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pdf Non-visible Questions
Label
Organization
Description
PDF Name
(step)
Location
Accreditation Below
Report (1)
Organization
Type
Respons Visibility Trigger
e Input
Item
Other
Text
Entry
The field is
displayed if the
user selects an
organization type
that requires a
description.
FDA (Federal Food Accreditation Below checkbox Drop
and Drug
Report (1)
"Does the
List
Administration)
subject have a
FDA or CLIA
identification
number?"
The field is
displayed if the
user selects the
checkbox for
"Does the subject
have a FDA or
CLIA
Identification
number?"
Selecting the
checkbox displays
FDA, and CLIA text
entry fields.
CLIA (Clinical
Accreditation Below checkbox Text
Laboratory
Report (1)
"Does the
Entry
Improvement Act)
subject have a
FDA or CLIA
identification
number?"
The field is
displayed if the
user selects the
checkbox for
"Does the subject
have a FDA or
CLIA
Identification
number?"
Selecting the
checkbox displays
FDA, and CLIA text
entry fields.
Type of Affiliation Accreditation Below the
Drop
Report(1)
checkbox "Is the List
organization
affiliated with a
health care
entity?
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting ""Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Address,
Address Line 2,
City, State and ZIP
entries.
Entity Name
Accreditation Below the
Text
Report(1)
checkbox "Is the Entry
organization
affiliated with a
health care
entity?
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting ""Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Country,
Address, Address
Line 2, City, State
and ZIP entries.
Country
Accreditation Below Entity
Report (1)
Name
Drop
List
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting "Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Country,
Address, Address
Line 2, City, State
and ZIP
entries. United
States is selected
by default.
Address
Accreditation Below Entity
Report (1)
Country
Text
Entry
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting "Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Country,
Address, Address
Line 2, City, State
and ZIP entries.
Address Line 2
Accreditation Below Address
Report (2)
Text
Entry
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting "Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Country,
Address, Address
Line 2, City, State
and ZIP entries.
City
Accreditation Below Address
Report (2)
Line 2
Text
Entry
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting "Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Country,
Address, Address
Line 2, City, State
and ZIP entries.
State
Accreditation Beside City
Report (2)
Drop
List
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting "Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Country,
Address, Address
Line 2, City, State
and ZIP entries.
ZIP
Accreditation Below State
Report (2)
Text
Entry
The field is
displayed if the
user selects the
checkbox for "Is
the organization
affiliated with a
health care
entity?"
Selecting "Is the
organization
affiliated with a
health care entity?"
displays Type of
Affiliation, Entity
Name, Country,
Address, Address
Line 2, City, State
and ZIP entries.
Description
Accreditation Below Select up
Report(2)
to 5 actions
Text
Entry
The field is
displayed if the
user selects an
adverse action
that requires a
description.
Description
Accreditation Below Basis for
Report(2)
Action(s)
Text
Entry
The field is
displayed if the
user selects a
basis for action
that requires a
description.
State Changes
Label
PDF Name
Item Type
Trigger
Public Burden
Statement
Accreditation Modal
Report
When the user selects the Public Burden
Statement link the modal is displayed.
License Number
Accreditation Text Entry Text entry is disabled if the user selects the
Report
"No/ Not sure" option for "Does
the organization have a license?"
Select a Basis for
Action
Accreditation Modal
Report
When the user sets focus on the Basis for
Action(s) text entry, the modal to select an
act is displayed and focus is set on the
Search text entry. The user can enter text
in the Search text box to find a
specific basis or select a basis from the list
without searching. The modal is hidden
once the user selects a basis from the
list. The user's selection populates the
Basis for Action(s) text entry.
| File Type | application/pdf |
| File Modified | 2017-11-09 |
| File Created | 2017-09-25 |