Patient ExperienceWhat your patient sees on their own device
Insurance & eligibility
Healthcare Program Demonstration
⚙️ ENGINEER BUILD DEV Mock data throughout · integration points flagged with TODO · settings editable in the drawer.
Personal info
Manage your basic details to keep your profile accurate and up to date.
HV
Upload image
Min 400×400px, PNG or JPEG
Contact information
Provide the contact information for your records and communications.
Residential address
Enter the patient's current address to support billing, correspondence, and location-based services.
HIPAA Consent
Please review how your health information is used and confirm your information and preferences.
Privacy practices & authorized contacts
Authorized contacts
You may add people you authorize us to communicate with about your care, appointments, billing, or medical information. You may update or revoke these permissions in writing at any time.
Membership Agreement
Please read the full agreement. You choose how to pay your membership on the Secure payment step.
TODO: concierge check-in step. The agreement is the same document as P4 → Subscriptions → Membership forms (wording version, plan and prices from Subscription settings). Store the typed signature, date, wording version and device with the membership.
Medical historyDental health history
Medical screening
Do you have any of the following? Choose DK if you don't know.
Active tuberculosis
YesNoDK
Persistent cough > 3 weeks
YesNoDK
Cough that produces blood
YesNoDK
Exposed to anyone with tuberculosis
YesNoDK
If you answered Yes to any of the four items above, please stop and return this form to the receptionist.
TODO: forms engine is shared for dental & medical; bind to the practice's form library + past-forms carry-over. Questions are generated from Intake Form Designs — change wording there, not here.
🩺
Medical history — History & Physical
H&P intake · Dr. Sample’s Office · same questions as Intake Form Designs
Reason for visit
Tell us why you’re here today
You’re booked for your check-up.
You’re booked for the next visit in your treatment plan:
Go over your resultsFollow-up visit · from your treatment plan
NoYes
We use this to prepare your estimate.
Weight managementKnee painBack painChest painStomach or belly painHeadacheCough or coldAnnual check-up
New problemFollow-upAn old problem that’s worse
No injuryAt homeAt workCar accident
About the problem
The details your clinician asks about first
Where, and what it feels like
LeftRightBothMiddle
How bad, and when
0 is no pain · 10 is the worst you can imagine
All the timeIt comes and goes
What you’ve tried
One row for each thing you tried — so we know which one helped.
Your clinician will go over any other symptoms with you during the visit.
Medical history
Confirm what we have on file, and add anything new
Health conditions
YesNo
Surgeries
YesNo
Medicines you take now
Include vitamins, supplements and anything over the counter.
YesNo
Allergies
YesNo
Family health
Only close blood relatives. Tap what you know — “None known” is a real answer.
Lifestyle & measures
A few habits and measurements
Tobacco
NeverI used toI do now
NeverI used toI do now
Alcohol — three quick questions
1. How often do you have a drink containing alcohol?
NeverMonthly or less2–4 times a month2–3 times a week4+ times a week
2. How many drinks do you have on a typical day when you drink?
1 or 23 or 45 or 67 to 910 or more
3. How often do you have 6 or more drinks on one occasion?
NeverLess than monthlyMonthlyWeeklyDaily or almost
Activity and measurements
How you’ve been feeling
Two short check-ins
Over the last 2 weeks, how often have you been bothered by…
1. Little interest or pleasure in doing things
Not at allSeveral daysMore than half the daysNearly every day
2. Feeling down, depressed, or hopeless
Not at allSeveral daysMore than half the daysNearly every day
3. Trouble falling or staying asleep, or sleeping too much
Not at allSeveral daysMore than half the daysNearly every day
4. Feeling tired or having little energy
Not at allSeveral daysMore than half the daysNearly every day
5. Poor appetite or overeating
Not at allSeveral daysMore than half the daysNearly every day
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Not at allSeveral daysMore than half the daysNearly every day
7. Trouble concentrating on things, such as reading the newspaper or watching television
Not at allSeveral daysMore than half the daysNearly every day
8. Moving or speaking so slowly that other people could have noticed — or the opposite, being so fidgety or restless that you have been moving around a lot more than usual
Not at allSeveral daysMore than half the daysNearly every day
9. Thoughts that you would be better off dead, or of hurting yourself in some way
Not at allSeveral daysMore than half the daysNearly every day
PHQ-2 first. The other seven questions appear only if the first two add up to 3 or more.
A few more questions — in the past month
1. Have you wished you were dead, or wished you could go to sleep and not wake up?
YesNo
2. Have you had any actual thoughts of killing yourself?
YesNo
3. Have you been thinking about how you might do this?
YesNo
4. Have you had these thoughts and had some intention of acting on them?
YesNo
5. Have you started to work out, or worked out, the details of how to kill yourself? Do you intend to carry out this plan?
YesNo
6. Have you ever done anything, started to do anything, or prepared to do anything to end your life?
YesNo
6b. Was this in the past 3 months?
YesNo
Columbia Suicide Severity Rating Scale — screener. Shown only after a positive answer to question 9.
And over the last 2 weeks, how often have you been bothered by…
1. Feeling nervous, anxious, or on edge
Not at allSeveral daysMore than half the daysNearly every day
2. Not being able to stop or control worrying
Not at allSeveral daysMore than half the daysNearly every day
3. Worrying too much about different things
Not at allSeveral daysMore than half the daysNearly every day
4. Trouble relaxing
Not at allSeveral daysMore than half the daysNearly every day
5. Being so restless that it is hard to sit still
Not at allSeveral daysMore than half the daysNearly every day
6. Becoming easily annoyed or irritable
Not at allSeveral daysMore than half the daysNearly every day
7. Feeling afraid, as if something awful might happen
Not at allSeveral daysMore than half the daysNearly every day
GAD-2 first. The rest appear only if the first two add up to 3 or more.
🦷
Dental health history
Dental intake · Dr. Sample’s Office · same questions as Intake Form Designs
Reason for visit
Tell us why you’re here today
You’re booked for your check-up.
You’re booked for the next visit in your treatment plan:
Fill the small cavity found at your last examFollow-up visit · from your treatment plan
NoYes
We use this to prepare your estimate.
About the tooth or area
NoYes
New problemFollow-upAn old problem that’s worse
Dental & medical history
The health details that change dental care
YesNo, I’ve been here before
Nothing has changedSomething changed
Bone-strength medicines
NoYesNot sure
A pillAn IV dripAn injection
Still takingI stopped
Blood thinners
NoYesNot sure
Diabetes
NoYesPrediabetes
A lab reportMy best memory
Heart and antibiotics
NoYesNot sure
Pregnancy
NoYesNot sure
Allergies that matter in the dental chair
Your last visits
Within 6 months6–12 months1–2 yearsMore than 3 yearsNever
This helps us check what your insurance covers today.
A few pictures while I bit down on a small tabLots of small pictures all around my mouthA machine moved around my headNot sure
TODO: in the product this is asked only when today’s visit includes X-rays and neither the payer (Stedi) nor our chart has the last date. Stedi returns the limit; this fills the date when nothing else can.
NoYesNot sure
Create your Good Faith Estimate
Snap the insurance card — the Eligibility Waterfall verifies benefits and prepares the estimate.
How would you like to proceed for this appointment?
Diagnostic & preventive 100% Basic services 80% Major services 50%
Annual max $1,500 Deductible $50 Ortho lifetime $1,000
Fully Insured · Payer ID 94276Delta Dental PPO Plus
📷 Kiosk: place your ID / insurance card under the built-in scanner.📱 Your phone: snap your ID / insurance card with your camera.
TODO: card OCR → new patient creates profile + runs 270/271; existing patient auto-revalidates each visit. Kiosk or any device via appointment-reminder deep link.
0/100
Eligibility Waterfall running…
Building your assurance rating across multiple verification levels.
Level 1 — real-time payer eligibility (270/271)
Level 2 — alternate clearinghouse cross-reference
Level 3 — billing & eligibility specialist review
Benefits verified
Benefits verified · 92 assurance Multi-level checks build a real assurance score: Level 1 automated payer eligibility (270/271) ✓ · Level 2 alternate clearinghouse cross-reference ✓ · Level 3 human eligibility expert confirms in real time when your desired score isn't reached. This waterfall ensures efficiency, accuracy, and Good Faith Estimate compliance!
✦ Verified automatically by your built-in Biller agents.
Services we’ll estimate for this visit
Office visit with your provider
Heart tracing (ECG)
Routine blood panel
Blood draw
Check-up with your dentist
Bite-down X-rays
Cleaning
Fluoride
Services estimated from your reason for visit — confirmed by our team before your claim.
TODO: POL embedded from choose-payment.html (#pol). Mount as a component; pass verified benefits + Healthcare Program config. On payment completion, advance the demo to After-your-visit.
BEFORE TREATMENT · HOW YOUR PRACTICE TAKES PAYMENT
Accept payment
Offer one or both. Payment can be before or after treatment based on your workflow. Forms alone can come first if that works better for you.
⏸ OFF-SCREEN MOMENT · NOT IN THE SOFTWARE
Your patient is seen & treated
Payment can be before or after treatment based on your workflow. Forms alone can come first if that works better for you.
Treatment happens in the exam room — outside any software. If you're using Myriad MediPay as an integrated or stand-alone solution, your patient is treated through your current system — you are in charge of your workflow. Upgrade now or later at no additional cost. For dental, clinical documentation will proceed through your outside DPMS system.
For an all-in-one demo and to see Myriad's clinical flow — simply ask your consultant to demonstrate now or in the future.
Practice interface · front officeAt the time of treatment
6–7
Practice interface · back officePatient RCM & reporting
What your clinician receivesH&P — new patient · drafted from check-in · the clinician confirms before signing
Chief complaint
“Tightness in my chest on the stairs” — chest pain · 3 weeks · new problem.
History of present illness
Chest, midline, aching. 3/10 now, 5/10 at worst. Comes and goes, a few minutes at a time. Started climbing stairs at work. Rest — a little better. Does not spread. Associated: numbness or tingling.
Review of systems
1 suggestion from check-in Neurologic · numbness or tingling — reports · Accept / Dismiss
Documented by the clinician in the note. Nothing prints until accepted.
Past history · medicines · allergies · family
High blood pressure. Lisinopril 10 mg daily. Penicillin — hives. Father — heart disease.
Social history & screening
Never smoker. AUDIT-C 1/12. PHQ-2 0/6 and GAD-2 0/6 — negative; full questionnaires not administered.
Exam · assessment & plan
Written by the clinician — never asked of the patient.
What your clinician receivesDental record — new patient · drafted from check-in · the dentist confirms before signing
Reason for visit
Check-up and cleaning · no concerns reported · last dental visit 6–12 months ago.
Medical & dental history
No bone-strength medicines. No blood thinners. No diabetes. No heart condition needing antibiotics. Not pregnant.
Medical gates in force
None.
Allergy flags
Latex — none. Local anesthetic — none. Antibiotics — none.
Charted findings
Charted by the dentist — never asked of the patient.
TODO: H4 preview is a static picture of the clinical environment (myriad.health/login). In the product the H&P draft, ROS suggestions and dental gates come from the check-in answers via the note engine.
Every next action for this encounter, queued and ready to execute.
This is the practice portal your team lives in. Everything the patient did at check-in lands here — and when they'd rather not do it themselves, your front office can run the whole payment for them from this screen.
TODO: practice portal embedded from myriad-portal.html (rebuild of /portal/dashboard per the Sep 18 UI handoff). Perform Checkout posts to the payments service; the rest is the live product.
P4 · Subscriptions runs memberships for concierge and direct primary care: enrollment, the membership letter and agreement, check-in, checkout and the prepayment ledger. A member who signs up on the Patient Option Letter lands here.
TODO: P4 Subscriptions embedded from the concierge demo build (same code as the standalone file). Settings → Concierge practice and P4 → Subscription settings → Membership program are the same keys.
Insurance has posted. IncomeIQueue lines up every next action for this encounter — you validate and execute in one click.
TODO: IncomeIQueue embedded from incomeiqueue.html (exact product interface). Pass the encounter + Healthcare Program config in production.
Guaranteed
A dramatic reduction in patient A/R and billing costs — or we take it back.
We do it this way — and report it back to your practice — so you never have to take our word for it. Track it yourself and watch time-of-treatment payments and payment arrangements rise with a healthcare-exclusive payment compliance platform.
TODO: figures from the reporting service (same calc as the PracticeIQueue savings widget). Wire live values + date-range filter.
Healthcare Program Demonstration
Sign in
Access your demo environment by choosing what you’re here to do, then signing in
This tags the session in your demo history and personalizes the run.
Thank you for your interest.
We waive our setup and training fees and simply need some basic information to get you up and running on this system. If it fails to significantly decrease patient A/R and billing costs, we will take the system back at absolutely no cost or penalty to your practice.
But don’t take our word for it… try it and see the results for yourself.
Effective Date: Not available Practice Name: Dr. Sample’s Office Contact: (914) 555-0142 · privacy@drsampleoffice.com · 123 Main Street, Suite 200, New York, NY 10001
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This notice applies to health information maintained by Dr. Sample’s Office, including information created, received, stored, or transmitted through our electronic health record, patient portal, billing systems, payment systems, and related healthcare technology vendors acting on our behalf.
Your Rights
When it comes to your health information, you have certain rights.
Get a copy of your medical record.
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record.
You can ask us to correct health information you believe is incorrect or incomplete.
We may say “no,” but we will tell you why in writing within 60 days.
Request confidential communications.
You can ask us to contact you in a specific way (phone, email, text, portal, or a different address).
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share.
You can ask us not to use or share certain information for treatment, payment, or operations.
If you pay out-of-pocket in full, you may ask us not to share that information with your health insurer.
Get a list of those with whom we have shared information.
You can ask for an accounting of disclosures for the six years before your request.
Get a copy of this notice.
You can ask for a paper or electronic copy of this notice at any time.
Choose someone to act for you.
A medical power of attorney, legal guardian, or authorized representative may exercise your rights on your behalf.
File a complaint if you believe your rights were violated.
You can complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you.
How does payment start?
Patient initiated or practice initiated. Every path ends at treatment.
Patient initiated
Practice initiated
Entering the kiosk…Signing you in at the front desk.
9:41
‹DS
Dr. Sample’s OfficeText Message
Today 1:00 PM
Hi Hannah, this is a reminder of your appointment with Dr. Sample’s Office in 1 hour, 2:00 PM EST.
Details:
123 Main Street, Suite 200
New York, NY 10001
Confirm or complete your forms:
We found your appointment. To finish checking in, please complete your forms and any required details. It only takes a few minutes, and a staff member is happy to help if you need anything.
ProviderAnthony D.
Date07/27/2026, 7:09 PM
Welcome to Dr. Sample’s Office
It appears you are a new patient or new to this secure check-in system. We’re happy to have you! For any assistance, please call (914) 555-0142, or ask a staff member.
Or scan to sign in from your phone
Terms & Conditions
Set up before you startApplies to the whole demonstration.
Standard — the full option set including cash, check and deferral.
MyRelay enabled
Forms come before treatment either way.
🩺
Your workflow, your choice
Myriad Clinical gives you charting, notes & orders in one platform. Prefer your existing clinical or billing system? It integrates seamlessly.
You’re in charge of your workflow — upgrade now or later, at no additional cost.
🔗
Integrated workflow — MediPay × MedBill
MyGuide AI
Healthcare Program tour
◆ The Pre-Authorized Healthcare Rider
What makes this different
The Pre-Authorized Healthcare Rider linked in your letter converts a standard retail processing agreement into a healthcare agreement — recognizing your care as a healthcare service, not a product. That’s what protects the practice from chargebacks.
It’s also what unlocks payment options a retail account can’t offer — guarantees, plans, and card-on-file. Proprietary and patent-pending.
🗺️
Hannah’s journey
You are now viewing: Patient experience — Check-in
Patient (1–4) → Front office (5) → Back office (6–7) → loops back · tap any stop to jump
▲ Demo guide · steps, settings & tour ▲
Patient → Practice · tap any stop to jump
Program configuration
◆ Demo only
Practice
Dr. Sample’s Office
Medical practice
As a concierge practice, are you also in network with insurance?
Do you collect all copayments, coinsurance and deductibles on top of your concierge fee?
Does the membership prepayment also cover deductibles?
Which version of your membership forms?
Membership plan on the letter
This patient’s membership fee
CPT sample codes & services
Switches the GFE & Dr. ClearCare code set, the intake form (H&P vs dental health history), and practice branding across the demo.
Patient check-in entry
Kiosk patient status
Patient intake forms
Check-in & kiosk background
#1F9AE2
Practice software · front desk
Practice softwareMyRelay posts payments, forms and documents back
Saving the payment in their softwareMyRelay fills the payment screen in their software. Staff click its Save / Post button, or MyRelay clicks it too
MedBill waterfall eligibilityLive human checks behind every automated check. Below your desired rating, MedBill runs rush eligibility. Patent pending confidence-tier automations
Desired assurance ratingThe goal on the eligibility PDF; the checkout and the kiosk rate against it
Eligibility before the visitRun ahead of the visit (batch), or a walk-in: staff press Run eligibility in the checkout
Demo eligibility resultHow today’s live check comes back, in the checkout and at check-in
Kiosk hardwareiPad on a stand, or the Myriad Terminal Kiosk (ID scanner, tap to pay, embedded card reader, status light)
KiosksOne kiosk by default. Add more for practices with several
Patient signatureWhere the patient signs on the kiosk
Intake formsSpecialty category. Its intake forms are pre-selected in the checkout
GratuityThe gratuity switch in the checkout payment summary
Good Faith Estimate & Dr. ClearCareAdded by staff as forms (default), or included automatically with every card payment and patient choice
Payment timingForms come before treatment either way
Integrated: the front desk clicks the amount field in their own software and the Myriad checkout opens beside it, pushing their screen aside. Stand-alone: the front desk works in Myriad’s payment screen.
Patient Option Letter
ToPs requires a payment option + a $250-capped card on file, removes “None of the above”, and pay-in-full saves 5% (reservation).
ToPs — Total Patient Services arrangements
Offered on the Patient Option Letter
Guarantee balance — $0 today; tokenized card on file covers only what insurance leaves.
Half now, half later — pay 50% at check-in; remainder scheduled to the card on file.
Pay in full today — 5% same-day discount (ToPs tier).
Request a payment plan — reviewed before any charge.
Card on file required for guarantee / plan arrangements.
Payment types
Base · included in every program
💳 Credit / debit card💵 Cash🧾 Check🏦 ACH / bank🛡 Guarantee · any amount🔁 Recurring charge
Always on. Guarantee covers whatever insurance leaves, up to Cap 1 below. Recurring charges are set up by staff in IncomeIQueue → P4.
In-person tender at the kioskCard is always accepted; choose what else the front desk takes
Recurring charge · longest patient-selected term
Optional · on by choice
Half now, half laterPay 50% today; the rest to the card on file
Pay the rest within
Remainder
Payment plansRequest a payment plan on the letter
Balance paid off within
With payments of at least
Patients can pay
Practice approval before a plan starts
Existing balances at check-inPop-up when the patient reaches payment
Allow plans for existing balances
Practice approval for those plans
Reservation SavingsA same-day discount on any pay-today option — card, cash, check or bank
Discount
Custom discount
%
Outside financingFinancing partner application from the letter
“None of the above apply”Lets the patient defer to the front desk
Card on file & caps
What should we hold on file?Default: the patient chooses whether to keep a card on file. Require = every payment option is followed by the Pre-Authorized Healthcare Form; the card covers ongoing treatments for one year. Locked to Require for ToPs. (v26M9.36)
Require a card when assurance is below
Cap 1 · GuaranteeAbove the cap is never charged; it is sent by statement
Cap 2 · Ongoing treatmentsPer-visit limit for later treatment balances on the card
Dollars per visit
Percent of the allowed amount
Authorization applies to
Estimate & letter
Show assurance rating to patient
Min assurance to show estimate
Minimum assurance to continueBelow it, check-in is routed to an eligibility expert before the letter
Show the cap on the letter
Compliance costA small per-transaction line on the letter and receipts
Amount
Label
Payment Policies
Use Payment PoliciesLinked from the letter footer; generated from these settings
Every setting here is the same field in Settings → MediPay Healthcare Program inside the app — change it in either place and both follow.
This patient
Signature already on fileA patient who kept a card on file has a signed Pre-Authorized Healthcare Form on record, valid twelve months — so they acknowledge and apply that signature. A patient without one signs. Decided per patient, not set by the practice.
Clinical handoff
Show clinical handoff previewStage 5 · what the clinician receives from this check-in. For all-in-one conversations; off for a MediPay-only demo.
Patient answers & the codes
How much should patient answers change the codes?
The practice default. Appointment types can override it, and staff can lock one appointment.
Using Swap automatically · practice default
Backend & dev notes
Build annotations · not practice-facing
Show dev notes in the appYellow dashed notes on every IncomeIQueue and P4 screen describing what to build
Card account updaterOff shows the at-risk upsell and the service order instead of the batch
Dev notes referenceOpens the full build-notes panel inside IncomeIQueue
Automated in product · exposed for the demo
Self-pay amount less than charge amountYes = self-pay discount applies (from Schedule of Fees)
IncomeIQueue — RCM policy
1 · Reconciliation
If final is below estimate
If responsibility exceeds the cap
Auto-charge run
2 · Invoicing
Automated invoice cadenceRe-send until paid or expired
Stop invoicing after
Once full payment is rendered, invoices stop automatically.
2b · Declines & chargebacks
When a recurring charge declines
Re-attempt after
Declined charge → text patient
Chargebacks & reversalsReturn the encounter to the queue with a suggested re-charge
Tell the patient when a default action runs
If a suggestion is never approved
3 · Patient RCM communications
Required blocks the action until the calls are logged (manager override with reason). Suggested only nudges.
Before a pre-auth is chargedMoney moves against the card on file.
Before an invoice goes outOften resolves the balance before it mails.
After an invoice goes outFollow-up once the patient has it in hand.
Recurring while a balance stays openRepeats until the balance clears.
TODO: mirrors Settings → Healthcare Program → IncomeIQueue RCM setup. Bind to the practice's saved policy; push to the embedded POL via postMessage.