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Checkbox on bottom of Fax-to-Quit form clears out patient info

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We’ve had an issue (I think it is recent) with the Fax-to-Quit smart form. When you click on the checkbox at the bottom of the smart form that states “I certify that the patient has consented to be contacted and that I have faxed this form…” it deletes the patient name, today’s date, and patient DOB at the top of the form.

Any ideas? Or can anyone confirm this is also happening on their end? I can’t find any work around other than faxing without checking that box.


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