This section provides a detailed overview of ABCDisability operation and features. Feel free to follow along with your iPhone/iPad and ABCDisability app.
The ABCDisability app has been designed and optimized for a landscape (horizontal is wider than vertical) screen orientation. We do not support using the current version of the app in portrait orientation.
This (above) is the ABCDisability app ("ABCD") start screen/login screen. You will see this screen only when starting the app for the first time or after restarting (not just screen off) your iPad.
Note the app version number in the lower right corner (current version is 148). Also note that the alpha version of ABCD is not intended for clinical use.
The login has been disabled for the alpha version. Just touch "Signup to ABCDisability to get started.
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| Fig. 1 |
This (above) is the "Add New Claimant" screen.
Touching the "Date of Birth" or "Date of Exam" boxes will bring up spinnable date wheels to make it easier to select the proper date.
"Adjustment #" should be "Adjudicator Number." It will be corrected in a subsequent release. "Location" means "location of exam." You may leave any field blank if there is no data for it.
Touch the male or female icon to indicate sex of the claimant.
Be sure to touch "Save" in the upper left corner before proceeding. You will see the notification "Record inserted successfully."
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| Fig. 2 |
Once you add one or more claimants, you will see a list of claimants (below), from which you will be able to access their disability reports. Touch the name of the claimant's report you want to access and then touch "Start Report Session."
You can edit claimant basic information by touching the claimant's name, then touching "Edit." Similarly, touching "-" will delete all records for a claimant while touching "+" will open the "ABCDisability Claimant Entry" screen.
As you navigate though the app, you will see a "Home" icon - looks like a little house. Touching the "Home" icon will return you to the "ABCDisability Claimant List" screen. No data will be lost. The Narrative Report will remain intact.
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| Fig. 3 |
This is the Chief Complaint (CC) screen (below). You must enter at least one Chief Complaint before accessing the rest of the app.
As you can see from the picture, major sections of the app are tabbed across the bottom of the screen and are visible at all times:
- CC Chief Complaint
- HPI History of Present Illness
- ROS Review of Systems
- F/SH Family History and Social History
- MEDS Medications and Allergies
- PE Physical Examination
- FA Functional assessments
- H&P History and Physical (Narrative Report (NR) is located here)
You can switch between tabs at any time. Any data you entered is always saved. Modifications/updates to the NR are also preserved.
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| Fig. 4 |
The Chief Complaint(s) - up to three - are entered in the box at the upper right. Conditions and diagnoses (optional) - up to five - are entered in the box at the lower right.
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| Fig. 5 |
Touching an entry box will open the on-screen keyboard (OSK). You may also use voice input (Siri) if you have an Internet connection by touching the microphone icon on the OSK. You can also connect a Bluetooth keyboard if you prefer typing on real keys.
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| Fig. 6 |
The balance of the CC screen contains optional inputs for
- Chart Review
- Imaging Results
- Physician Reports
- Prior Surgeries
- Lab Results
In future releases, you will be able to import electronic data from external sources and include it in these categories.
The top button, Initial Impressions, is different. It opens a new page containing a number of assessments.
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| Fig. 7 |
The screens below show assessments and inputs for
- General Appearance
- Handedness
- Coordination and Gait
- Assistive Devices
- Living Conditions
- Speech
- Corrective Lenses
Touching the "circle i" on the gray bar brings up an overlay showing textual tips where available. Touching the "circle i" hides the "Tool Tips." These Tool Tips do not interfere with functioning of the app.
Touching an icon may turn it green ("normal") or red ("abnormal").Touching it again will change the color of the icon and the finding text in the NR. In some instances, you may touch more than one icon in an assessment. In other instances, only one icon may be selected. Feel free to experiment. You won't break the app!
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| Fig. 8 |
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| Fig. 9 |
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| Fig. 10 |
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| Fig. 11 |
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| Fig. 12 |
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| Fig. 13 |
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| Fig. 14 |
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| Fig. 15 |
The next screen is History of Present Illness (HPI).
At top left is an interactive chart of history vs. severity for CC 1. Note that the time line increases from right to left. The farthest right column is "today." Touch a block in each column to show progression of the condition. You can indicate the date the condition began in the lower right of the screen.
At top right, you may select one or more causes for CC1. The window scrolls - touch, hold, and slide up to see the rest of the list.
At bottom left are icons for all of the activities impaired by the claimant's disability. Touching an icon turns it red. You can see the name of each activity by touching "circle i" in the lower right. You can change any assessment/data entry at any time simply by touching it. You can also delete or revise any text entered by clicking on the data field and changing the text as desired.
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| Fig. 16 |
The screen below shows HPI after entering data. Remember that the NR is being updated as data is entered into each of these sections. Click on the H&P tab at any time to see a "live" draft Narrative Report.
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| Fig. 17 |
The next section is Review of systems (ROS). Reported symptoms are shown by body systems. (Tool Tips are turned on in the screenshots for ease of explanation):
- General
- Cardio
- Endocrine
- GI
- GU
- HEENT
- Heme
- MSK
- Neuro
- Resp
- Psych
Touching an icon turns it red and updates the NR. Touching the icon again removes the red color and removes the NR text.
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| Fig. 18 |
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| Fig. 19 |
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| Fig. 20 |
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| Fig. 21 |
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| Fig. 22 |
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| Fig. 23 |
The next section is Family History.
In the diagram, the claimant is at center. Parents are above, siblings are left and right, and children are below.
Touch any family member icon for a drop-down menu of conditions (see second screenshot below). You may select one or more conditions for each family member. Touch anywhere on the screen to hide the drop-down menu. Touching the green Reset button will delete all of the selected conditions from the screen and from the NR.
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| Fig. 24 |
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| Fig. 25 |
Social History is accessed by touching the gray bar at the bottom of the Family History screen. There are assessments for alcohol consumption, tobacco consumption, illicit drug use, and exercise. Touch and hold the white dot while sliding it to the right. You can also indicate tobacco use history, up to ten years, by sliding your finger up or down in the small window to the right of "Years" on the tobacco consumption assessment.
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| Fig. 26 |
The next tab is Medications and Allergies. There are only a few medications and allergies shown. Touch one or more medications and/or allergies to select.
In future releases, we plan to include all prescription medications in the FDA database and all common allergies along with a free-text field for rare conditions.
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| Fig. 27 |
The next tab - a major one - is Physical Exam. The initial screen is for vital signs. Subsections are accessed via tabs across the top of the screen:
- Vital signs
- HEENT
- Neuro
- Musculoskeletal
- Respiratory
- cardiovascular
- GI
- Endocrine
- Skin
- Diagnoses
For PE Vitals, enter claimant's height and weight using the slider controls. The app automatically calculates BMI. You can choose English or Metric units using the slider switch in the middle top of the screen.
On the right of the screen, enter claimant's blood pressure and pulse using the sliders.
On the bottom right of the screen, indicate heart rhythm assessment:
- Normal
- Extra Beats
- AFib
- Other
For either of the abnormal heart rhythm assessments and "other," you may enter a note. Touch the abnormal finding you wish to annotate for a second or two, then remove your finger. A free text box will pop up (see screenshot 3 below). Touching inside the box will bring up the on-screen keyboard where you can type or dictate your note. All text in the box will be reproduced in the Narrative Report. There is no limit to the size of the note.
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| Fig. 28 |
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| Fig. 29 |
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| Fig. 30 |
The next PE tab is HEENT (Head, Ears, Eyes, Nose, Throat). Access it by touching the second tab along the top row.
Scroll down by touching the screen while swiping "up" to see the entire HEENT assessment screen.
The first set of assessments are normal/abnormal assessments for
- Head
- Ears
- Eyes
- Nose
- Throat
Touch the green button for a normal assessment and red for abnormal. Hold the red button for a popup text window. Touching the button a second time will remove the selection. Unselecting an abnormal assessment with text entered will delete that text.
In each section of HEENT, you may touch the "All Nl" (All Normal) green button to mark all assessments in that section normal. You may also change any of the assessments marked normal to abnormal. "All Nl" can serve as a shortcut to save time.
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| Fig. 31 |
The next section in HEENT is a detailed assessment of the eyes, arranged by the associated cranial nerve (II, III, IV, VI)
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| Fig. 32 |
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| Fig. 33 |
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| Fig. 34 |
Assessments for the balance of the cranial nerves not associated with eyes (V, VII, IX, X, XII, XI, and VIII) are in the next section.
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| Fig. 35 |
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| Fig. 36 |
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| Fig. 37 |
The next PE tab is Neuro - assessments of neurological and neuromuscular function. The three screens below show a number of neuro assessments involving body, arm, and hand movements.
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| Fig. 38 |
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| Fig. 39 |
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| Fig. 40 |
Next PE Neuro section is the sensory exam.
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| Fig. 41 |
Next PE Neuro section is examination of the claimant's reflexes.
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| Fig. 42 |
The last PE Neuro section is the neuromuscular strength assessment.
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| Fig. 43 |
The next PE section is Musculoskeletal ("MSK").
The first part of MSK consists of range-of-motion ("ROM") assessments, followed by assessments of extremity joints, followed by spine assessments.
The ROM assessments employ a slider that you touch and move. The ROM degrees number will change as you move the slider. The number and slider bar will change from gray to red or green as you move the slider, representing traditional ranges for normal and abnormal ROM. It is not possible to add notes to these assessments in this version of the app.
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| Fig. 44 |
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| Fig. 45 |
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| Fig. 46 |
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| Fig. 47 |
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| Fig. 48 |
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| Fig. 49 |
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| Fig. 50 |
The next section of PE MSK is assessment of the joints in the upper extremities. You may enter a note for any abnormal assessment by holding, then releasing the red button for that assessment. Don't overlook the assessments for the left and right sterno-clavicular joint on the inside of the diagram.
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| Fig. 51 |
Here are assessments for lower extremity joints.
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| Fig. 52 |
The last section in PE MSK is assessment of the sections of the spine.
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| Fig. 53 |
Moving to the right along the PE tabs at the top of the screen, the next section is Respiratory assessments.
At the top of the Respiratory section is a tool for entering the assessment of chest expansion upon inspiration. Use the slider to enter the difference between inspiration and expiration, in cm.
As you auscultate the claimant's breath sounds, you may choose from the following sounds/symptoms to document:
- Normal
- Rales/Crackles
- Wheeze
- Severe Wheeze
- Rhonchi
- Rub
Touch any picture in the middle of the screen to select that sound. Any or all sounds may be selected. Selecting Normal removes all other sounds; however, if you select Normal first, you may select any other individual sounds.
You may also select individual quadrants for sounds in both anterior and posterior locations by touching on the affected quadrant on the right side of the screen.
It is not possible to add text notes on this page in this version of the app.
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| Fig. 54 |
The next section in PE is Cardiovascular. The focus is on conducting the assessment via auscultation. You can document a number of heart sounds here from the following positions:
- Mitral
- Tricuspid
- Pulmonic
- Aortic
The waveforms show the approximate shapes of the sounds as heard through a stethoscope. Touching the waveform picture turns it green or red. Appropriate text is added to the NR. Touching the waveform picture again turns it back to gray and the text is removed. It is not possible to add text notes to this screen in this version of the app.
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| Fig. 55 |
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| Fig. 56 |
The next PE section is Gastrointestinal ("GI"). The diagram on the left is active for male claimants while the diagram on the right is active for female claimants.Touch the green button to indicate All normal. You may then select individual quadrants as abnormal and touch them to turn them red. Touch and hold a red quadrant to open a text box for notes.
The next section in PE is the Endocrine assessments. Again, touch the green circle at top for All normal, change any green area to red with another touch, and bring up the popup text window by holding, then releasing a red area.
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| Fig. 57 |
The diagram on the left is active for male claimants while the diagram on the right is active for female claimants.Long press and release on the red buttons opens a popup text box.
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| Fig. 58 |
The last section of PE is a free text box for your diagnosis/diagnoses. All text in this box will be replicated in the NR.
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| Fig. 59 |
Now that we have completed the overview of ABCD through PE, it's time to introduce you to the Findings Clipboard ("FC"). The FC lives in the background of ABCD, quietly collecting data as you work through the exam and app. The Findings Clipboard collects findings from the claimant's History (HPI, ROS, F/SH, MEDS) and from your Physical Exam (PE). The first screen below shows the History portion of the FC and the second screen shows the Physical portion. The History portion of the FC has a grayish blue background and the Physical portion has a light pink background.
The FC serves as sort of a digital notepad for the exam. It has a second important purpose in providing data for justification sentences that we will describe later.
Most entries will show an icon (some are incomplete, "coming soon"), a description of the abnormality, some details/values such as a specific angle for a ROM assessment, and any free text notes that you have entered for a given assessment.
You can see the FC at any time by touching the "circle f" icon shown on most screens. Scroll up and down through the FC by touching, holding and swiping vertically.
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| Fig. 60 |
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| Fig. 61 |
The next to last tab on the bottom bar is Functional Assessments (FA). The input screens are reproduced below. Here is a list of the assessments:
- Lifting
- Carrying
- Sitting, Standing, and Walking at one time without interruption
- Sitting, Standing, and Walking in an eight hour day
- Uses a cane/Does not use a cane
- Ability to perform activities involving left and right upper extremities
- Ability to perform work-related activities
- Work activity-related hearing and vision assessment
- Ability to tolerate exposure to various environmental conditions
- Ability to perform various personal activities
For the assessments Lifting, Carrying, Ability to perform activities involving left and right upper extremities, Ability to perform work-related activities, and Ability to tolerate exposure to various environmental conditions, touch one of the circles (Never, Occasionally, Frequently, Always) for each assessment.
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| Fig. 62 |
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| Fig. 63 |
For the assessments Sitting, Standing, and Walking at one time without interruption and Sitting, Standing, and Walking in an eight hour day, touch each slider and move it to the right to indicate the desired number of hours and minutes.
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| Fig. 64 |
For the assessment Sitting, Standing, and Walking in an eight hour day, If the total for sitting + Standing + walking is less than eight hours, the app requires you to enter an explanation for what the claimant was doing for the balance of the eight hours. Alternatively, you can adjust the sliders so that the total time is equal to or greater than eight hours.
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| Fig. 65 |
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| Fig. 66 |
For the assessment Uses a cane/Does not use a cane, if you touch Uses a cane, a window pops up with three additional cane-related assessments:
- How many blocks the claimant can walk without a cane
- If the cane is medically necessary
- If the claimant can carry small objects while walking with a cane
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| Fig. 67 |
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| Fig. 68 |
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| Fig. 69 |
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| Fig. 70 |
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| Fig. 71 |
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| Fig. 72 |
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| Fig. 73 |
For the hearing assessment, touch the left picture once for adequate communication (talking/listening) ability (green). Touch it again for inadequate communication ability (red). Touch the right picture once for adequate telephone ability (green). Touch it again for inadequate telephone ability (red).
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| Fig. 74 |
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| Fig. 75 |
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| Fig. 76 |
For the vision assessment, touch each picture once (green) to note adequate visual ability for the situation shown and touch again (red) to note inadequate visual ability.
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| Fig. 77 |
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| Fig. 78 |
Touching the Noise Tolerance icon brings up a popup with four Maximum Tolerable noise levels:
- Library
- Office
- Traffic
- Jackhammer
Personal activity performance assessments are yes (green) or no (red).
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| Fig. 79 |
Lastly, you may have noticed the "circle j" icon on the top gray bar for each assessment. Touching the "circle j" opens the Justification Clipboard ("JC").
The JC helps you build sentences in the Narrative Report that justify your ratings on each of the various functional Assessments. The sentences include chosen findings from the claimant's history and from the physical exam.
The sentence at the top of each screen details which of the Functional Assessments is being justified. TIP: Clicking on the "circle j" icon on a particular Functional Assessment screen will open the JC for that specific assessment.
The gray bar under the top sentence shows the justification sentence "under construction" in real time as you add findings to the Impacting Findings for the Functional Assessment.
The pink (first screen below) and gray (second screen below) boxes on the left of the screen show the contents of the Findings Clipboard you generated as you navigated through the app and exam.
To close the JC, simply touch a part of the screen that is not part of the Clipboard.
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| Fig. 80 |
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Fig. 81
To select a Finding and add it to the list of Impacting Findings, touch it and it will appear in the box on the right side. You can scroll up and down by touching, holding, and swiping.
The Impacting Findings box on the right on each screen will contain the Impacting Findings you select for the Justification Sentence for the Functional Assessment.
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| Fig. 82 |
To remove a Finding from the list of Impacting Findings, touch it and move your finger to the left. A "Delete" button will be revealed. Touch Delete and the Impacting Finding will disappear (it will still be available in the left side box if you change your mind later).
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| Fig. 83 |
Repeat this process for each Functional Assessment. All of the justification sentences will be placed in the proper location in the Narrative Report.
The Narrative Report (NR) is located in the History and Physical (H&P) tab. As explained on the "How Does It Work?" page, the ABCDisability app ("ABCD") generates a disability report "on the fly" as you navigate through the app and enter findings, history, and observations about the claimant.
The app starts with a "skeleton" report template. The template is fleshed out as you enter data. The report is updated "in real time" and it also removes data, phrases, and sentences if you go back into the app and make changes.
When you are finished entering data, the report is also finished. At that point you can edit the Narrative Report on the H&P tab to polish the report to your liking or just submit it via email to your state disability agency. At this point (alpha app version), manual edits made to the Narrative Report are not saved by the app. You have three options for saving/sharing the Narrative Report:
- Email the report using the default email client on your iPad. The NR will be sent as a PDF file attachment. Touch the "Email Report" button. [The View Tables Report button and feature is not functional in the alpha app version.]
- Print the NR to a network printer (must be on the same WiFi network as the iPad).
- Save and edit the NR in a word processing app. You will copy all of the text in the NR and paste to another app. Instructions:
- Touch anywhere in the NR. The on-screen keyboard will appear.
- Touch the screen again with a long press. A popup will appear "Select | Select All | Paste".
- Touch Select All. Another popup will appear: "Cut | Copy | Look Up | Share...".
- Touch Copy and the entire NR will be copied to the iPad clipboard.
- Exit the ABCD app.
- Select your favorite word processing app (Pages, Word, etc.).
- Create a blank document.
- Touch anywhere on the blank page. A popup will appear "Paste".
- Touch Paste and the NR will appear. You can then edit, format, etc.
Click here to see a completed sample Narrative Report.
