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System Administrator Guide to the Criterions EHR

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Administrators Guide to The Criterions EHR

System Administrator Guide to the Criterions EHR

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Security While the Criterions EHR is a client/server based product with a browser based interface, some clients choose to allow access across public networks (i.e. the Internet) to provide remote access. While this increases level of functionality in some cases, this also presents security risks to your data, your practice, and ultimately, your patients. Criterions, LLC. formally requires all clients to adhere to security measures if attempting to access data across open networks.

Security of practice and patient information is the sole responsibility of the practice. Guidelines given below may or may not apply to any given practice and are for information purposes only. A system administrator should perform a vetting of client needs and make appropriate recommendations.

If you have questions or need assistance is configuring your network to meet security standards, please contact Criterions at 516.466.1942 or [email protected]

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Contents Security .................................................................................................................................................................................. 2 Overview ............................................................................................................................................................................... 5 Remote Access ................................................................................................................................................................ 5 1.0 - Windows Domain Authentication ............................................................................................................................ 5 Configuring Windows Authentication ...................................................................................................................... 6 2.0 - SSL ................................................................................................................................................................................ 20 IIS 6.0 ............................................................................................................................................................................. 20 Verify that SSL is working............................................................................................................................................ 30 4.0 - Password Transfer ...................................................................................................................................................... 32 5.0 – Power Supply ............................................................................................................................................................. 33 6.0 – Network/System Requirements .............................................................................................................................. 33 7.0 – HL7 – Electronic Lab Retrieval ................................................................................................................................ 36 8.0 – Electronic Billing ........................................................................................................................................................ 36 9.0 – Peripherals – Printing, Scanning, Faxing, Email .................................................................................................... 37 Setting Up eRx Printing Alignment ............................................................................................................................... 37 10.0 – Updates to System.................................................................................................................................................. 41 TCMS ............................................................................................................................................................................. 41 EHR ................................................................................................................................................................................ 42 11.0 – Error Logs .................................................................................................................................................................. 44 Common System Error Messages ............................................................................................................................ 45 Navigation Errors......................................................................................................................................................... 46 12.0 – EHR User and Practice Setup................................................................................................................................ 49 13.0 – System Backup........................................................................................................................................................ 53 14.0 – Remote Support...................................................................................................................................................... 57 15.0 – User Setup, Rights, Passwords and Audits........................................................................................................... 60

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15.1 – Accessing Setup.................................................................................................................................................. 60 Create a User Group ..................................................................................................................................................... 61 Modify Existing User Accounts...................................................................................................................................... 69 Deactivate a User Account ......................................................................................................................................... 73 Passwords ........................................................................................................................................................................ 83 Admin Reset of Passwords............................................................................................................................................ 88 Administrative Unlocking of Accounts ....................................................................................................................... 95 Incorrect User Attempts .............................................................................................................................................. 101 Accessing Audit Logs .................................................................................................................................................. 104 Contact ............................................................................................................................................................................. 120

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Overview The following document contains guidelines a system administrator should adhere to when developing a network for a practice. These are security and network settings that provided a heightened level of security to data and systems while allowing access to authorized users. Note: This document contains guidelines for practices to follow. The client system administrator should perform a thorough vetting process to determine client needs and configure the system accordingly, complying with all regulations and security standards.

Remote Access If deemed acceptable by the systems administrator, the application can be made available over https via the internet. Client must authenticate themselves against the application using their secure login. If the server resides on a domain the network administrator may choose to require the user authenticate against the domain in addition to the application.

1.0 - Windows Domain Authentication Windows authentication without impersonation. This is the default setting. ASP.NET performs operations and accesses resources by using your application's process identity, which by default is the Network Service account on Windows Server 2003. URL authorization. You use URL authorization to control access to requested files and folders based on the request URL. You configure URL authorization by using an element in the Web.config file to control which users and groups of users should have access to requested resources. Authorization is based on the IPrincipal object stored in HttpContext.User. With Windows authentication, this object is of type WindowsPrincipal and it contains a WindowsIdentity object that holds the Windows token for the authenticated user.

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Note ASP.NET version 2.0 on Windows Server 2003 protects all files in a particular directory, even those not mapped to ASP.NET such as .html, .gif, and .jpg files.

Configuring Windows Authentication

To configure your application to use Integrated Windows authentication, you must use IIS Manager to configure your application's virtual directory security settings and you must configure the element in the Web.config file. To configure Windows authentication 1. Start Internet Information Services (IIS). 2. Right-click your application's virtual directory, and then click Properties. 3. Click the Directory Security tab. 4. Under Anonymous access and authentication control, click Edit. 5. Make sure the Anonymous access check box is not selected and that Integrated Windows authentication is the only selected check box. In your application's Web.config file or in the machine-level Web.config file, ensure that the authentication mode is set to Windows as shown here. Windows Server 2003 includes all the functionality customers expect from a mission critical Windows Server operating system, such as security, reliability, availability, and scalability. In addition, Microsoft has improved and extended the Windows server product family to enable organizations to experience the benefits of Microsoft .NET—a set of software for connecting information, people, systems, and devices. This tutorial will explain how to create a first domain controller(DC) in your network or company includes DNS server setup in windows server 2003 .You have to install DNS server for DC without DNS the client computers wouldn’t know which one is DC.You can host DNS on a different server than DC. Before Starting the DC installation process you need to make sure the following points •

You have installed Basic windows server 2003 installation



Make sure you have assigned a static ip address to your server

Now start DC and DNS Setup process 1. First you need to go to Start–>All Programs–>Administrative Tools–>Manage Your Server

Administrators Guide to The Criterions EHR

Here you need to select Add or remove a role.

2. Click Add or remove a role. Verify the following steps.

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Administrators Guide to The Criterions EHR 3. Click on Next

4. Select Server Role as Domain Controller option click on Next.

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Administrators Guide to The Criterions EHR

5. Summary of Your Selections click on Next.

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6. Active Directory Installation Wizard click on Next.

7. Click “Next” on the compatibility window.

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8. Next window select the default option of “Domain Controller for a new domain” and click “Next”.

9. In this tutorial we will create a domain in a new forest, because it is the first DC, so keep that option selected.

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Now we have to think of a name for our domain. If you have a domain like “criterions.com”, you can use it, but it isn’t suggested because computers inside of your domain may not be able to reach the company website. Active directory domains don’t need to be “real” domains like the one above - they can be anything you wish. Example: “internaldomain.int”.

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Now in order to keep things simple, we will use “windowsreferenc”, which is the default selection, as the NetBIOS name of the domain.

The next dialog suggests storing the AD database and log on separate hard disks and you can just leave the default settings.

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The SYSVOL folder is a public share, where things like .MSI software packages can be kept when you will distribute packages and you can just leave the default settings or you can change the path.

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Next Screen basically says that you will need a DNS server in order for everything to work the way we want it (i.e., our “windowsreference.int” to be reachable). Install the DNS server on this machine or if you want you can installed else where. 10. Select “Install and Configure…” and click Next.

11. Here you need to select the permissions for win 2000 or win 2003 server if you have any NT4 select first option otherwise select second option and click Next.

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The restore mode password is the single password that all administrators hope to never use, however they should also never forget it because this is the single password that might save a failed server. 12. Click Next.

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Now we will see a summary of what will happen. 13. Click Next.

Active directory installation process started this can take several minutes. It’s likely that you will be prompted for your Windows Server 2003 CD (for DNS) so have it handy.

14. Active directory Installation finish screen click Finish.

Administrators Guide to The Criterions EHR

15. Now you need to select “Restart Now” option to reboot your server.

After rebooting you can see new option for logon

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After logging in you can see similar to the following screen saying your server is now domain controller.

That’s it now your server is configured as domain controller and DNS server.

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2.0 - SSL Secure Socket Layer (SSL) is a protocol to provide security and data integrity across open networks. SSL functions by not only verifying the servers authenticity, but also verifying the authenticity of the requesting party. Using SSL requires a certificate to be purchased. Criterions, LLC will purchase and provide you with a certificate at your request. Client are to disable access over HTTP protocol forcing all transaction to take place over HTTPS secure protocol. SSL properties are managed by both MS IIS and Router properties. IIS 6.0

To configure SSL for your website on IIS 6.0 (running on Windows Server 2003) complete the following steps: Note: Although the screenshots are made with IIS 6.0 on Windows Server 2003, the same procedure applies for IIS 5.0 and IIS 5.1. 1. Click Start, point to All Programs, point to Administrative Tools, and then click Internet Information Services (IIS) Manager. 2. In Internet Services Manager, in the console tree, expand SERVERNAME (your local computer), and then expand Web Sites. 3. In the console tree, right-click Default Web Site, and then click Properties.

Note: It's possible that the site you've created was stored under a different virtual server. If your website is not stored within the Default Web Site, right-click your own web site and click Properties. Part 1: Preparing a Certificate Request Open the Internet Information Services (IIS) Manager (found in the Administrative Tools portion of the Control Panel).

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Select the Website you wish to generate the certificate for, in this case, we will be using the Default Website. Right click and select properties.

In the Default Web Site Properties window, select the ‘Directory Security’ tab and click on the ‘Server Certificate’ button to spawn the Web Server Certificate Wizard. Click ‘Next ‘ to advance beyond the introductory form:

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Select the first option ‘Create a new Certificate’ and click ‘Next’.

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Select the first option, to ‘Prepare the request now, but send it later’

It’s good practice to match the naming convention used in IIS, since we are working on the Default Web Site that is the name we will provide here. If your website is named differently in IIS, you may want to use that name. Leave the bit length at 1024 and leave the ‘Select cryptographic service provider (CSP) for this certificate blank. Click next to advance.

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Provide the name of your Organization and Organizational Unit and click next to advance to the next form.

Next we have to provide either a DNS name (if you have purchased a DNS for your site from a 3rd party retailer such as GoDaddy.com) or the machine name of the server if the application will be hosted over the local intranet. Once entered click on next to advance to the next form.

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Next we provide the Country, State, and Zip Code the server will be residing in, then click ‘Next’.

Last, we indicate where to save the certificate request.

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We now verify that the information entered is correct, and click ‘Next’ to complete the certificate request.

At this point, the user is to submit their certificate request to a valid 3rd party vendor such as GoDaddy.com. They may choose to do this on their own, or submit their certificate request to Criterions who will take care of the processing for them. Part 2: Installing a Certificate At this point you should have prepared your Certificate Request, submitted it to the proper party, and have been returned your certificate file (*.ctr). Open the Internet Information Services (IIS) Manager (found in the Administrative Tools portion of the Control Panel).

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Select the Website you generated your certificate request for. Right click and select properties.

In the Default Web Site Properties window, select the ‘Directory Security’ tab and click on the ‘Server Certificate’ button to spawn the Web Server Certificate Wizard.

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This time, we will be processing the certificate, so select the first option and click next.

We now use the browse button to locate the certificate (*.cer)file, and click on the next button.

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We are then prompted to dictate which port should be used for SSL. By default this port is 443, your network administrator may have it configured differently. If you are unsure of which port to use, consult with your network administrator, or check the properties on your router if you have access. We are now prompted to review the properties tied to this certificate, by clicking the ‘Next’ button will officially install it.

Click on the ‘Finish’ button in the next form, and the certificate installation is complete.

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Verify that SSL is working

To test your new settings connect your open a browser and type your server's FQDN (or NetBIOS name, if on the LAN) in the address bar (for example: http://server200 for your Intranet, or http://www.kuku.co.il for the Internet). Since you still used HTTP (plain text http, using TCP port 80) you'll get the following error message:

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Now re-type the URL by using HTTPS instead of HTTP. You should be able to view your website. You'll receive a Security Alert window. Click Ok.

If configured correctly, you should be able to connect to your now SSL-protected website. To verify that you're using SSL try to find a small yellow lock icon on the browser lower right corner the lock icon. A Certificate window will open. Review the information that is entered into the certificate and click Ok.

. Double click

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Note: Make sure you renew your certificate a few weeks before it expires in order to prevent mishaps like this one: Expired SSL Website Certificate.

4.0 - Password Transfer All password transfer is handled using System.Security.Cryptography. The System.Security.Cryptography namespace provides cryptographic services, including secure encoding and decoding of data, as well as many other operations, such as hashing, random number generation, and message authentication.

For additional information please visit: http://msdn.microsoft.com/en-us/library/system.security.cryptography(vs.71).aspx http://www.faqs.org/rfcs/rfc1321.html

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5.0 – Power Supply Note: Client System Administrators should be authority regarding all hardware setup. Clients are advised to have power redundancy to prevent data loss in the even of power failure. Uninterrupted Power Supplies (UPS) should be provided at every station.

6.0 – Network/System Requirements Clients are responsible for the installation and upkeep of items related to hardware/malware prevention. We strongly recommend the use of proven Malware/Antivirus protection programs (such as Symantec Anti-Virus, McAfee Anti-Virus) on all server and client stations and schedule automated scans to run regularly.

To Properly run all functionality of the EHR each PC must have the following installed. Tablet SDK: http://www.microsoft.com/downloads/details.aspx?familyid=B46D4B83-A82140BC-AA85-C9EE3D6E9699&displaylang=en .Net 2.0: http://www.microsoft.com/downloads/details.aspx?FamilyID=0856EACB-43624B0D-8EDD-AAB15C5E04F5&displaylang=en Ajax 1.0: http://www.microsoft.com/downloads/details.aspx?FamilyID=ca9d90fa-e8c942e3-aa19-08e2c027f5d6&displaylang=en Adobe Reader: http://download.cnet.com/Adobe-Acrobat-Reader/30002378_4-10349804.html

Performance and security of Criterions products, as with any IT system, is contingent on many parts working effectively together. Below is a list of Benchmark settings and minimum requirements. Benchmark Performance: Using Windows 2008 on an Quad Core processor with 4Gb of RAM and 500Gb RAID 5 drive, on a HL switch with 20 ports, with 20 concurrent users, entering data, running the EHR and Practice management, running reports, most queries return back within 4 seconds.

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The system also has a number of minimum requirements that should be met.

6.1 - Client is required to get a high speed internet connection from a reputable ISP 6.2 - Must have a router or hub with enough connectivity to handle the desired number of connections. -router may include firewall -client may use windows firewall for added security 6.3 - Minimum hardware requirements for IIS and Oracle. 6.3.1 - For IIS Server: FOR WINDOWS 2003 • For an x86-based computer: •



One or more processors with a recommended minimum speed of 550 megahertz (MHz). The minimum supported speed is 133 MHz. A maximum of eight processors per computer is supported. Processors from the Intel Pentium/Celeron family, AMD K6/Athlon/Duron family, or compatible processors are recommended. 256 megabytes (MB) of RAM (recommended minimum). 128 MB is the minimum supported, and 32 gigabytes (GB) is the maximum supported. For computers with more than 4 GB of RAM, be sure to confirm hardware compatibility by clicking the appropriate link in Support resources.

• For an Itanium-based computer: • •

One or more processors with a minimum speed of 733 MHz. A maximum of eight processors per computer is supported. 1 GB of RAM minimum, 1024 GB (1 Terabyte) maximum. For computers with more than 4 GB of RAM, be sure to confirm hardware compatibility by clicking the appropriate link in Support resources.

• For an x64-based computer: • •

One or more processors with a minimum speed of 1.4 GHz. A maximum of eight processors per computer is supported. 1 GB of RAM minimum, 1024 GB (1 Terabyte) maximum. For computers with more than 4 GB of RAM, be sure to confirm hardware compatibility by clicking the appropriate link in Support resources. • A hard disk partition or volume with enough free space to accommodate the setup process. To ensure that you have flexibility in your later use of the operating system, we recommend that you allow considerably more space than the minimum required for running Setup, which is approximately 2 GB to 3 GB for x86-based versions of Windows Server 2003, and 4 GB for Itanium-based and x64based versions of Windows Server 2003. The larger amount of space is required if you are running

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Setup across a network instead of from a CD-ROM, or if you are installing on a FAT or FAT32 partition in the case of x86-based or x64-based versions of Windows Server 2003. (NTFS is the recommended file system for both x86-based and x64-based versions of Windows Server 2003. Itanium-based versions of Windows Server 2003 support only NTFS). In addition, a domain controller upgrade from Windows NT 4.0 could require much more space than other upgrades or installations, because the existing user accounts database can expand by as much as a factor of ten during the upgrade, as Active Directory functionality is added.

6.3.2 - FOR ORACLE 10G Database on a Windows Based Machine Oracle 10g PC Minimum Hardware Requirements:

Physical memory (RAM)

512 MB minimmum

Virtual memory

Double the amount of RAM

Temp disk space

Hard disk space 1.5 GB

Video adapter

256 colors

CPU Processor

200 MHz minimum

Oracle 10g Minimum Windows System Requirements:

Architecture

32 bit or 64 bit

Windows OS

- Windows NT Server 4.0 - Windows NT Server Enterprise Ed. 4.0 - Windows NTTerminal Server Edition with SP 6 - Windows 2000 with SP 1 or higher - Windows Server 2003 - Windows XP Professional

Network protocol

- TCP/IP - TCP/IP with SSL - Named Pipes

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Minimum Requirements are given only as a guideline by Criterions. System Administrators are responsible for determining client needs and required hardware/software to accomplish those needs. For more information, please contact 516.466.1942 or [email protected]

7.0 – HL7 – Electronic Lab Retrieval HL7, or Health Language 7, is one of several American National Standards Institute (ANSI) -accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven’s domain is clinical and administrative data. With your Criterions products you can receive lab results from major labs electronically that automatically populate a patient’s documents. With Criterions products, we do not ‘pull’ documents from the labs themselves or any other external source. To receive labs, practices must contact their labs to have the labs run their own local applications, per their specifications, to bring data into client local site. Criterions products will access information from the internal lab source.

Installation of lab systems and the security protocols associated with accessing outside information is the sole responsibility of the practice and their system administrators.

8.0 – Electronic Billing Electronic Billing is transmitted using the standards implemented by the carrier in question, or via a clearing house. If you choose to bill electronically, Criterions uses Emdeon for electronic billing. Emdeon provides a secured web service that is integrated into the Criterions billing system. Security is in compliance with Emdeon standars (see Emdeon_ITS_User_Guide_20081021x[1].pdf).

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Installation of lab systems and the security protocols associated with accessing outside information is the sole responsibility of the practice and their system administrators.

9.0 – Peripherals – Printing, Scanning, Faxing, Email The networking of Printers, Scanners and other devices is the responsibility of the practice. Printers and Scanner – Criterions only supports locally installed scanners (1 per station). Printers can be local or shared. Shared printers are installed on IIS server on a per-location basis using standard TCP/IP ports. Upon login to the system the user indicates whether or not they are currently inside the office, or working from a remote location. If they are inside the office, all printed reports are fed to a queue, which is managed by the application server, which will print to any designated device on their network. If they are outside the office, they may choose to print to devices local to their current location. There is no way to input information into the system directly through peripheral devices. Clients may choose to purchase one of the following fax solutions for transmission of documents via fax; EasyLink or Castelle Fax Server. Criterions EHR includes it own proprietary secure messaging system. This is for internal messaging only and does not connect to any mail server or outside systems. They system will neither accept nor send email to addresses outside of the practice’s EHR.

Setting Up eRx Printing Alignment Because eRx goes through internet explorer each computer must have its IE printer settings customized.

Administrators Guide to The Criterions EHR

Right Click on the internet explorer page.

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Select Print Preview.

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Select the Preferences icon.

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Make sure that the “Header” and “Footer” are blank. Make sure Margins are set to the above settings.

10.0 – Updates to System TCMS To update TCMS first access the “What’s New” icon to learn about the updates and requirements for a TCMS update. Next, Click Help-> Update TCMS.

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If you are currently on the latest version of TCMS the following error will appear:

If an update is available,

EHR Due to the potentially impact of an EHR upgrade on client operations, all EHR upgrades are managed by Criterions Implementation Specialists. Specialists are charged with determining impact, downtime (if applicable), scheduling, and notification to system administrators. Account Specialists are tasked with clearly conveying to clients to changes to system and processes, as well as any client requirements that may need to be met.

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The Criterions EHR has no Operating System (OS) prerequisites for patch installation. Clients are encouraged to maintain OS self-patches and all client systems should be set to Windows Auto Update to maintain currency of their systems.

To view available updates to your system, please visit www.criterions.com and use your client ID and password to login to the client website using the “login” link. Once you have determined that the patch is applicable to your operations and you would like to proceed, the following steps need to be taken. 1. Client contacts Criterions Account Specialist to request patch update. 2. Criterions Implementation Specialist will be assigned to your account. 3. Implementation Specialist determines patches to apply, impacted aspects of client system and required client steps to be taken (e.g. TCMS update, estimated downtime, user access, etc). While in most cases updates to the Criterions EHR will not result in any change of performance or usage of TCMS Practice Management, there are occasions where users will be required to exit both systems to complete a patch. In some cases, practices will be required to update their TCMS system prior to Criterions EHR updates. In these cases, please refer to the above TCMS update section for instructions on how to update your TCMS.

4. Account specialist is informed of the changes and the impact to the client. 5. Account specialist reviews impact with client and relays pertinent information a: Instruction manual excerpts given as necessary b: Client processes are reviewed as necessary c: Web-Demo or Live Instruction given as necessary d: System Administrator is informed of update information pertaining to client system 6. Patch Request Form is completed. 7. Patch update is scheduled. 8. Patch is performed at scheduled time. 9. Patch test script is executed by Criterions Implementation Specialist. 10. Client System Administrator is notified of patch completion.

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11. Client contact is notified by Account Specialist of patch installation and additional steps, if any, required for use of updated system. 12. Training via web or in-person is delivered, if necessary. 13. Patch release is closed. To contact your Account Supervisor, please call 516.466.1942 or email us at [email protected] Should any changes be made to the patch process, all clients will be informed by their Account Supervisor with updated protocols.

11.0 – Error Logs Through most of the Criterions systems errors are answered with a pop-up box that will give instructions regarding the steps required to Should you experience system errors, Criterions products record these errors in an Error Log located in TCMS under HELP -> ERROR LOG.

The Error Log will display.

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We document errors in a log accessible to the System Administrator from the application’s virtual directory. The Oracle error descriptions and error codes are listed in it, as well as internal error codes. For a complete listing of Oracle error code go to http://ora-code.com/ or http://www.oracle.com/pls/db92/db92.error_search. This information is used by Criterions developers to pinpoint application failures and provide resolutions.

The Error Log records the date, time, workstation, workstation information, and error information. Using this information, System Admins or Criterions staff can troubleshoot the problem. Common System Error Messages

Exception Message :

Code

“ '' is not a valid integer value.

connection lost contactProcess ID: 5216Session ID: 1627 Serial number:

ORA03135:

Meaning

Resolution

A null value was entered in a field that requires an integer.

Ensure all required fields have the required integer and save again

Connection to the server was lost.

Reinitiate session.

Administrators Guide to The Criterions EHR Exception Message :

Code

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Meaning

Resolution

You cannot access field data beyond Eof.

The query that was submitted has completed without finding any results.

Check what was sought and resubmit query.

List index out of bounds (-1).

The query that was submitted is looking for a value that is out of range.

Check query and submit again.

37278.

unique constraint (<>) violated.

ORA00001:

When entering a value into a Field, a user entered a code that already exists.

The system requires certain fields to be unique. Check the value is unique and reenter.

not connected to ORACLE.

ORA03114:

There is no connection to the oracle server.

Establish a connection to the server.

Error in File :Print job busyConnect.Retrieve .

Error:524 The print job could not be run.

Attempt print again. If error remains, logout of system

Not enough storage is available to process this command..

The computer has run out of memory.

Close other applications and attempt process again.

Field '<>' must have a value.

The field in the <> section must have a value before saving.

Enter value, attempt save again.

The values being inserted do not satisfy the named check constraint.

Do not insert values that violate the constraint.

The field requires a value.

Enter a valid value. Run process again.

check constraint (TCMS_DATA.CK_ALLOWED) violated

ORA02290:

cannot insert NULL into ORA("TCMS_DATA"."USERLOGIN"."USERID") 01400:

Navigation Errors User errors generate warning or error messages for the user to view with the required solution to resolve the conflict. They are stated in plain English and are pertinent to the screen the user is viewing. Error messages and warnings must have an acknowledgement by the user prior to any additional steps being taken. This acknowledgement is either a single option click to close the error message or a dual option choice that will direct additional actions. Some examples are listed below.

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User Errors and Warnings

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Location

Resolution

Phone Encounter

User must select a diagnosis before entering a new Rx.

Removing a visit will prompt a user to confirm the operation.

Vaccine

Vaccine

Vaccine

Complete the “Dose” field prior to saving

Complete the “Vaccine” field prior to saving

Complete the “Done by” field prior to saving.

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Location

Resolution

Advanced Directives

Complete the First Name field.

Advanced Directives

Enter a description of the directive.

Advanced Directives

Enter the patient’s last name.

Advanced Directives

Enter the status of the directive.

Allergy Search

The search criteria revealed no matches.

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Location

Resolution

Allergy Search

Before saving, select an allergy value.

Add Problem

Before saving select at least one problem.

Add past surgical history

When using custom procedures, enter the name.

12.0 – EHR User and Practice Setup The below list provides users with the location of administrative functions for configuring the EHR. For help configuring your system, please contact Criterions at 516.466.1942 or at [email protected]

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Test Configuration

Define the values and routing or internal and external labs, including Units, Specimens, and Containers.

Procedures

Define the results, configuration, instructions and location of procedures.

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Order Transmittal

Create settings for Medication, Test, and Procedure transmittal.

Plan

Define Instruction, Goals, and Problem and Rx DC reasons.

History

Create Allergy, Social History, and Family History settings.

Vitals Configuration

Define the units and ranges for vitals.

Immunization

Add disease type and doses for immunization.

Work Bench

Create templates and set defaults for HPI, ROS and Exam.

Patient Tracker

Setup rooms for placement and tracking of patient visit.

Print Management

Define printers and routing of print types.

Referrals

Create/Design referral orders and consultation letters.

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Health Maintenance

Create/Edit Health Maintenance Rules

System Alerts

Create/Edit System Alerts to be sent to all users.

User Security

Define EHR users and associations.

Visit Summary Config

Define File to be created at visit closure and if comments are required.

Patient Portal Config

Define what aspects should be accessible to patients through secure portal and create Alias text for easier understanding by patient.

ESB Config

Define if system should automatically create superbill.

E&M Config

Define override codes and modifiers.

Disease Management

Create categories and guidelines to display in disease management.

Intake Sheet Config

Define values to be used with Intake sheet.

Coumadin Sheet Config

Enable or disable coumadin tracking sheet.

Task Management

Define users to receive tasks and recalls.

Administrators Guide to The Criterions EHR 13.0 – System Backup

Backteria defaults to this Log screen. Here you will see a brief status: It will note if the backup was Good or Bad = Good = Bad

This portion of the Log screen will show you a more detailed view of the backup.

- 53 -

Administrators Guide to The Criterions EHR

- 54 -

This should only be checked if the TCMS database is on Oracle 8i.

This section denotes the current tasks that have been setup in Backteria

Name of backup task

This section is only used for TCMS Backups. TNS Name: refers to the TNSNAMES.ORA file for Oracle. It ensures that the system connects to the database. Tickler Users: Utilized to notify any selected user of

Keep backup copy: TCMS exports normally move from the source folder to the destination folder. When this feature is check, the exports are stored locally as well as on the destination

Source Folder: Source Location of desired files for backup.

Dest. Folder: Destination location of backup.

Administrators Guide to The Criterions EHR

- 55 -

The History tab allows users to see a full detailed view of the backup. By double clicking on any day, a log file (txt format) will open. Below is a detailed look at an example log file

Administrators Guide to The Criterions EHR

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Administrators Guide to The Criterions EHR

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TCMS Database (Linux / Windows Oracle) Server

Backup PC

USB (E:\)

TCMS shared data F:\data

Process of backup: 1. TCMS data from TCMS Database Server (Either Linux or Windows Server) is exported to the local drive (C:\) of the Backup PC – stored in C:\TCMSBACKUP. 2. Backup software (Backteria) then begins process of backing up data to the USB Hard Drive (E:\). 3. Shared Appliance (F:\Data) then begins backup to USB Device (Data backups are not recommended with Backteria. The software was designed initially for TCMS).

14.0 – Remote Support Should you require assistance from Criterions where it is necessary for Criterions staff to connect to a computer remotely, the connection is based on rights determined as secure by your system administrator. If your application is setup to be accessed over the internet using aforementioned protocols, the Criterions Staff may provide support by using an administrative level account present in all instances of the application. The client is encouraged to allow SSH access to their database for update purposes, we may also choose to host the application locally and pull the data from their site to assist in troubleshooting. Other support options include 3rd party utilities such as Symantec PcAnywhere or web based services such as GoToMeeting.

Administrators Guide to The Criterions EHR Remote Support protocols are left to the discretion of the client system administrators.

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Administrators Guide to The Criterions EHR

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Administrators Guide to The Criterions EHR

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15.0 – User Setup, Rights, Passwords and Audits 15.1 – Accessing Setup

1. Open the Criterions TCMS Practice Management System 2. Click File -> Setup (Figure 1). Note: A user must have administrative rights to access the Practice Management Setup.

The Practice Setup Options List will appear (Figure 2).

Figure 1

Administrators Guide to The Criterions EHR

- 61 -

Figure 2

Create a User Group

Administrators Guide to The Criterions EHR

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Before creating a user in the Criterions TCMS Practice Management System a Group should be created. Groups allow administrators to manage the rights of all users in the group without changing individual user profiles. A group can have any number of users as designated by the practice.

1. From the Setup menu, click Practice Setup (Figure 3). 2. Click User Setup. Figure 3

A list of active users will appear.

3. Click the User Groups tab.

Note: Adding a user without groups will allow for a user to be given two options for system rights: Administrator or No Rights.

Figure 4

Administrators Guide to The Criterions EHR

- 63 -

Figure 5

Administrators Guide to The Criterions EHR

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A list of any active groups will appear.

4. Click

.

5. Enter a GROUP NAME in the displayed Pop-Up. 6.

Click

Note: Group names should be easily identifiable and created with the understanding that all group members will have equivalent system rights.

Figure 6

Administrators Guide to The Criterions EHR

- 65 -

The added group names display in the left hand column.

7. Click on the GROUP NAME you would like to edit. In this example, a user has created groups labeled as Frontdesk, Nurse, and Physician.

Next, the user will give each group distinct rights and then place users into the groups.

Figure 7

Administrators Guide to The Criterions EHR

- 66 -

The system admin can choose what operations and access should be given to users of a particular group. If a group does not have an item selected they will not be able to perform the associated function.

8. Select the GROUP NAME and modify appropriate functions. 9. Click the USER tab.

Note: There is no save button on these screens. Once you click an option it is automatically added to that group profile.

Figure 8

Administrators Guide to The Criterions EHR 10.

Click

- 67 -

.

Figure 9

Administrators Guide to The Criterions EHR

- 68 -

The User Setup screen will appear.

11. Enter a LOGIN NAME for the user. 12. Enter the users FULL NAME. In the Group Rights list will show the two default settings, No Rights and Administrator, as well as the custom groups you have created. These Group Rights will be displayed for every location that the practice has setup. This allows users to have one set of rights at one location and another set of rights at another.

13. Select the GROUP RIGHTS for this user at each location. 14.

Click

The user has been created and given rights. Figure 10

Administrators Guide to The Criterions EHR

- 69 -

Modify Existing User Accounts Once a user account has been added it will display in the User list. Editing users consist of two parts. 1. Editing the User Groups they belong to 2. Editing the rights the Group has. In the first scenario we will edit the Groups to which a user belongs.

1. Double-Click on the name of the user you would like to edit.

Figure 11

Administrators Guide to The Criterions EHR

- 70 -

The user’s current user rights are displayed.

User Mark Greenleaf has become an administrator for the Main Office.

Figure 12

Administrators Guide to The Criterions EHR

- 71 -

2. Select the ADMINISTRATOR for the Main Office Location. 3. Click The user’s system rights will now reflect the settings for an administrator in the Main Office Location.

Figure 13

If a user needs a change in system rights there is an important distinction that must be made. Do the changes required for

Administrators Guide to The Criterions EHR the user apply to ALL members of the group they belong to.

- 72 Figure 14

In this scenario, we will edit the rights of the frontdesk group to allow all front desk members to scan insurance cards. 4. Click on the USER GROUPS tab. The added group names display in the left hand column.

5. Click on the GROUP NAME you would like to edit. In this example, we are editing the rights for the Frontdesk group.

A list of group rights displays.

Figure 15

Administrators Guide to The Criterions EHR

- 73 -

6. Scroll down to find the right you want to edit. In this scenario insurance card scanning rights are to be given to all members of the front desk group.

7. Check the box before “Scan Patient Insurance Card.”

All users across all locations who are given Frontdesk group rights will now have the ability to scan Patient Insurance Cards. If a user is a member of a group and needs rights that should not be given to the additional group members, a new group should be added and the user moved to that group.

Deactivate a User Account Should a user be removed from the system completely, the system administrator can Inactivate the user account.

Figure 16

Administrators Guide to The Criterions EHR

- 74 -

1. Open the Criterions TCMS Practice Management System

2. Click File -> Setup (Figure 17).

Note: A user must have administrative rights to access the Practice Management Setup.

The Practice Setup Options List will appear (Figure 2).

Figure 17

Administrators Guide to The Criterions EHR

- 75 -

3. From the Setup menu, click Practice Setup (Figure 3). 4. Click User Setup.

Figure 18

Administrators Guide to The Criterions EHR

- 76 -

Once a user account has been added it will display in the User list.

5. Double-Click on the name of the user you would like to edit.

In this scenario we are going to inactivate the account for MGREENLEAF.

Figure 19

Administrators Guide to The Criterions EHR

- 77 -

Currently the User Setup shows a green check mark in the Active box.

6. Uncheck the Active box.

Figure 20

Administrators Guide to The Criterions EHR

- 78 -

7. Click

Figure 21

Administrators Guide to The Criterions EHR

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The user is now removed from the User list.

Note: No record is permanently deleted. The user account has been inactivated.

Figure 22

8. Click the check box to “Show inactive users”. Figure 23

Administrators Guide to The Criterions EHR

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The complete list of users, active and inactive are displayed.

The inactive users are designated by a flag symbol beside the name. To re-activate an inactive account access the user setup screen,

9. Double-Click on the user name to reactivate.

Figure 24

Administrators Guide to The Criterions EHR

- 81 -

The Active box is unchecked.

10.

Check the Active

box 11.

Click

Figure 25

Administrators Guide to The Criterions EHR

- 82 -

The user MGREENLEAF is reactivated.

Figure 26

Administrators Guide to The Criterions EHR

- 83 -

Passwords Managing passwords and defining criteria is quick and easy.

1. Open the Criterions TCMS Practice Management System 2. Click File -> Setup (Figure 1).

Note: A user must have administrative rights to access the Practice Management Setup.

The Practice Setup Options List will appear.

Figure 27

Administrators Guide to The Criterions EHR

- 84 -

1. Select Practice Setup -> User Setup. 2. Select the Password Rule Setup.

Figure 28

All practice password setup options are available from this screen.

3. Click

.

Note: Changes to the Password Rule Setup screen are applied to ALL users of the Practice Management and EHR systems. Figure 29

Administrators Guide to The Criterions EHR

- 85 -

System administrators can define the minimum length to which user passwords must adhere.

4. Click in the box right of the “Minimum password length” field. 5. Enter the number for the minimum password length. Note: Alpha characters are not accepted in this field. The field is limited to two numeric characters.

Figure 30

System administrators can set criteria that define passwords as case sensitive and/or requiring passwords to contain both letters and numbers.

6. Click the check box next to the “Password is Case Sensitive field”. 7. Click the check box next to the “Password must contain both letters and numbers” field. Figure 31

Administrators Guide to The Criterions EHR

- 86 -

System administrators can define the number of incorrect login attempts that can be made before the user account is locked.

8. Click in the box right of the “Maximum incorrect login attempts before locking” field. 9. Enter the number for the maximum incorrect login attempts.

Note: Alpha characters are not accepted in this field. The field is limited to one numeric character.

Figure 32

System administrators can define the number of minutes before a locked account will automatically unlock and accept repeated attempts.

10. Click in the box right of the “Number of minutes before autounlocking account” field. 11. Enter the number minutes before auto-unlocking account. Note: Alpha characters are not accepted in this field. The field is limited to four numeric characters. Note: 24 hours = 1440 minutes

Figure 33

Administrators Guide to The Criterions EHR

- 87 -

System administrators can define the number of days that are required to pass before a password may be reused.

12. Click in the box right of the “Maximum Days for not allowing the password to repeat” field. 13. Enter the number days required before a password may be reused. Note: Alpha characters are not accepted in this field. The field is limited to three numeric characters.

Figure 34

Administrators Guide to The Criterions EHR

- 88 -

14. Once all password requirements have been defined, click

A pop-up box will appear notifying the administrator that the changes made will force all users to reset their passwords at their next login. Figure 35

15.

Click

.

Admin Reset of Passwords If a user account is locked or the password needs to be reset for any reason, log into the practice management setup to access a user account.

Administrators Guide to The Criterions EHR

- 89 -

1. Open the Criterions TCMS Practice Management System 2. Click File -> Setup (Figure 1).

Note: A user must have administrative rights to access the Practice Management Setup.

The Practice Setup Options List will appear. Figure 36

Administrators Guide to The Criterions EHR

- 90 -

3. From the Setup menu, click Practice Setup (Figure 3). 4. Click User Setup.

Figure 37

Administrators Guide to The Criterions EHR

- 91 -

A list of active user accounts is displayed.

5. Double-Click on the name of the user you would like to reset the password for.

Figure 38

Administrators Guide to The Criterions EHR

- 92 -

System administrators can force the reset of a user’s password.

6. Check the box next to Reset Password. 7. Click

.

Figure 39

Administrators Guide to The Criterions EHR

- 93 -

The system will ask the administrator to confirm the action.

8. Click

.

Figure 40

Administrators Guide to The Criterions EHR

- 94 -

Upon login the user will receive the following prompt: “Your Password has been reset by the Aministrator. Please enter a new password.”

9. Click Figure 41

The user will be asked for a new password.

Figure 42

Administrators Guide to The Criterions EHR

- 95 -

Administrative Unlocking of Accounts After a user fails to enter the correct combination of user name and password past the allowed number of attempts the account will become locked.

Figure 43

Administrators Guide to The Criterions EHR

- 96 -

The administrator has rights to unlock a patient account.

1. Open the Criterions TCMS Practice Management System 2. Click File -> Setup (Figure 1).

Note: A user must have administrative rights to access the Practice Management Setup.

The Practice Setup Options List will appear.

Figure 44

Administrators Guide to The Criterions EHR

- 97 -

3. From the Setup menu, click Practice Setup (Figure 3). 4. Click User Setup.

Figure 45

Administrators Guide to The Criterions EHR

- 98 -

A list of active user accounts is displayed. User accounts that are locked will show a lock icon next to the name.

5. Double-Click on the name of the account you would like to unlock.

Figure 46

Administrators Guide to The Criterions EHR

- 99 -

The user setup page will appear. The “Unlock User” field is now active.

6. Check the box next to Reset Password. 7. Click

.

Figure 47

Administrators Guide to The Criterions EHR

- 100 -

A pop-up will appear to confirm that the user wants to unlock the account.

8.

Click

.

Figure 48

The user account is unlocked. The user can now attempt to log in again.

Figure 49

Administrators Guide to The Criterions EHR

- 101 -

Incorrect User Attempts Attempts to reuse a password prior to the limit being reached will result in an error message displayed to the user.

Figure 50

Administrators Guide to The Criterions EHR

- 102 -

If a password has been reset by the administrator the user will be required to enter a new password, then retype the new password upon next login.

Criteria of the new password is displayed on the pop-up box.

Figure 51

The user will be presented with errors if they incorrectly attempt to reset their password.

Figure 52

Administrators Guide to The Criterions EHR

- 103 -

Figure 53

Figure 54

Figure 55

Administrators Guide to The Criterions EHR

- 104 -

Accessing Audit Logs Access to audit logs are a group right. To give a group rights you must have rights to access the practice management setup. The administrator has rights to unlock a patient account.

1. Open the Criterions TCMS Practice Management System 2. Click File -> Setup (Figure 1).

Note: A user must have administrative rights to access the Practice Management Setup.

The Practice Setup Options List will appear. Figure 56

Administrators Guide to The Criterions EHR

- 105 -

3. From the Setup menu, click Practice Setup (Figure 3). 4. Click User Setup.

Figure 57

Administrators Guide to The Criterions EHR

- 106 -

To give audit rights the admin must edit the User Group.

5.

Click on the USER GROUPS tab.

Figure 58

Administrators Guide to The Criterions EHR

- 107 -

The added group names display in the left hand column.

6. Click on the GROUP NAME you would like to give audit log rights. In this example, we are editing the rights for the Frontdesk group.

A list of group rights displays.

Figure 59

Administrators Guide to The Criterions EHR

- 108 -

7. Scroll down to find the right you want to edit. In this scenario insurance card Viewing Audit Log rights are to be given to all members of the front desk group.

8. Check the box before “View Auditlog.” All users across all locations who are given Frontdesk group rights will now have the ability to view the auditlogs.

If a user is a member of a group and needs rights that should not be given to the additional group members, a new group should be added and the user moved to that group.

Figure 60

Administrators Guide to The Criterions EHR

- 109 -

Audit logs are separated into two categories: Patient and Practice Audit Logs.

Practice Audit Logs:

If rights are granted to a user they can view audit logs within the admin section of the EHR.

9. In the EHR click

.

The admin menu will display.

10. Click the User Security link.

Figure 61

Administrators Guide to The Criterions EHR

- 110 -

The list of user security options is displayed.

11. Click on the User Login Audit link.

Figure 62

Administrators Guide to The Criterions EHR

- 111 -

The User Login audit log is displayed. The user login audit log allows a user to perform a filtered search by user, start date or end date.

Each entry is date/time stamped with login and logout time.

12. Click

on the User Locked Audit link.

Figure 63

Administrators Guide to The Criterions EHR

- 112 -

The user Locked Audit will display the lock and unlock date/time for each lock event. The user who unlocked the account is also displayed.

Figure 64

Administrators Guide to The Criterions EHR

- 113 -

Patient Audit Logs:

Audit Logs involving patient records are displayed within the patient record.

13. Click to search for a patient. 14. Enter the patient name or account. 15. Click

Figure 65

Administrators Guide to The Criterions EHR

- 114 -

A list of patients matching the search criteria will display.

16. Select the patient by clicking on their name.

Figure 66

Administrators Guide to The Criterions EHR

- 115 -

The patient chart is opened.

Because audit logs record information changed in the course of a visit or outside of a visit we store audit logs at a visit level. The audit log will display audit information pertaining to the visit as well as information independent of the visit.

17. Click on a PRIOR VISIT.

Figure 67

Administrators Guide to The Criterions EHR

- 116 -

The patient visit is displayed.

18. Click

to

display the audit information.

Figure 68

Administrators Guide to The Criterions EHR

- 117 -

All items pertaining to the patient record and the visit are accessible.

By default the Visit Audit log displays.

This screen records who has changed any status (Open, Close, Started, Reopened) to the visit.

A list of additional filters is displayed on the left hand side. Links on the top half pertain to items that are separate from a particular visit. The items in the lower half of the screen are visit specific audit logs. Figure 69

19. Click

the link for Pat Chart Access.

Administrators Guide to The Criterions EHR

- 118 -

A list of all users who have accessed the patient chart at any time is displayed.

Any list in the audit log can be printed.

20. Click

the Print Preview link.

Figure 70

Administrators Guide to The Criterions EHR

- 119 -

A preview of the printout is viewed.

Figure 71

A print button is located in the upper left corner.

Figure 72

Administrators Guide to The Criterions EHR

- 120 -

Contact For clarification of any part of this document or policies regarding Criterions or our products, please contact us at 516.466.1942 or [email protected]

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