Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device.
Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device. Atlassian cookies and tracking notice, (opens new window)
{"xsrfToken":"f6db49a53eca29f41c7e612975b4c0924d221d04_lout","branding":{"id":"38","key":"cce","name":"CareAssist Customer Evaluations","portalBaseUrl":"/servicedesk/customer/portal/38"},"helpCenterBranding":{"logoUrl":"https://api.media.atlassian.com/file/f2a00341-0a6c-41f0-b5c7-4eaa8519b008/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiJlOTMxYjEyYy0zN2NlLTRlNGUtOTM0OS1lZjE2MjZhNGNhYjAiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOmYyYTAwMzQxLTBhNmMtNDFmMC1iNWM3LTRlYWE4NTE5YjAwOCI6WyJyZWFkIl19LCJleHAiOjE3ODQwNjQ4NDEsIm5iZiI6MTc4NDA2NDI0MX0.fszP0CSFB2B4Vt8SCgwBwm6I1L_rnJ58VWcpNpMYu4A&client=e931b12c-37ce-4e4e-9349-ef1626a4cab0&mode=fit","logoId":"f2a00341-0a6c-41f0-b5c7-4eaa8519b008","isLogoAvailable":true,"helpCenterTitle":"Welcome to the Long Tail Help Center","sharedPortalName":"Long Tail Help Center","translations":{"en-US":{"helpCenterTitle":"Welcome to the Long Tail Help Center","sharedPortalName":"Long Tail Help Center","localeDisplayName":"English (United States)"}},"canEditAnnouncement":false,"siteDefaultLanguageTag":"en-US","userLanguageTag":"en-US","portalThemeColor":"#0074e0","helpCenterTitleColor":"#0074e0","bannerMediaApiUrl":"https://api.media.atlassian.com/file/6e3ecae6-9842-4f17-8540-5828a01f3992/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiJlOTMxYjEyYy0zN2NlLTRlNGUtOTM0OS1lZjE2MjZhNGNhYjAiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOjZlM2VjYWU2LTk4NDItNGYxNy04NTQwLTU4MjhhMDFmMzk5MiI6WyJyZWFkIl19LCJleHAiOjE3ODQwNjQ4NDEsIm5iZiI6MTc4NDA2NDI0MX0.I6F28Bc3wCL5wsCb9tpyOkIio7vTAqstQsjYVKc78mA&client=e931b12c-37ce-4e4e-9349-ef1626a4cab0&height=300&mode=fit","bannerMediaApiFileId":"6e3ecae6-9842-4f17-8540-5828a01f3992","useDefaultBanner":false,"isBannerAvailable":true,"hasTopBarBeenSplit":false},"portal":{"id":"38","key":"cce","projectId":10337,"serviceDeskId":38,"name":"CareAssist Customer Evaluations","description":"<p>Welcome! You can raise a request for CareAssist Customer Evaluations using the options provided.</p>","portalBaseUrl":"/servicedesk/customer/portal/38","onlyPortal":false,"reqTypes":[{"id":"10476","name":"CareAssist Evaluation Report","descriptionHtml":"","callToAction":"CareAssist Evaluation Report","introHtml":"<p>Use this form to report any issues, disagreements, or suggestions for the CareAssist Level of Care Evaluations</p>","icon":10311,"iconUrl":"https://longtailhealth.atlassian.net/rest/servicedeskapi/requesttype/icon/type/issuetype/id/10311","groups":[46],"key":""}],"reqGroups":[{"id":46,"name":"General"}],"orderMapping":{"46":[10476]},"kbs":{"kbEnabled":true,"kbLink":{"appLinkId":"e6d1e36e-05b7-35db-99bc-fc9830ccf35b","appLinkName":"","appLinkUrl":"","spaceKey":"CAE","spaceName":"Care Assist Evaluation","spaceUrl":"","isServer":false},"labels":[],"projectKey":"CCE","serviceDeskId":38,"kbLinkDomainURLs":["https://longtailhealth.atlassian.net"]},"createPermission":true,"portalAnnouncement":{"portalId":38,"canEditAnnouncement":false,"canAdministerProject":false,"portalProjectKey":"CCE","userLanguageHeader":"","userLanguageMessageWiki":"","defaultLanguageHeader":"","defaultLanguageMessage":"","defaultLanguageDisplayName":"English (United States)","isUsingLanguageSupport":false,"translations":{}},"canViewCreateRequestForm":true,"isProjectSimplified":true,"mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiJlOTMxYjEyYy0zN2NlLTRlNGUtOTM0OS1lZjE2MjZhNGNhYjAiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpjb2xsZWN0aW9uOnVwbG9hZC11c2VyLWNvbGxlY3Rpb24tLTIwMzE1Nzg1NzAiOlsicmVhZCIsImNyZWF0ZSIsInVwZGF0ZSJdLCJ1cm46ZmlsZXN0b3JlOnVwbG9hZDoqIjpbInJlYWQiLCJjcmVhdGUiLCJ1cGRhdGUiXSwidXJuOmZpbGVzdG9yZTpjaHVuazoqIjpbInJlYWQiLCJjcmVhdGUiXX0sImV4cCI6MTc4NDA2NTQ0MSwibmJmIjoxNzg0MDY0MjQxLCJhbm9uSWQiOiJhbm9uLXVzZXIiLCJodHRwczovL2lkLmF0bGFzc2lhbi5jb20vYXBwQWNjcmVkaXRlZCI6ZmFsc2V9.5pFLRV3v2Ud4dT_EUHePrX9DsUrMa0gPhOufxawwaZE","targetCollection":"upload-user-collection--2031578570","endpointUrl":"https://api.media.atlassian.com","clientId":"e931b12c-37ce-4e4e-9349-ef1626a4cab0","tokenDurationInMins":20},"categories":{"categoriesSupported":true,"categories":[]}},"reqCreate":{"id":10476,"projectId":10337,"issueType":{"id":"10476","name":"CareAssist Evaluation Report"},"form":{"name":"CareAssist Evaluation Report","descriptionHtml":"","callToAction":"CareAssist Evaluation Report","intro":"<p>Use this form to report any issues, disagreements, or suggestions for the CareAssist Level of Care Evaluations</p>","instructions":"","icon":10311,"iconUrl":"https://longtailhealth.atlassian.net/rest/servicedeskapi/requesttype/icon/type/issuetype/id/10311","key":""},"fields":[{"fieldType":"text","fieldId":"email","fieldConfigId":"","label":"Email confirmation to","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"summary","fieldId":"summary","fieldConfigId":"","label":"Summary","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:textfield","fieldId":"customfield_10737","fieldConfigId":"10928","label":"Account ID","description":"","descriptionHtml":"","required":false,"displayed":false,"presetValues":[]},{"fieldType":"text","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:url","fieldId":"customfield_10733","fieldConfigId":"10924","label":"Attached Story","description":"","descriptionHtml":"","required":false,"displayed":false,"presetValues":[]},{"fieldType":"select","jiraFieldType":"priority","fieldId":"priority","fieldConfigId":"","label":"Priority","description":"","descriptionHtml":"","required":false,"displayed":false,"presetValues":[],"values":[{"value":"1","label":"Highest","selected":false,"children":[]},{"value":"2","label":"High","selected":false,"children":[]},{"value":"3","label":"Medium","selected":true,"children":[]},{"value":"4","label":"Low","selected":false,"children":[]},{"value":"5","label":"Lowest","selected":false,"children":[]}],"noneOptionRequired":false}],"userOrganisations":[],"canBrowseUsers":false,"requestCreateBaseUrl":"/servicedesk/customer/portal/38/create/10476","requestValidateBaseUrl":"/servicedesk/customer/portal/38/validate/10476","calendarParams":{"firstDay":0,"date":"2026-07-14T17:24:02-0400","useISO8601WeekNumbers":false,"dateIfFormat":"%e/%b/%y","dateTimeIfFormat":"%e/%b/%y %I:%M %p","timeFormat":"12"},"kbs":{"kbEnabled":true,"kbLink":{"appLinkId":"e6d1e36e-05b7-35db-99bc-fc9830ccf35b","appLinkName":"","appLinkUrl":"","spaceKey":"CAE","spaceName":"Care Assist Evaluation","spaceUrl":"","isServer":false},"labels":[],"projectKey":"CCE","serviceDeskId":38,"kbLinkDomainURLs":["https://longtailhealth.atlassian.net"]},"canRaiseOnBehalf":false,"canSignupCustomers":false,"canCreateAttachments":true,"attachmentRequiredField":false,"hasGroups":true,"canSubmitWithEmailAddress":false,"showRecaptcha":true,"siteKey":"6LePXLkdAAAAAF4gCNalrL1IvZcqbNbZf_Zakudd","mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiJlOTMxYjEyYy0zN2NlLTRlNGUtOTM0OS1lZjE2MjZhNGNhYjAiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpjb2xsZWN0aW9uOnVwbG9hZC11c2VyLWNvbGxlY3Rpb24tLTIwMzE1Nzg1NzAiOlsicmVhZCIsImNyZWF0ZSIsInVwZGF0ZSJdLCJ1cm46ZmlsZXN0b3JlOnVwbG9hZDoqIjpbInJlYWQiLCJjcmVhdGUiLCJ1cGRhdGUiXSwidXJuOmZpbGVzdG9yZTpjaHVuazoqIjpbInJlYWQiLCJjcmVhdGUiXX0sImV4cCI6MTc4NDA2NTQ0MiwibmJmIjoxNzg0MDY0MjQyLCJhbm9uSWQiOiJhbm9uLXVzZXIiLCJodHRwczovL2lkLmF0bGFzc2lhbi5jb20vYXBwQWNjcmVkaXRlZCI6ZmFsc2V9.MU94yfFVGAABeBaOUlFKi1Cl-EHeeh3fOkIn2ieTr3U","targetCollection":"upload-user-collection--2031578570","endpointUrl":"https://api.media.atlassian.com","clientId":"e931b12c-37ce-4e4e-9349-ef1626a4cab0","tokenDurationInMins":20},"hasProformaForm":true,"proformaTemplateForm":{"id":8384929743967185,"updated":"2026-06-24T03:45:34.636911873Z","publish":{"jira":{"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[10474,10476],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":8384929743967185,"name":"CareAssist Level of Care Evaluation","submit":{"lock":false,"pdf":false},"templateFormUuid":"b242cb63-59a2-446a-9dd9-8588421c4ea3"},"layout":[{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1},"text":"","layout":"default","localId":"43982069-18c9-4324-a107-e812933551ae"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":11},"text":"","layout":"default","localId":"9055aced-5385-485e-89f1-efac5c6e1c9f"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":9},"text":"","layout":"default","localId":"43eca599-3a90-4fbe-a99a-0ef52554e585"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":10},"text":"","layout":"default","localId":"22a39ff1-b1b7-4a2f-882d-4857894dc61f"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":6},"text":"","layout":"default","localId":"4ed0023a-58c9-44a4-b2de-8f398ed752c6"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":4},"text":"","layout":"default","localId":"c43aa3e1-8099-4dcd-a23a-da6371a694db"}}]}],"conditions":{},"sections":{},"questions":{"4":{"type":"rt","label":"Details","description":"Please provide any details possible on the issues marked above","validation":{"rq":false},"choices":[],"questionKey":""},"10":{"type":"cd","label":"CareAssist Determination","description":"The overall recommended patient status from CareAssist","validation":{"rq":false},"choices":[{"id":"1","label":"Inpatient","other":false},{"id":"2","label":"Outpatient","other":false},{"id":"3","label":"Evaluate","other":false}],"questionKey":""},"11":{"type":"da","label":"Evaluation Date","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"9":{"type":"cd","label":"Clinician Determination","description":"The patient status determined by you or a member of your team","validation":{"rq":false},"choices":[{"id":"1","label":"Inpatient","other":false},{"id":"2","label":"Outpatient/Observation","other":false}],"questionKey":""},"6":{"type":"cm","label":"Any Observed Issues","description":"","validation":{"rq":false},"choices":[{"id":"1","label":"Incorrect overall determination","other":false},{"id":"2","label":"Incorrect determination for specific day(s)","other":false},{"id":"3","label":"Missing clinical data in report","other":false},{"id":"4","label":"Incorrect clinical data","other":false}],"questionKey":""},"1":{"type":"ts","label":"Account #","description":"","validation":{"rq":true},"choices":[],"questionKey":""}}},"uuid":"b242cb63-59a2-446a-9dd9-8588421c4ea3"},"proforma":{"formExists":true,"formValid":true,"formTemplateData":{"id":8384929743967185,"updated":"2026-06-24T03:45:34.636911873Z","publish":{"jira":{"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[10474,10476],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":8384929743967185,"name":"CareAssist Level of Care Evaluation","submit":{"lock":false,"pdf":false},"templateFormUuid":"b242cb63-59a2-446a-9dd9-8588421c4ea3"},"layout":[{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":1},"text":"","layout":"default","localId":"43982069-18c9-4324-a107-e812933551ae"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":11},"text":"","layout":"default","localId":"9055aced-5385-485e-89f1-efac5c6e1c9f"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":9},"text":"","layout":"default","localId":"43eca599-3a90-4fbe-a99a-0ef52554e585"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":10},"text":"","layout":"default","localId":"22a39ff1-b1b7-4a2f-882d-4857894dc61f"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":6},"text":"","layout":"default","localId":"4ed0023a-58c9-44a4-b2de-8f398ed752c6"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":4},"text":"","layout":"default","localId":"c43aa3e1-8099-4dcd-a23a-da6371a694db"}}]}],"conditions":{},"sections":{},"questions":{"4":{"type":"rt","label":"Details","description":"Please provide any details possible on the issues marked above","validation":{"rq":false},"choices":[],"questionKey":""},"10":{"type":"cd","label":"CareAssist Determination","description":"The overall recommended patient status from CareAssist","validation":{"rq":false},"choices":[{"id":"1","label":"Inpatient","other":false},{"id":"2","label":"Outpatient","other":false},{"id":"3","label":"Evaluate","other":false}],"questionKey":""},"11":{"type":"da","label":"Evaluation Date","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"9":{"type":"cd","label":"Clinician Determination","description":"The patient status determined by you or a member of your team","validation":{"rq":false},"choices":[{"id":"1","label":"Inpatient","other":false},{"id":"2","label":"Outpatient/Observation","other":false}],"questionKey":""},"6":{"type":"cm","label":"Any Observed Issues","description":"","validation":{"rq":false},"choices":[{"id":"1","label":"Incorrect overall determination","other":false},{"id":"2","label":"Incorrect determination for specific day(s)","other":false},{"id":"3","label":"Missing clinical data in report","other":false},{"id":"4","label":"Incorrect clinical data","other":false}],"questionKey":""},"1":{"type":"ts","label":"Account #","description":"","validation":{"rq":true},"choices":[],"questionKey":""}}},"uuid":"b242cb63-59a2-446a-9dd9-8588421c4ea3"},"linkedJiraFields":[]},"key":""},"portalWebFragments":{"headerPanels":[],"subheaderPanels":[],"footerPanels":[],"pagePanels":{"propertyPanels":[],"legacyPropertyPanels":[]}}}