Athena Schedule and Appointment Type Request Form

Athena Schedule and Appointment Type Request Form

This form is to be completed when requesting: a schedule build for new providers; a schedule build for existing providers joining a different practice in athena; modifications to the provider’s existing schedule(s) (e.g., change in days or hours); opening the provider’s schedule on a specific day; inactivation of a schedule; addition/removal of appointment types. Complete one form for each provider.
Section A: Requester Information
Requester
Requester Email
example@example.com
Approving Executive Director
Approving Practice Manager
Date of Request

MonthDayYear
2 digit month, 2 digit day, 4 digit year

Section B: Schedule Request Information
Type of schedule request
For more information about the types of schedule build requests, refer to the "Athena Request Forms Guide" under SPHome > Athena > Request Forms folder.
For modification of current schedule: Provide brief description of changes to be made.
Detailed schedule must be provided on Section E of the form.
For modification of current schedule: Select an option below

The Athena IT Team can proceed with the requested schedule modifications without future appointments being addressed beforehand by the staff. I understand that appointments impacted by the schedule modification will route to Claims > Workflow Dashboard> Appts to Resched column to be addressed by the staff. I also understand that if the impacted appointments are not addressed in a timely manner, the patients may receive an automated call within the next business day stating that their appointment needs to be rescheduled.
For "Addition/removal of appointment types": Changes are to be applied to
athena Department
If selected "Not listed - new department", provide the HelpDesk ticket number(s) for the new department build request(s). If a HelpDesk ticket number is not available, enter the "Submission ID(s)" found at the bottom of the submitted Jotform request form.
athena department selected is currently using Phreesia for pre-registration/check-in
If department not listed, provide department name
Scheduling name of the provider
List name as it appears in Athena (e.g., SPUH_LoweW, MONENDO_NURSEVISIT, WH_HR03). If provider is new to athena, enter provider's full name.
For adding/removing appointment types to specific provider(s), list the scheduling name(s)
List name as it appears in Athena (e.g., SPUH_LoweW, MONENDO_NURSEVISIT, WH_HR03).
Schedule start date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Schedule end date will be: (refer to "Hover Note" for explanation of each option)
Date schedule will end

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Schedule end date
As a default, the schedule will initially be set for 2 years and then enabled to automatically extend on an ongoing basis. Enabling schedule auto-extension eliminates the need for practices to request schedule extensions. If you would like the default schedule setup, enter "N/A" above. If you would like a specific end date for the schedule, provide the date above.
For "Inactivation of schedule": Enter date provider will no longer see patients at the department selected above

MonthDayYear
2 digit month, 2 digit day, 4 digit year

Section C: Web Scheduling
Allow patients to schedule appointments via the Athena Patient Portal
Allow patients to schedule appointments via ZocDoc

Section D: Appointment Types
Appointment types to be associated
In the case of appointment type requests tailored for providers, the practice of duplicating existing builds is not employed. This approach guarantees the provision of accurate information tailored to each individual request.
Appointment Type(s) - **If web scheduling via the Patient Portal/Zocdoc will be allowed for the provider, indicate appointment types to be enabled for web scheduling below.

Section E: Schedule Templates
Schedule Template
Schedule note to be visible on the "Schedule Page"
If "Yes" to schedule note, provide note to include on the "Schedule Page"

Section F: Other
Additional information regarding request:

0/120

Section G: IT Use Only
Ticket/INC #
Enter the numeric value after "INC00".
Should be Empty:

Athena Schedule and Appointment Type Request Form

Section A: Requester Information

Section B: Schedule Request Information

Section C: Web Scheduling

Section D: Appointment Types

Section E: Schedule Templates

Section F: Other

Section G: IT Use Only