Patient information

• Patient’s last name (required)
• Patient’s first name (required)
• Patient’s middle name (optional)
• Patient’s date of birth (required)
• Patient address (required)
  • SimpleReport standardizes addresses:
    • Patient’s street address (required)
    • Patient’s city (required)
    • Patient’s county (system-generated)
    • Patient’s state (required)
    • Patient’s zip code (required)
• Patient’s phone number (required)
• Patient’s sex (optional)
• Patient’s ethnicity (optional)
• Patient’s race (optional)
• Patient’s email (optional)
• Patient’s role (optional)
  • Example: student, staff, resident, visitor

Ask on order entry

• Is the patient employed in healthcare? (required)
• Is the patient a resident of a congregate setting? (required)
• Is this the patient’s first test for COVID-19? (optional)
  • If not, when was the last test, what was the test type, and - what was the result?
• Is the patient symptomatic for this disease? (optional)
  • If yes, list symptoms
  • Illness onset date
• Is the patient pregnant? (optional)

Test information

• Device Name (system-generated)
  • The SimpleReport user selects from a dropdown menu
• Ordered test code (system-generated)
  • LOINC code of the test performed. This is a standardized coded value describing the test.
• Swab Type (system-generated based on device)
• Test date (required)
  • The default test date is today

Results

• Specimen ID (system-generated and unique for every test result)
• Corrected result ID (optional)
  • This field is usually blank, and is used to correct or modify a past test result
• Test result code (required and system-generated SNOMED code)

SimpleReport collects facility information and organization information. A facility can belong to a parent organization, like a school district, chain of nursing homes, health system, or university.

The testing lab and ordering facility are the same thing in SimpleReport, so you’ll receive information about the same entity.

• Testing lab’s name (required)
• Testing lab’s CLIA (required)
  • SimpleReport doesn’t enforce unique CLIAs
• Testing lab’s street address (required)
• Testing lab’s city (required)
• Testing lab’s state (required)
• Testing lab’s zip code (required)
• Testing lab’s phone number (required)
• Testing lab’s county (system generated)
  
• Organization name (required)
  • Use when an organization (like a large hospital system) owns many facilities
• Ordering facility’s name (required)
• Ordering facility’s street address (required)
• Ordering facility’s city (required)
• Ordering facility’s state (required)
• Ordering facility’s zip code (required)
• Ordering facility’s phone number (required)
• Ordering facility’s county (system-generated)
• Ordering facility’s email (optional)
  
• Reporting facility’s name (required)
• Reporting facility’s CLIA (required)
  • SimpleReport doesn’t enforce unique CLIAs

• Ordering provider’s ID (optional)
  • The ordering provider’s National Provider Identifier
• Ordering provider’s last name (optional)
• Ordering provider’s first name (optional)
• Ordering provider’s street address (optional)
• Ordering provider’s city (optional)
• Ordering provider’s state (optional)
• Ordering provider’s zip code (optional)
• Ordering provider’s phone number (optional)
• Ordering provider’s county (optional)

The information below is all completely fake. It’s here to give you a sense of the information you’ll receive from SimpleReport. All required and system-generated fields appear in the example data below, but only some optional fields do.

Patient information

Patient information

• Patient’s last name: Doe
• Patient’s first name: Jane
• Patient’s middle name: A
• Patient’s date of birth: 1/1/1970
• Patient address
  • Patient’s street address: 1234 Maple Street
  • Patient’s city: Springfield
  • Patient’s county: Pleasantview
  • Patient’s state: IA
  • Patient’s zip code: 12345
• Patient’s phone number: (123) 456-7890
• Patient’s sex: Female
• Patient’s race: Black or African American
• Patient’s role: Visitor

Ask on order entry

• Is the patient employed in healthcare? No
• Is the patient a resident of a congregate setting? No
• Is this the patient’s first test for COVID-19?: Yes
• Is the patient symptomatic for this disease?: Yes
  • Symptoms: Chills, Fever, Cough
  • Symptom Onset Date: 1/30/2021

Test information

Test information

• Device Name: Abbott BinaxNow
• Ordered test code: 94558-4
• Swab Type: Nasal swabs
• Test date: 2/1/2021

Results

• Specimen ID: 30aea118-1eae-41db-8aea-0652358fc37b
• Test result code: Negative

Testing lab/facility/organization information

• Testing lab’s name: Your Local Facility
• Testing lab’s CLIA: 12D3456789
• Testing lab’s street address: 987 Main Street
• Testing lab’s city: Springfield
• Testing lab’s state: IA
• Testing lab’s zip code: 12345
• Testing lab’s phone number: (987) 654-3210
• Testing lab’s county: Pleasantview
  
• Organization name: Iowa Communities Testing
• Ordering facility’s name: Your Local Facility
• Ordering facility’s street address: 987 Main Street
• Ordering facility’s city: Springfield
• Ordering facility’s state: IA
• Ordering facility’s zip code: 12345
• Ordering facility’s phone number: (987) 654-3210
• Ordering facility’s county: Pleasantview
  
• Reporting facility’s name: Your Local Facility
• Reporting facility’s CLIA: 12D3456789

Ordering provider information

• Ordering provider’s ID: 1538234679
• Ordering provider’s last name: Smith
• Ordering provider’s first name: Barbara
• Ordering provider’s city: Northville
• Ordering provider’s state: IA
• Ordering provider’s zip code: 23456