eng appeal
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- [Нецелевые запросы](./Нецелевые запросы/)
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- [Нецелевые запросы](./Нецелевые запросы/)
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- [Настройка замещения](./Настройка замещения/)
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- [Настройка замещения](./Настройка замещения/)
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- [Работа под замещением](./Работа под замещением.md)
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- [Работа под замещением](./Работа под замещением.md)
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- [User Guide](./User Guide/)
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docs/User Guide/Non target request.md
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Website for working on the Lexema portal - [https://lexema.zub.ru/](https://lexema.zub.ru/)
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Login Start Page
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Initial Page
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## Stage 1 of Non-Targeted Request
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To create a Non-Target Request, click the button in the tile menu – __«Create non-target request»__
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A form will open.
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Mandatory fields for filling will be highlighted in red when sending the request through the route.
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__Fill in the patient’s details:__
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<br/>Full Name – MRN and Full Name
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<br/>Date of birth
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<br/>Contact phone
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<br/>Patient Category – VMI, Cash payment, Not specified.
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<br/>Short description of the request
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<br/>
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__Main Information:__
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<br/>Urgency – Yes, No, Unknown
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<br/>Operator’s contact number – operator’s internal number
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<br/>Request Category – select from the dropdown list
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To select «Subdivision», you need to click the «plus» button 
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From the dropdown list, select your direction: General Medicine or Dentistry.
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Then click on the empty Responsible manager field and click «Insert».
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<br/>
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If desired, you can add comments.
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You can also add __attachments__.
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Once all fields in the request are filled, send the non-target request through the route __«Send Workflow»__.
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The route is built. Then click the **«Register»** button.
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Click «OK»
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The request will be visible in the sent items (Inbox) until it is processed
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Upon completion of a non-targeted request, a comment (response) will be received as follows:
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A push notification to the email with the comment on the non-targeted request.
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<br/>The token "Main Page" – "Inbox".
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After receiving the response, the agent needs to go to the "Inbox" token, open the request, and in the upper left corner, click “Finish”.
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## Stage 2 of Non-Targeted Request
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Requests received for processing are located on the main incoming requests screen.
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To complete the non-targeted request stage, you need to click the "Confirm Execution" button, fill in the mandatory field, and click "OK."
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<br/>
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Comments about completing the stage will be displayed by clicking the "Route" button. 
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<br/>
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Without completing the stage, a comment can be added to the "Entering comments" table by clicking the "Add" button.
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## Registry of non-target requests
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All non-target requests can be found in the «Appeal Journal» on the main form
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In the what to find field, select «Non-targeted requests data» and click
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The selection by categories can be collapsed
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Colors in the selection
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<br/>Red - Overdue
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<br/>Yellow – 2 hours before any stage is overdue or one of the stages is overdue
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<br/>White – in progress
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<br/>Green – closed
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## Participants of the route by request categories
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The route for a non-target request consists of three stages:
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<br/>Stage 1: Initiator – Start the route
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<br/>Stage 2: Responsible persons – Execute
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<br/>Stage 3: Initiator – Complete
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For each category, Observers are assigned who have access to non-target requests. They also receive a notification about delays if the request processing deadline expires.
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| | Direction | Category | Performers | Observers |
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|---|---|---|---|---|
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| 1 | General Medicine | Request to send documents (invoice, medical report, refund form) | Alaa Ali Rahal <br/> Shayma Mohamad | Anna Voskanyan <br/> Wesam Al Ashkar <br/> Mustafa Omer |
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| 2 | Dentistry | Request to send documents (invoice, medical report, refund form) | Alaa Ali Rahal <br/>Shayma Mohamad | Anna Voskanyan <br/>Olga Voronets <br/>Mustafa Omer |
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| 3 | General Medicine | Approval status | Imran Mohamed <br/>Priya Manoharan | Anna Voskanyan <br/>Mustafa Omer |
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| 4 | General Medicine | Test results | Alaa Ali Rahal <br/>Shayma Mohamad | Anna Voskanyan <br/>Wesam Al Ashkar <br/>Mustafa Omer |
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| 5 | General Medicine | Worsening condition | Wesam Al Ashkar <br/>Alaa Ali Rahal <br/>Shayma Mohamad | Anna Voskanyan <br/>Charalampos Harris Zourelidis <br/>Mustafa Omer |
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| 6 | Dentistry | Worsening condition | Olga Voronets <br/>Alaa Ali Rahal | Anna Voskanyan <br/>Charalampos Harris Zourelidis <br/>Mustafa Omer |
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| 7 | General Medicine | Explanation of prescribed tests/medications | Wesam Al Ashkar <br/>Alaa Ali Rahal | Anna Voskanyan <br/>Charalampos Harris Zourelidis <br/>Mustafa Omer |
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| 8 | General Medicine | Approval status - no request (no appointment, medical record not filled) | Wesam Al Ashkar <br/>Imran Mohamed <br/>Priya Manoharan | Anna Voskanyan <br/>Mustafa Omer |
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| 9 | Dentistry | Approval status - no request (no appointment, medical record not filled) | Olga Voronets <br/>Imran Mohamed <br/>Priya Manoharan | Anna Voskanyan <br/>Mustafa Omer |
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| 10 | General Medicine <br/> Dentistry| File won’t open, application not working | Ihsana K Mohammed | Anna Voskanyan <br/> Mustafa Omer |
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| 11 | General Medicine | Results not received, although they were sent | Alaa Ali Rahal <br/>Shayma Mohamad | Anna Voskanyan<br/> Mustafa Omer |
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| 12 | General Medicine | Want to contact the doctor (Questions after the visit) | Wesam Al Ashkar | Anna Voskanyan <br/>Mustafa Omer |
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| 13 | General Medicine | Availability of medications for IV drip | Alaa Ali Rahal <br/>Shayma Mohamad | Anna Voskanyan <br/>Wesam Al Ashkar <br/>Mustafa Omer |
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| 14 | General Medicine | MRI and CT Scan Details | Alaa Ali Rahal <br/>Shayma Mohamad | Anna Voskanyan <br/>Wesam Al Ashkar <br/>Mustafa Omer |
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| 15 | General Medicine <br/> Dentistry | Send a payment receipt, send a link to the payment | Mustafa Omer <br/> Maryna Protsenko <br/> Narek Aleksanian <br/> Nataliia Loboda| Anna Voskanyan |
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If you have any questions about working in Lexema, please contact us by clicking on "headphones"
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2
docs/User Guide/SUMMARY.md
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- [Non target request](Non target request.md)
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- [Working with the Appeal Card](Working with the Appeal Card.md)
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166
docs/User Guide/Working with the Appeal Card.md
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# Working with the Appeal Card
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## Creating an Appeal Card
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To create a patient appeal card, select the item in the tile menu – “Create Appeal Card”.
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A form will open<br/>
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In the opened window, you need to fill in the card fields; let’s consider them by blocks:
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1) __«Patient data», «Request text»__
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<br/>
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2) __"Main Information Block"__
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<br/>
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- _Category_
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<br/>Select from the “Appeal Categories” dropdown list:
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- _Pre-Trial_
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- _Subdivision, Responsible Manager_
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<br/>
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At the second stage, Responsible Managers become participants with the “Accept” action, as well as Branch Managers, via AND for multiple branches;
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Responsible Managers are also participants in the “Execute” stage; You can specify multiple divisions and their responsibles if the appeal concerns several branches or departments, using the “Add” button.
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To select a subdivision, click the “plus” to the right of “Responsibles”.</br>
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Click “Add”, select the required subdivisions from the dropdown list, click the “Responsibles” field (it will auto-fill).
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In the “Responsible Manager” field, Chief Physicians of the branch are selected; if there is no such position, an employee with the position of Manager will be selected.
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After that, click the “Insert” button.
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- _Direction_
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<br/>Select the direction; Observers are selected depending on the chosen “Direction”.
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- _Reason for appeal_.
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<br/>Selected from the dropdown list.
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- _Received from_<br/>
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- _Appeal source_<br/>
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- _Status_<br/>
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- _Accepted by_<br/>
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- _Payment type_<br/>
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- _Counterparty_ – insurance company, if known
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For the categories Quality of Treatment and Volume, the route also adds the Expert Physician stage (Conduct expert assessment). If the appeal is from an Insurance Company, the Initiator (accept) is added between Responsible Managers and the Expert Physician.
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3) In the __“The timing of the analysis”__ block, fill in the “Review Start Date” field. When sending the card along the route, a warning will appear if the field remains empty.
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Planned review deadline is 5 working days, excluding the “Review Start Date”; “Deadline Extension” – filled in by the Call Center employee at their stage, by the CC Manager at any stage. When changing the “Deadline Extension” field, the Planned review deadline also changes.
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The “Planned review deadline” value is set as the deadline for the route stages by the responsible person.
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“Deadline for insurance” – 2 working days, excluding the Review Start Date.<br/>
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The value is set as the deadline for the stages of reviewing appeals from insurance companies.<br/>
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The response date is also filled in manually. The number of review days is calculated automatically in working days according to the production calendar.<br/>
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4) Employees for whom the appeal is issued must be selected in the __“Employees”__ table:
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In the “Employees selection” column, a dropdown list of employees from the management structure.<br/>
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By entering part of the last name, you can filter the search:
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<br/>
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When selecting “Not defined”, the responsible person at the execute stage will need to add a new employee.
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5) __“Decisions of Responsible Managers”__ Table
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Using the “Load” button, the table is filled with rows for entering decisions and preventive measures for employees and categories
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Extra rows can be deleted. Deletion is also available at the “Correct” stage.<br/>
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Rows in the “Decisions of Responsible Managers” table added by the initiator are not available for deletion by other route participants – Responsible Managers.
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A Contact Center employee always has the option to withdraw the card using the button. <br/>
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To extend the review deadline at the request of route participants, it is necessary to fill in the field "Extension of the review deadline".<br/>
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|
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## Role: Responsible Manager
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### Description
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Cards for review are located on the main screen in the "Inbox" tab.
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In the request card, the Appeal Text and review deadlines are indicated.
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By clicking on Attachments, you can add files related to the review.
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### Accept
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At the "Accept" stage, you can add an employee to the card's route for review with the action "prepare"
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To do this, click on the route.
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Select the current stage and click Stage participant.
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|
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A new stage will be added with an empty field for adding a participant.
|
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|
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From the dropdown list, select the employee (this field is mandatory).
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|
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Then click _"Prepare"_.
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|
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You can add a comment when sending the card along the route.
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|
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### Execute
|
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|
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When the card arrives for processing with the action "execute", it is necessary to fill in the table "Decision of the Responsible Manager".
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|
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Mandatory fields are highlighted in red depending on Validity.
|
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|
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|
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The field "Who is guilty (Full Name)" is taken from the Employees table; you can add a new employee and then change it to the new one in the "Decision of the Responsible Manager".
|
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|
||||||
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<br/>
|
||||||
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|
||||||
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|
||||||
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If the employee "Not determined" is specified, it is necessary to fill in the "Employees" form and change the field "Who is guilty (Full Name)" in the "Decision of the Responsible Manager" table to the new participant.
|
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|
||||||
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If the review deadlines are approaching the end, you can click to send for revision, adding the corresponding comment with a request to extend the review deadline (excluding appeals from the insurance company).
|
||||||
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|
||||||
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<br/>
|
||||||
|

|
||||||
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|
||||||
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Comments are displayed in the route.
|
||||||
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|
||||||
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|
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