Veriphy Profile

Note: In this section, please identify your primary notification preferences. Veriphy messages are classified as Red, Orange, or Yellow. Based on experience, there are required devices for each finding. Any notification preferences you identify will be in addition to the required settings.
Step 1 - Red and Orange messages have a faster escalation cycle in that notifications are sent to the ordering physician rapidly over a brief period of time until the message is retrieved. Pager or a text message to your cell phone is required for Red and Orange messages.
Step 2 - Yellow message notifications are escalated over several days. Fax is required for Yellow messages.

Red results are critical / life threatening and require retrieval within 60 minutes. The Veriphy system will send a message every 25 minutes (2)

Orange results are priority / non-life threatening but could become so and require retrieval within 8 hours. The Veriphy system will send a message every 2.5 hours (3).

Yellow results are priority / non-emergent and require retrieval within 4 days. The Veriphy system will send a message once a day for 3 days.

instructionsI. Physician Information
Physician Name:
Nickname:
Practice/Group Name:
Office Phone:
Direct Office Telephone:
Primary Office Contact:
Address 1:
Address 2:
City:
State:	Zip:
Specialty:

instructionsII. Notification Devices (Please complete information for all devices)
Pager Number:
Pager Carrier:	MetroCall Arch Wireless Verizon SBC Other (please specify):
Pager Type:	Numeric Only Pager Alphanumeric (text) Pager
Clinical Fax Number:
Cell Phone Number:
Cellular Carrier:	Verizon Cingular T-Mobile Sprint Nextel Other (please specify):
Email:

instructionsIII. Primary Notification Preferences (X’s are system requirements, Please specify any additional devices)
PRIMARY CONTACT	“Red” Critical Results	“Orange” Priority Results	“Yellow” Priority Results
Pager: or Cell Ph txt Msg:
Fax:
Email:

instructionsIV. Backup Notification Devices (if different than section II)
Cell Phone Number:
Pager Number:
Fax Number:
Email:

instructionsV. Backup Notifications Preferences
BACKUP	“Red” Critical Results	“Orange” Priority Results	“Yellow” Priority Results
Pager: or Cell Ph txt Msg:
Fax:
Email:

instructionsVI. Telephone/Answering Service Voice Notification
Direct Number to Answering Service:

Seton Family of Hospitals Critical Values Reporting Profile