
code by SMS
message if I
forget my
password"
The field is
displayed if the user
selects the
checkbox for "Send
a sign-in code by
SMS message if I
forget my
password"
Country
Self-Query on Below "Same Drop List
an Individual as delivery
(2)
address" and
"A different
address"
options for
Billing Address
The field is
displayed if the user
selects the radio
button "A different
address"
Selecting "A different
address" displays
Country, Address,
Address Line 2, City,
State and ZIP
entries. United
States is the default
selection.
Address
Self-Query on Below Country Text Entry
an Individual
(2)
The field is
displayed if the user
selects the radio
button "A different
address"
Selecting "A different
address" displays
Country, Address,
Address Line 2, City,
State and ZIP
entries.
Address Line Self-Query on Below Address Text Entry
2
an Individual
(2)
The field is
displayed if the user
selects the radio
button "A different
address"
Selecting "A different
address" displays
Country, Address,
Address Line 2, City,
State and ZIP
entries.
City
Self-Query on Below Address Text Entry
an Individual Line 2
(2)
The field is
displayed if the user
selects the radio
button "A different
address"
Selecting "A different
address" displays
Country, Address,
Address Line 2, City,
State and ZIP
entries.
State
Self-Query on Beside City
an Individual
(2)
Drop List
The field is
displayed if the user
selects the radio
button "A different
address"
Selecting "A different
address" displays
Country, Address,
Address Line 2, City,
State and ZIP
entries.
ZIP
Self-Query on Below State
an Individual
(2)
Text Entry
The field is
displayed if the user
selects the radio
button "A different
address"
Selecting "A different
address" displays
Country, Address,
Address Line 2, City,
State and ZIP
entries.
Experian
Questions
Self-Query on After Step (3) - Radio
an Individual Review
button
(4)
Information
Question and answer
content is
determined by
Experian. User will
be shown four
questions, at least
one of which
contains financial
information. The
questions are
customized based on
the user's
information. The
user may be shown
questions other than
those pictured in the
PDF.
State Changes
Label
PDF Name
Item Type
Trigger
Place a SelfQuery Order
Self-Query on an Modal
Individual
When user starts a Self-Query,
the modal is displayed.
Public Burden
Statement
Self-Query on an Modal
Individual
When the user selects the
Public Burden Statement link
the modal is displayed.
Confidentiality
Statement
Self-Query on an Modal
Individual
When the user selects the
Confidentiality link the modal is
displayed.
Select an
Self-Query on an Modal
Occupation or
Individual
Field of Licensure
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.
Other Name for
Occupation
Self-Query on an Text Entry
Individual
Text entry is disabled if the
user does not select a
profession or field of licensure
requiring a description.
License Number
Self-Query on an Text Entry
Individual
Text entry is disabled if the
user selects the "No/ Not sure"
option for "Do you have a
license for your selected
profession or field of
licensure?"
Password
Requirements
Self-Query on an Info box
Individual
When the user sets focus on
the "Create a new password"
text entry, the info box is
displayed. The state of each
rule changes to indicate
whether or the rule is met as
the user enters their text.
| File Type | application/pdf |
| File Modified | 2017-11-09 |
| File Created | 2017-09-06 |