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Schedule change request form

Schedule change request form

Effective April 1, 2015 all schedule changes require this form to be completed. You will not be able to submit an incomplete form. The Scheduling Maintenance Team (PAIS-Scheduling) will not change schedules unless this form is completed.

Schedule change definitions

  • Cancel: To close a clinic day, time slot or session (vacation, conference, illness, etc.)
    • Sessions will change to a Non-Clinic / Unavailable day. If patients are on the schedule, they will be bumped (canceled) but will have a status of Bumped. The requestor is responsible for ensuring all bumped patients are notified and rescheduled.
  • Bump: Bumped appointments are the result of canceling days as described above.
    • Patients are placed on the GE-IDX Web Bump List. The bump list contains all the bumped patients (usually by bump date) for that request and allows rescheduling from the list.
  • Freeze: Freezing slots, sessions, etc., hide the slots from the First Available Search. Use this when you do not want the PAC to schedule into these appointment slots. Schedule remains the same but is hidden. If you use a Specific Date Search within Scheduling, you can see the day but will receive a popup, advising the slot is frozen. You have the option to continue scheduling and can place a patient on that day. Freezing does not bump any patients.
  • Edit: Change slots, appt types, beginning and end times, etc. on a schedule.
  • Open: To open a day’s schedule that does not contain any slots (day does not exist or it is currently Non-Clinic / Unavailable).
Schedule change request for (provider's name)  *Date submitted  *Submitted by  *Type of change (select one)  *Reason for change (select one)  *Number of patient appointments affected (Please research current daily schedules to identify roughly how many patients will be or may be bumped because of this change.) If 'Other', please explain Clinic locations affected by schedule change (please select all that apply) 

Requested schedule change beginning date  *Requested schedule change ending date  *Please list additional dates (mm/dd/yyyy, mm/dd/yyyy, etc) Additional comments