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Fertility Scout: User GuideVersion 1.0Purpose: To provide a visual guide of The AFP’s Clinical Finder and Referral Tool

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Screen Description

Home screen: https://locator.allianceforfertilitypreservation.org/clrt/map

Item Description

Map will default to nationwide view unless you accept your web browsers notification to use your current location (see next page)

SearchScreen

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Screen Description

Home screen: https://locator.allianceforfertilitypreservation.org/clrt/mapWith browser location accepted.

Item Description

Accepting browser notification of location shall redraw the map, with your local zip code as the center of the map (in this example the user’s location is New Haven, CT)

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SearchScreen

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Screen Description

Home screen: https://locator.allianceforfertilitypreservation.org/clrt/mapSearch capabilities for locating the clinic of your choice. Search by Services provided, by location, or both.

Item Description

Search clinics by services provided.

Search by location.

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SearchScreen

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Screen Description

Home screen: https://locator.allianceforfertilitypreservation.org/clrt/mapSearch criteria (Services and/or Location) will be used to pull a list of nearby clinics matching your criteria. ➊

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Item Description

List of clinics matching your search criteria.

Map “pins” matching your search criteria.

Click “Next” to view the next 10 closest clinics that meet your search criteria

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SearchScreen

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Screen Description

By clicking on the clinic of choice in the list, or map, a modal (pop-up), will appear, containing more information about the clinic

Code Description

➊ The clinic name will appear at the top of the modal

➋ List of available information provided by the clinic

➌ Option for patients to contact the clinic for an appointment

Option for Health Care Professionals to contact the clinic to make a referral on behalf of a patient.

Exit the modal by clicking the “x” in the top right of the screen

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ClinicPage

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For Patients

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Screen Description

Patients are presented with a form to make an appointment with a clinic. The following screens detail this process. This is a 4 step process.

Code Description

➊ By clicking on the “Make an Appointment” button, patients will be presented the Appointment Form.

➋ Step 1 - User Information: Indicate if you are the patient, or a caregiver.

➌ Step 2 - Medical Information: Provide patient details. Email Address is optional, and will never be shared with third parties.

Use the “Next” button to proceed to the next step throughout the process.➍

AppointmentForm

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Screen Description

Patients are presented with a form to make an appointment with a clinic. The following screens detail this process. This is a 4 step process.

Code Description

➊ Step 3 - Medical Information: Additional patient information.

➋Step 4 - Treating Physician Information: Patient can provide physician information if available. This will be helpful if receiving clinic needs to reach the physician.

➌Confirmation: Upon completion and submission of the Referral Form, a confirmation message is presented. Patient should print this screen.

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AppointmentForm

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For Healthcare Professionals

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Screen Description

For Healthcare Professionals, clicking on the “Make a Referral” button will lead to an opportunity to create a Fertility Scout account. This is requirement was added based on feedback from professionals and confers an added layer of security. This must be done in order to complete a referral on behalf of your patient. Once you set up an account, you can simply sign in. Code Description

➊ Click on “Make a Referral”

➋ Option to Sign In (through your account) or Register (to create an account) is presented

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ReferralForm

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RegisterAccount

Screen Description

From the Fertility Scout portal, by clicking “Register,” you are presented with a form to create your account. Once completed, you will be taken back to the portal.

Code Description

➊ Create Your Account form. Provide the email address you would like associated with your account, along with a password.

➋ Click “Create My Account” once you have filled out the email and password.

➌ Success message, providing further instructions to verify your new account.

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RegisterAccount

Screen Description

From the Fertility Scout portal, by clicking “Register,” you are presented with a form to create your account. Once completed, you will be taken back to the portal.

Code Description

➊ You will receive an email from “noreply@remedyhealthmedia”

➋ Click the link to be taken back to the account website

➌ Provide Email and Password again to sign in to your new account

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AccountProfileScreen Description

Once your account is created, and you login to the Health Care Professional portal, you will have the ability to complete your account Profile. This information will be used to pre-populate your future patient referral forms.

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➊ Click on “Profile”

➋ Check the circle that describes your role in patient referrals

➌ Complete the remaining fields

Remember to click “Save Profile” when complete

Click “Clinic Referral Tool” to return to the Fertility Bridge portal

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AccountReferrals

Screen Description

Once your account is created, and you login to the Health Care Professional portal, you will have the ability to view any referrals that have been made from your account.

Code Description

➊ Click on Referrals to view all referrals you have made

➋ A list of existing referrals will be presented in chronological order

➌The “eye” icon can be clicked the see the full details of the referral. The “download” icon can be used to download the individual referral.

All referrals can be downloaded in a single comma separated value (.csv) file format

Click “Clinic Referral Tool” to return to the Fertility Scout portal

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Screen Description

With an account created, you can now Sign In to complete your referral.

Code Description

➊ Click “Sign In” to initiate the Referral Process

➋ Provide your email address and password

Click “Submit” to proceed to the Referral Form

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ReferralForm

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Screen Description

With an account created, you can now Sign In to complete your referral. The referral form is a 5 step process.

Code Description

➊Step 1 - Referring Physician Information: If you created an account and completed your profile, this information will be pre-populated when you sign in.

➋Step 2 - Hospital/Institution Information: If you created an account and completed your profile, this information will be pre-populated when you sign in.

Step 3 - Patient Information: Complete all fields. The patient phone # will be used by the receiving clinic to contact the patient. Email address is optional. It is only used by the AFP for quality control purposes (follow-up) and is never shared with third parties.

Use the “Next” button to proceed to the next step throughout

ReferralForm

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Screen Description

With an account created, you can now Sign In to complete your referral. The referral form is a 5 step process.

Code Description

➊Step 4 - Medical Information: Provide the patient’s Cancer Diagnosis and Treatment Status. Use the “Comments” to provide any relevant medical and/or personal history; you can also use this area to describe what the patient is seeking (e.g., a consultation, etc.). You can type up to 1,000 characters.

➋ Step 5 - Documentation of Discussion: Optional “Note” fields.

Confirmation: Upon completion and submission of the Referral Form, a confirmation message is presented. Please “print screen” for your records.

ReferralForm

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For Fertility Clinics/Sperm Banks

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RegisterAccount

Screen Description

From the Fertility Scout portal, by clicking “Create an Account,” you are presented with a form to create your account. Once completed, you will be taken back to the Fertility Scout portal for Clinics.

Code Description

➊Go to the clinic portal registration at: (https://locator.allianceforfertilitypreservation.org/clrt/app/login/register) where you will be presented with a form to create your account.

➋Create Your Account form. Provide the email address of the designated “fertility preservation contact” for your clinic to authenticate your clinic account.

➌ Click “Create My Account” once you have filled out the email and password.

Success message, providing further instructions to verify your new account.

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RegisterAccount

Screen Description

From the Fertility Scout portal, by clicking “Create an Account,” you are presented with a form to create your account. Once completed, you will be taken back to the Fertility Scout portal for Clinics.

Code Description

➊ You will receive an email from “noreply@remedyhealthmedia.com”

➋ Click the link to be taken back to the account website

➌ Provide Email and Password again to sign in to your new account

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AccountReferrals

Screen Description

Once your account is authenticated, and you login via the Clinic portal, you will have the ability to view any referrals that have been made to your clinic by either Patients or Health Care Professionals.

Code Description

➊ Click on Referrals to view all referrals you received.

➋ A list of existing referrals will be presented in chronological order.

➌The “eye” icon can be clicked the see the full details of the referral. The “download” icon can be used to download the individual referral.

All patient referrals or HCP referrals can be downloaded in a single comma separated value (.csv) file format by clicking “download all appointments” or “download all referrals” respectively.

Click “Clinic Referral Tool” to return to the Fertility Scout portal

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Intelecare Compliance Solutions, Inc.Proprietary & Confidential // Not for External Use or Distribution

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Joyce Reineckejoyce@allianceforfertilitypreservation.org

Alliance for Fertility PreservationP.O. Box 535Lafayette, CA 94549

ContactInformation