APPOINTMENT CATEGORY Last Appointment Date 4/18/2018 Appointment tab 7/19/2018 Last Appointment Atlanta Appointment tab Waleska Location Last Appointment Type 001 Exam/Child Appointment tab 100 G&D Ck (20) (60) Last Appointment Time 4:10 PM Appointment tab 8:20 AM Last Appointment Wednesday Appointment tab Thursday Weekday Last Appointment 1/22/2018 Appointment tab 7/19/2018 Missed Date Last Appointment Atlanta Appointment tab Waleska Missed Location Last Appointment 631 Ret Ck #1-3 Appointment tab 100 G&D Ck (20) Missed Type Mos. (20) Last Appointment 2:00 Appointment tab 8:20 AM Missed Time Last Appointment Monday Appointment tab Thursday Missed Weekday Next Appointment Date 6/1/2018 Appointment tab 8/24/2018 Next Appointment Atlanta Appointment tab Waleska Location Next Appointment Type 036 Appointment tab 631 Ret Ck #1-3 Mos (20) Imp-TMJ/Splint Next Appointment 9:00 AM Appointment tab 8:30 AM Time Next Appointment Friday Appointment tab Friday Weekday Selected Appointment 6/1/2018 Appointment tab 8/24/2018 Date Selected Appointment Seattle Appointment tab Waleska Location Selected Appointment 036 Appointment tab 631 Ret Ck #1-3 Mos (20) Type Imp-TMJ/Splint Selected Appointment 9:00 AM Appointment tab 8:30 AM Time Selected Appointment Weekday Friday Appointment tab Friday July 2018 - v5.2.1805.2018 1
No-Show Count 2 Appointment tab 1 BASIC Today's Date 4/23/2018 System Date 7/19/2018 Today's Date Words April 23, 2018 System Date July 19, 2018 Signature John Doe (Displays written name from Topaz and Signature Pads) Financial Arrangements OR Letter Queue Note: If your merged field looks like this: Error! Bookmark not defined. It simply means that the Signature has not been used. DENTIST Important: For the Dentist's Merge Fields, the following conditions must exist: In People > Dentist (General or Pediatric) is selected for Profession AND In Patient > Relationships tab lists the Relationship as Patient's Dentist, General Dentist or Pediatric. Note: Any merge field will appear exactly as entered into Cloud9. For example, if the Dentist's Cell is entered as 4445556666, without any punctuation, it will appear in a merged document as typed. Dentist Cell (678) 522-1212 People, Contact Type = Cell (404)555-1212 Dentist Street Address 175 White St. NW Suite 300 People 175 White St. NW Suite 300 Dentist City State Zip Marietta, GA People Marietta, GA 30060 30060 Dentist Email dentist@cloud9 People dentist@cloud9.software Dentist Fax (404) 555-1212 People, (404) 555-1212 Contact Type = Fax Dentist First Name Nathaniel People Nathaniel Dentist Full Name Dr. Nathaniel People Dr. Nathaniel (Cole) Page (Cole) Page Dentist Formal Name Dr. Nathaniel Page People Dr. Nathaniel Page Dentist Gender Male People Male Dentist Greeting Cole People Cole Dentist Home Phone (404) 555-1212 People, (404) 555-1212 Contact Type = Home Dentist Last Name Page People Dentist Office Phone 800.662.5555 People 800-867-5309 July 2018 - v5.2.1805.2018 2
Contact Type = Work Dentist Title Dr. People Dr. FINANCIAL - RESPONSIBLE CATEGORY Account Balance $2,850.00 Ledger $5,648.02 Contract Start Date Contract Balance Contract Description First Periodic Charge Date Last Periodic Charge Date Current Due Due Day Discount Type Financed Amount 8/1/2017 Contract Note: If the contract is NOT started, use Expected Contract Start Date $2,400.00 Contract 6/29/2018 $0.00 Note: If the contract is NOT started, many fields will not appear when merged. Full Braces-Child Contract Oneinsurance 3/1/2017 Contract Note: If the contract is NOT started, use Expected First Chg. 8/1/2019 Contract $300.00 Ledger $148.02 To come To come 1st $50.00 Contract Paid in Full Discount $3,500.00 Contract $5,500.00 July 2018 - v5.2.1805.2018 3
$1,000.00 Contract $0.00 Down Amount 20 Contract 20 Number of s $6,000.00 Contract $5,500.00 Contract Amount $150.00 Ledger $0.00 Over 30 Due $0.00 Ledger $0.00 Over 60 Due $0.00 Ledger $0.00 Over 90 Due $150.00 Contract $250.00 Periodic Charge Amount $450.00 Ledger $148.02 Due Now $2,850.00 Ledger $0.00 Past Due $5,000.00 Ledger $5,648.02 Total Due $5,000.00 Contract $6,000.00 Treatment Fee Amount Comprehensive-Ch Contract Full Tx Adult Treatment Fee Charge Type ild $0.00 Contract $500.00 Discount Amount Contract Subtotal $5,000.00 Contract $5,500.00 FINANCIAL - INSURANCE CATEGORY $1,000.00 Contract $0.00 Account Balance 8/1/2017 Contract 6/29/2018 Contract Start Date $0.00 Contract $0.00 Contract Balance Quarterly Contract Monthly July 2018 - v5.2.1805.2018 4
Contract Charge Frequency Mom's Contract Contract Description 8/1/2017 Contract Contract First Date 8/1/2019 Contract Contract Last Date $125.00 Ledger $0.00 Current Due American Insurance tab, Pappas Restaurants Employer Name Airlines/123456 Insurance Company Due To come To come Day $1,000.00 Contract $0.00 Expected Benefit To come To come Financed Amount $1.00 Contract $0.00 Down Amount City Phoenix, AZ 85067 Insurance Billing Phoenix, AZ 85067 State Postal Code Center Pacific Life & Insurance tab, Pacific Life & Annuity Benefit* Company Annuity Benefit Insurance Company Fax (850) 555.1212 Insurance Billing Center, Contract Type = Fax Group Number 819995731000 Insurance tab 81995731000 Office Phone Policy Number Street Address (713)555-1212 Insurance Billing Center, Contact Type = Work PQ5912 Insurance tab 231123 Z99 Insurance Billing Center Insurance Billing Center PO Box 33699 July 2018 - v5.2.1805.2018 5
Number of s Original Contract Amount Over 30 Due Over 60 Due Over 90 Due Charge Amount Subscriber Name Subscriber ID Due Now Past Due Total Due Street 4 Contract $99.00 Contract $0.00 Ledger $0.00 $0.00 Ledger $0.00 $0.00 Ledger $0.00 $99.00 Contract Dr. Zoe Samples Insurance tab Drs. OneInsuranceContract Elmo (Zoe) Zamples 999-99-9999 Insurance tab 231123 $99.00 Ledger $0.00 $0.00 Ledger $0.00 $99.00 Ledger $0.00 IMAGE CATEGORY Image Note: Cloud9 will prompt for the Series Name or choose between: After Before Latest Then select the Image Name, like Frontal. Note: If the image does not appear or is incorrect: Images tab The imaging merge fields have been excluded to prevent viewing delays which would occur when prompts appear. July 2018 - v5.2.1805.2018 6
Verify that the letter has the correct selection of Image Series Name and Image Type. Then check the patient's Images tab to see if the image exists with the matching Images Series and Name. Image Series Choose the Series, then select: Image Series Date Image Series Name Image Series Type Image_Tooth_Chart Extractions Image_Odontogram Initial Records Note: Appears as a Text Field. -Same as above Note: To come in HTML5. Same as above Scheduled for a future release in HTML5. Same as above PATIENTCATEGORY Patient Age 9 years, 1 month Patient tab 9 years, 1 months Patient Birthday 6/1/2009 Patient tab 6/1/2009 Patient Birthday Words June 1, 2009 Patient tab June 1, 2009 Patient Cell (404) 222-4444 Patient tab, (404) 222-4444 Contact Type = Cell Patient Street Address 123 Street Patient tab 123 Street Patient City, State, Zip Kennesaw, GA Patient tab Kennesaw, GA 30144 30144 Patient Cleaning Date 7/3/2018 Tracking tab 7/3/2018 Patient Deband Date 7/24/2018 Tracking tab 7/3/2018 Patient Email support@cloud9.s Patient tab aparker@cloud9.software oftware Patient Estimated 6/29/2018 Tracking tab 6/29/2018 Completion Date Patient Fax 777.555.1212 Patient tab, Contact Type = Fax Patient First Name Elizabeth Patient tab OneInsuranceContract Patient First Name Elizabeth's Patient tab OneInsuranceContract's Possessive Patient Full Name Ms. Elizabeth Patient tab Drs. OneInsuranceContract Elmo (Zoe) July 2018 - v5.2.1805.2018 7
Paige (Zoe) Zamples Samples Patient Formal Name Ms. Elizabeth Paige Samples Patient tab Drs. OneInsuranceContract Elmo Zamples Patient Gender Female Patient tab Female Patient Greeting Beth Patient tab Zoe (Nickname) Patient Greeting Beth's Patient tab Zoe's Possessive Patient Home Phone (404) 555-1212 Patient tab, Mom's home Contact Type = Home Patient ID 013745 Patient tab 18AC0074 Patient Last Name Doe Patient tab Zamples Patient Location Name Acworth Patient tab Acworth Patient Location Street 205 Towne Lake Patient tab 5987 Shadow Ridge Drive Address Pkwy, Ste 201 Patient Location City Woodstock, GA Patient tab Acworth, GA 30101 State Zip 30188 Patient Medical Alert To come To come Patient Nickname Beth Patient tab Zoe (Greeting) Patient Nickname Beth's Patient tab Zoe's Possessive Patient Office Phone (999) 999-9999 Patient tab, (404) 222-1212 Contact Type = Work Patient Orthodontist Dr. Aaron King Patient tab Dr. E Driesman Patient Pan Date 12/6/2016 Tracking tab 7/3/2018 Patient Social 000-00-0000 Patient tab 000-00-0000 Patient Start Date 7/3/2016 Tracking tab (entry) 6/29/2018 Patient Title Ms. Patient tab Drs. Patient Treatment 18 Tracking tab 0 Months Estimated Patient Type Surgical Tracking tab She - He She Patient (Gender) She she-he she Patient (Gender) she son-daughter daughter Patient (Gender) daughter July 2018 - v5.2.1805.2018 8
her-him her Patient (Gender) her Her-His Her Patient (Gender) Her her-his her Patient (Gender) her PORTAL CATEGORY Important: The Portal User Name and Password can NOT be sent en masse from the Letter Queue. An email will be generated from the PracticePortal via invitation and will only populate the fields WHEN the invitation is sent. Patient Portal User Name -Same as above Relationship tab Patient Portal Password -Same as above Relationship tab Patient Portal URL https://cloud9.co Practice Information m PRACTICE CATEGORY Practice Street Address 1301 Shiloh Rd. NW, Ste 1840 Practice Information or Location Practice City, ST, Zip Kennesaw, GA Practice Information 30144 or Location Practice Fax (800) 394-4444 Practice Information, Contact Type = Fax Practice Name Keifer Orthodontic Practice Information Practice Phone (777) 222-1234 Practice Information, Contact Type = Work 1945 Shiloh Rd Kennesaw, GA 30144 (404) 555-1122 800-867-5309 Orthodontist License Number 1234 May be found in 1 of 3 places: Practice Information -Insurance Setup - Location Setup - Employee 11673 Practice Tax ID 123456456456 -Same as above 582363949 Printed By To come To come QUESTIONS CATEGORY Tip: To easily copy a Questionnaire document containing one text style, like Technical, to Lay-person: Save As the original letter. Use Find and Replace. July 2018 - v5.2.1805.2018 9
Find Technical, Replace with Lay-Person. Questionnaire Question Treatment is progressing on schedule. Note: To merge the correct response, Cloud9 will prompt for the following: 1. Questionnaire - Select from the list of your Questionnaires. 2. Question - Choose the particular question. 3. Text Style - Pick from: Default Lay-person Technical Note: Verify that the letter has the correct Questionnaire and Question selected. Check the Questionnaire's response. The Questionnaire merge field has been excluded to prevent viewing delays which would occur when the prompts appear. RECALL CATEGORY Recall Date 7/7/2018 Treatment 7/3/2018 Card/Recalls Recall Orthodontist Dr. Aaron King TreatmentCard/Recal Dr. E Driesman ls Recall Appointment 001 Exam/Child Treatment 100 G&D Ck (20) Type (60) Card/Recalls Recall Type G&D Treatment Ck Card/Recalls Recall Comment 1234 Treatment Comment from History Card/Recalls RECIPIENT CATEGORY Important: Cloud9 recommends using Recipient fields as the most common merge fields when creating letter tempates. The Recipient is selected in the Letter Queue when generating the letter. Recipient Cell 214.236.5555 Patient, Relationship tab OR People Contract Type = Cell (404) 222-4444 Recipient Street Address 227 Pine Valley Court -Same as above 123 Street July 2018 - v5.2.1805.2018 10
Recipient City State Zip Nashville, TN -Same as above Kennesaw, GA 30144 37215 Recipient Zip 37215 -Same as above 30144 Recipient Email dnill@cloud9 -Same as above aparker@cloud9.software Recipient Fax (602)555-1212 -Same as above Recipient First Name Dee -Same as above OneInsuranceContract Recipient Full Name Mrs. Dee Nicholson -Same as above Drs. OneInsuranceContract Elmo (Zoe) Zamples Recipient Formal Name Mrs. Dee Nicholson -Same as above Drs. OneInsuranceContract Elmo Zamples Recipient Gender Female -Same as above Female Recipient DOB 4/27/1975 -Same as above 6/1/2009 Recipient Social 123-45-6789 -Same as above 000-00-0000 Recipient Greeting Di -Same as above Zoe Recipient Home Phone 678-555-1212 -Same as above Mom's home Recipient Last Name Nicholson -Same as above Zamples Recipient Office Phone 678-667-1212 -Same as above (404) 222-1212 Recipient Title Mrs. -Same as above Drs. REFERRAL CATEGORY Referral Cell (404) 555-1212 People (404)555-1212 Contact Type = Cell Referral Street Address 120 North Medical Parkway People 175 White St. NW Suite 300 Referral City State Zip Woodstock, GA People Marietta, GA 30060 30189 Referral Email drsaulsbery@clou People dentist@cloud9.software d9 Referral Fax (555) 667-1234 People (404) 555-1212 Contact Type = Fax Referral First Name Jennifer People Nathaniel Referral Full Name Dr. Nathaniel People Dr. Nathaniel (Cole) Page (Cole) Page Referral Formal Name Dr. Nathaniel Page People Dr. Nathaniel Page Referral Gender Female People Male Referral Greeting Jenn People Cole Referral Home Phone (678) 555-3214 People (404) 555-1212 Referral Last Name Saulsbery People Page July 2018 - v5.2.1805.2018 11
Referral Office Phone (770) 555-2343 People 800-867-5309 Referral Title Dr. People Dr. TREATMENTCATEGORY Treatment Discount $100.00 Contract $500.00 Treatment Fee $6000.00 Contract $6,000.00 Treatment Fee after $5,900.00 Contract $5,500.00 Discount Extraction Text (FDI) Maxillary Right Maxillary Left Third Molar First Premolar Extraction Text Palmer Maxillary Right Maxillary Left Third Molar First Bicuspid Extraction Text Maxillary Right Maxillary Left Third Molar Universal First Premolar Uncover Text (FDI) Maxillary Left World Dental Second Molar Uncover Text Palmer Maxillary Left Second Molar Uncover Text Universal Maxillary Left Second Molar Uncover Text FDI World Maxillary Left Dental Second Molar Evaluation Text Palmer Mandibular Right Second Molar Evaluation Text Universal Mandibular Right Second Molar TREATMENTPLAN CATEGORY Treatment Plan Name Comprehensive Adult - Fixed Appliances Treatment Card Treatment Plan Treatments Band/Bond Upper and Lower 6-6 Elastics 3-6-3 U/L Treatment Card July 2018 - v5.2.1805.2018 12
FINANCIAL ARRANGEMENTS CATEGORY Important: The (FA) merge fields must be enabled before the first use. Contact Cloud9 Support at Support@cloud9.software. merge fields can only be merged in Contract > s. The Services Table creates a five column table, so be sure to provide plenty of room when formatting. Account Number Autopay Type Autopay Type Card Expiration Card Type Description Down First Date Frequency is Autopay 75201027 FA, Patient Information Credit Card FA, Patient Information Manual FA, Patient Information 03/22 FA, Patient Information Visa FA, Patient Information Mom's Add a Financial Arrangement $200.00 FA, Patient Arrangement Details 7/17/2018 FA, Patient Arrangement Details Monthly FA, Patient Arrangement Details True FA, Patient Credit Card Manual 2nd $49.00 7/19/2018 Monthly True July 2018 - v5.2.1805.2018 13
Last Date Net Contracted Net Patient Share Net Primary Amount Net Secondary Amount Net UCR Amount Primary Insurance Company Recurring Balance Responsible Cell Responsible Street Address Responsible City State Zip Responsible Zip Code Information 7/17/2019 FA, Patient 7/19/2018 Arrangement Details $500.00 FA, Net Case Fee $94.00 $100.00 FA, Net Case Fee $49.00 $45.00 FA, Net Case Fee $45.00 $9.99 FA, Net Case Fee $0.00 $45.00 FA, Net Case Fee $45.00 $9.50 FA, Patient Arrangement Details Pacific Life & Annuity Insurance tab Benefit $0.00 Pacific Life & Annuity Benefit* $19.01 FA, Patient Arrangement Details $0.00 (404) 222-4444 Relationships tab, (404) 222-4444 Contact Type = Cell 123 Street Relationships tab 123 Street Kennesaw, GA 30144 Relationships tab Kennesaw, GA 30144 30144 Relationships tab 30144 support@cloud9.soft Relationships tab aparker@cloud9.software July 2018 - v5.2.1805.2018 14
Responsible Email Responsible Fax Responsible First Name Responsible Full Name Responsible Formal Name Responsible Gender Responsible DOB Responsible Social Responsible Greeting Responsible Home Phone Responsible Last Name Responsible Office Phone Responsible Title Routing Number Secondary Insurance Company Services Table ware (404) 555-1212 Relationships tab, Contact Type = Fax Francis Relationships tab OneInsuranceContract Francis Zoe (Franki) Smith Mrs. Francis Zoe Smith Relationships tab Relationships tab Female Relationships tab Female 6/1/2009 Relationships tab 6/1/2009 123-45-6789 Relationships tab 000-00-0000 Franki Relationships tab Zoe (404) 556-1212 Relationships tab, Contact Type = Home Mom's home Smith Relationships tab Zamples (404) 678-1212 Relationships tab, Contact Type = Work (404) 222-1212 Mrs. Relationships tab Drs. 000017000042 Contract Cigna Insurance tab Drs. OneInsuranceContract Elmo (Zoe) Zamples Drs. OneInsuranceContract Elmo Zamples See below: FA, Net Case Fee This merge field has been excluded. July 2018 - v5.2.1805.2018 15
Financial Arrangement Total Contracted Financial Arrangement Total Patient Share Financial Arrangement Total s $500.00 FA, Net Case Fee $99.00 $200.00 FA, Net Case Fee $54.00 12 FA, Net Case Fee 1 July 2018 - v5.2.1805.2018 16