Allscripts Appointment Schedule Master File

Allscripts Appointment Schedule Master File
Complete this form whenever an appointment schedule requires an additional item, change or purge of existing entry or template. Contact the Vision Help Desk at 860-714-4746 if a day or cycle template needs to be created in addition to below.
Is this provider on Allscripts Enterprise EMR?:
Resource Code

This code can be a doctor, nurse, technician or other medical professional.
Was a Provider Master File Request Form submitted?:
Resource name / Code:
Booking Limit:
Appointment Type Code

This Code is used when booking appointments.
Appointment Code Description:
Code 4 character max(optional):
Cancellation Code

This code is used wen canceling appointments.
Cancellation description:
Code 4 character max(optional):
Block Code

This code is used to block the appointment schedule.
Block Description:
Code (optional):
Schedule Purge

All below information is required if requesting a purge of an existing schedule.
Date to be purged From:

MonthDayYear
To:

MonthDayYear
Facility Code(s):
Additional Resources
Resource Code:
Name:
Resource Code:
Name:
Resource Code:
Name:
Special Instructions:
Submitted By:

First NameLast Name
Date:

MonthDayYear
Phone Number:

Area CodePhone Number
Fax:

Area CodePhone Number
E-mail:
Internal Use
Vision Request Completed By:

First NameLast Name
Date:

MonthDayYear
Enterprise Completed By:

First NameLast Name
Date:

MonthDayYear
Click to edit
Schedule Format
Should be Empty: