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Label
PDF Name
(step)
Location
Respons
e Input
Item
Visibility Trigger
Other
Organization
Description
Self-Query
Below
Text
on an
Organization Entry
Organization Type
(1)
The field is
displayed if the
user selects an
organization type
that requires a
description.
Country
Self-Query
on an
Organization
(1)
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
Below
on an
Country
Organization
(1)
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. United States is
the default selection.
Address Line
2
Self-Query
Below
on an
Address
Organization
(1)
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. United States is
the default selection.
City
Self-Query
Below
Text
on an
Address Line Entry
Organization 2
(1)
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.
Below "the
Drop List
location
address" and
"a different
address"
options for
Delivery
Address
State
Self-Query
Beside City
on an
Organization
(1)
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. United States is
the default selection.
ZIP
Self-Query
Below State
on an
Organization
(1)
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. United States is
the default selection.
MPN/MSN
(Medicare
Provider/Sup
plier Number)
Self-Query
on an
Organization
(1)
Text
Entry
The field is
displayed if the
user selects the
checkbox for "Do
you have a
MPN/MSN, FDA or
CLIA Identification
number?"
Selecting the checkbox
displays MPN/MSN,
FDA, and CLIA text entry
fields.
FDA (Federal Self-Query
Below
Food and
on an
MPN/MSN
Drug
Organization text entry.
Administratio (1)
n)
Text
Entry
The field is
displayed if the
user selects the
checkbox for "Do
you have a
MPN/MSN, FDA or
CLIA Identification
number?"
Selecting the checkbox
displays MPN/MSN,
FDA, and CLIA text entry
fields.
CLIA (Clinical Self-Query
Below FDA
Laboratory
on an
text entry
Improvement Organization
Act)
(1)
Text
Entry
The field is
displayed if the
user selects the
checkbox for "Do
you have a
MPN/MSN, FDA or
CLIA Identification
number?"
Selecting the checkbox
displays MPN/MSN,
FDA, and CLIA text entry
fields.
Below
checkbox
"Do you
have a DEA,
FEIN, or
UPIN
identificatio
n number?"
Mobile Phone Self-Query
on an
Organization
(1)
Below
Text
checkbox
Entry
"Send a signin 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 an
Organization
(2)
Below "the
Drop List
location
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
Below
on an
Country
Organization
(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.
Address Line
2
Self-Query
Below
on an
Address
Organization
(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.
City
Self-Query
Below
Text
on an
Address Line Entry
Organization 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
Beside City
on an
Organization
(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
Below State
on an
Organization
(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.
State Changes
Label
PDF Name
Item Type
Trigger
Place a Self-Query
Order
Self-Query on
an
Organization
Modal
When user starts a Self-Query, the modal
is displayed.
Public Burden
Statement
Self-Query on
an
Organization
Modal
When the user selects the Public Burden
Statement link the modal is displayed.
Confidentiality
Statement
Self-Query on
an
Organization
Modal
When the user selects the Confidentiality
link the modal is displayed.
Are you authorized Self-Query on
to act on behalf of an
the organization? Organization
Modal
When the user selects Organization for
"Which type of NPDB search do you
need?
License Number
Self-Query on
an
Organization
Text Entry
Text entry is disabled if the user selects
the "No/ Not sure" option for "Does your
organization have a license?"
Password
Requirements
Self-Query on
an
Organization
Info box
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 |