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If there is no prior appointment, EXACT will prompt you to create it during the COT.

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1. In the Chart tab, click the Add COT button to display the Add COT window (image below).
2. Specify NHS in the Payor field (if you leave this blank, EXACT will create a Private Course of Treatment)
3. Click the OK button (image below).
4. If you have not previously captured NHS fields for this patient, you will be presented with a NHS Patient Mandatory Fields screen, for capturing information that is required by NHS.

   NOTE: You must complete these fields to be able to continue.

   

   Guidelines:

   • If this information is unavailable at the time the appointment is booked or marked as arrived, the practitioner may Cancel and continue with the appointment, in which case this prompt will appear again when the practitioner opens a new COT for the patient.
   • If this prompt appears when opening an NHS COT, then this will be the last opportunity to enter this information... and if you do not enter the information at this point, you will not be able to save the patient file, so patient information will need to be gathered prior to the patient leaving the practice.
   • If the data is captured at the time the appointment is made, this prompt will not show again.
5. Complete the fields and then click OK to display the Treatment Plan Type:

   

   
   

   NHS patients under the pilot/prototype program fall into four Treatment Plan Types:

   
   

   Assessment	This is either an initial Oral Health Assessment (OHA) when the Patient first comes in (this can only be conducted once), or the Oral Health Review (OHR), which is a "repeat OHA". For OHA on edentate patients see also: Video 04: Special Oral Health Assessment Requires the following forms and actions: Exemptions and charges form Medical history Social history BPE Intra-oral assessment Extra-oral assessment (not mandatory) Clinical history Full Case System generated full risk assessment based on the input to the other forms FP17 on TC
   Additional Treatment	Any treatment required following an assessment or review. This includes urgent treatment where the patient does not wish to have a full assessment or review. No risk assessment will be calculated for this appointment type.
   Treatment outside of Pilot/Prototype	All treatments that cannot be categorised with the above two treatments, such as a treatment on referral into the Practice or orthodontic treatment. Requires the following forms and actions: Exemptions and charges form FP17 on TC
   Private Only	This is available from Phase IV (Prototype) as an option so that if a patient at your practice appears in your capitation list, all private course of treatment details for this patient will be sent with your appointment data transmissions.

   
   

6. With the Treatment Plan Type finalised, you need to complete the Exemptions and Charges Form (this has not specifically changed for the NHS Pilot/Prototype), and then click OK:

   

   
   

7. When you click OK, the Charting tab screen is pre-populated for charting and treatments on this patient, according to the Treatment Plan Type.

   For example:

   

   These are the assessment items that are mandated by the Department of Health.
   All items must be completed as part of the assessment, with the exception of the Soft Tissue Extra Oral Exam, which is optional.
   Complete all base charting before selecting the Full Risk Assessment, as the Full Risk Assessment software initially calculates scores from the base chart data.

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Each time that a practitioner completes any one of the NHS treatment items in Treatment Plans, EXACT checks whether the current appointment is linked to an appointment in the book.

If it is, EXACT uses the planned appointment.

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For example, if you have not yet created an appointment, EXACT prompts you to Create and Link Appointment for Today (if you already have an appointment booked, you won't see this button)

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For a copy or explanation of this guidance contact your PCC Regional Support Lead.

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For NHS Pilot/Prototype practices base charting is particularly important because it is used in two automated processes:

• EXACT automatically feeds the base chart data into the Full Risk Assessment, which a clinician runs after patient assessment.
• EXACT automatically transmits base chart data to NHS Dental Services.

  Please ensure that all clinical staff in the practice understand how to base chart in EXACT (learning resources include the Help information and the base charting video on the Portal).

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The DMF screen shows calculated scores from your base charting and enables you to adjust them.

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1. Create an NHS Course of Treatment (COT) for the patient, selecting the Assessment option:

   

   Work through the process, and after completing the Exemptions and Charges Form, the Charting tab screen will be ready for inputs on this patient:

   

2. Your task is to complete all of the NHS Assessment Items in the list. So long as they are incomplete, these items are represented with unchecked boxes (as below) and possibly blue text (this is customisable). The NHS Assessment is complete when every box is checked.

   Either click the checkbox or double-click the icon to open each item to edit its fields:

   

   IMPORTANT: You need to fully complete all assessment items (so that they all show as checked (ticked)). EXACT allows you to open each of these assessment items, partially complete it, close it, and then come back later to complete it - this is particularly useful for Receptionists who capture data off printed patient medical history forms. It also speeds the Assessment process once the patient is in the chair. To re-open an Assessment item, double-click its icon.

   When you fully complete an assessment item, it shows in the list with a checked box and black text. For example:

   

   
   

3. Each time that you complete any one of these NHS assessment items, EXACT checks whether the current appointment is linked to an appointment in the book. If not, it pops up a screen for you to either
   • Link to an existing appointment, or
   • Create and link an appointment.

   For example, if you have not yet created an appointment, EXACT prompts you to Create and Link Appointment for Today (if you already have an appointment booked, you won't see this button).

   

   Click this button to define the appointment as follows:

   

   You will then see the appointment at the top of the Course Of Treatment area, with the current time and the current user (In this example, "RGP"):

   

4. When you have successfully completed the NHS Assessment item, it will show as completed in the COT area. For example, here the Medical History item has been completed, shows a checked box, and displays in black text:

   

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• There is limited access to the patient's mouth.
• The patient refuses to answer questions / provide data.

EXACT enables clinicians to manage patient non compliance

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Patient medical history details are not transmitted to the NHS Dental Services, but EXACT does inform the NHS that the Medical History has been recorded.

IMPORTANT: EXACT will only inform the NHS of Medical History completion if you use this NHS Medical History screen (if you use the standard EXACT medical tab to record details the NHS will never know!).

There are no medical history questions specifically for the New Dental Contract Pilot, so practices can continue to use either the default form in EXACT or their current medical history form, which should be entered into the system through the medical history service code in the COT, rather than the medical history tab.

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1. Click the checkbox or double-click the icon for Medical History:

   

   NOTE: You must use this means of recording Medical History for NHS patients so that EXACT can transmit to the NHS a confirmation that the mandatory medical history was recorded. If you use the standard EXACT Medical screen, NHS will receive no confirmation that you completed a Medical History for this patient.

   The default Medical History screen displays:

   

   This is the same screen that you would access by means of the Update Medical History button in the Medical tab or in the Medical screen popup tooltip. It is customised for the Practice and has been pre-selected from options in the Medical History Configuration settings. NHS does not prescribe what questions to ask on this form, but requests that a medical history be completed.

   In most cases, you can update the screen by simply clicking options on-screen. Instead of a simple OK button, you are required to confirm changes by means of a dated button:

   

2. Click the Confirm Medical History on [date] button.
3. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

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The Intra Oral Assessment form is preset for the New NHS Contract. It is mandatory, and when you tick it, EXACT will load the Intra Oral Assessment window with Not Done defaulted.

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However, it is not mandatory, and items that you record are not transmitted to NHS Dental Services.

When you tick it EXACT will load the Extra Oral Assessment window with Not Done defaulted. This is the only extra oral option that can remain “Not Done”.

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Full Risk (system generated)

EXACT generates a Full Risk Assessment based on the information captured in base charting and in each of the forms from the NHS Oral Health Assessment.

The Risk Assessment Summary screen allows practitioners to review the scores for each of the domains, all patient actions, and all dental team actions.

EXACT calculates a Recall Interval based on the New Contract guidelines.

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1. Click the checkbox or double-click the icon for Full Risk Assessment:

   

   You will see a DMF (Decayed/Missing/Filled) screen with scores that the system has calculated from the base chart data on the state of the tooth, the state of the tooth surface, caries present and un-erupted/missing teeth. (This is the reason that base charting needs to be completed before the full risk assessment)

   

2. (Compulsory for NHS) Review these scores, edit them where necessary and check (tick) to confirm that this is a complete and accurate record. The information is later transmitted through to the Board and to the Department of Health.
   Note that changing the scores on the DMF screen does not retrospectively change the base charting on the tooth chart, and that the DMF will adjust automatically if a tooth with base-charted Caries is subsequently restored.
3. Complete the Full Risk Assessment Wizard. This uses the matrix in the backend of the EXACT system to provide a RAG (Red, Amber, Green) Score for each one of four domains:

   Caries Domain

   Tooth Surface Loss Domain

   Perio Domain

   Soft Tissue Domain

4. You may be prompted to link this COT to an appointment (all COTs must be linked to appointments). 

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1. Reopen it by double clicking on the Full Risk Assessment icon in the COT.
2. Move through the wizard to the summary screen and tick Preview Care Plan on Finish.

Caries Domain 

1. EXACT calculates a Caries Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

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To manually override the Calculated Score in a Caries Domain Full Risk Assessment

EXACT initially calculates the score/colour for the Caries Domain, based on Clinical and Patient findings.

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Tooth Surface Loss Domain 

1. EXACT calculates a Tooth Surface Loss Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

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Perio Domain

1. EXACT calculates a Perio Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

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In the prototype phase, this recall period was been increased to 12 months.
Note that you can still manually change it to a different period.

Soft Tissue Domain

1. EXACT calculates a Soft Tissue Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

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Even with assessment actions split across multiple appointments, EXACT is still able to correctly calculate the cumulative fields for the Summary Full Risk Assessment.

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When you charge for an appointment, EXACT calculates a recall period

When you charge for an appointment, EXACT calculates a recall period, and populates Recall Manager with the necessary data for recalls.

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"TC"ing is the process of completing a Course of Treatment (COT) in EXACT.

To see if there is a planned Interim Care (IC) appointment, look at the Care Pathways tab on the right of the screen in the Patient file:

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• The patient is considered stabilised.
• EXACT updates Recall Manager with relevant recall data.
• EXACT creates line items for the suggested Interim Care, including
  • Dental Team Actions based on the previous Summary Screen for Full Risk Assessment, and
  • An 0601 Patient Instruction for Oral Hygiene (if this is advice only it carries no charge, but if it contains treatment items such as scale or fissure sealants it carries a charge).
• EXACT suggests an Interim Care (IC) appointment date.
• EXACT populates the Appointment Workflow Departure List with a prompt for the receptionist to process the suggested appointment.

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1. Ensure that all Appointment lines are checked (ticked)

   

2. Click the TC button to display the Treatment Plan Completion window:

   

   
   

   Check on validity of the COT completion date: When you TC a COT a check is made to see if the contract is valid for the completion date of the COT. If it is valid for the completion date, the TC dialog displays with the contract disabled. If the contract is invalid for the completion date, and if there is only one valid contract, that valid contract displays with the control disabled. If the contract is invalid for the completion date, and there is more than one valid contract, the contract control displays as a combo box where you can choose a contract.

   
   

   You are asked whether you wish to continue with this care pathway (i.e. is the patient going to return for the IC?)

   The Yes option is checked by default. If the patient is willing to return for the IC appointment, to continue simply click OK.

   However, if the patient has stated that they do not wish to continue with treatment, select No and then select a reason from the dropdown menu:

   

   This will complete the treatment.

3. The FP17 form appears as usual, and you click the Send Claim button to continue.

   REMINDER: Select the Best Practice Prevention check box (mandatory) before you send the claim.

   

4. EXACT then does the following:
   • populates the COT

   

   • Sends all completed treatment items to History as they are completed.
   • Recalculates the recall due date based on the recall period from the date of stabilisation:

     

   • Suggests an approximate appointment date:

     

   • Automatically populates the Appointment Workflow Departure List with the suggested appointment. The Receptionist is then prompted to confirm this booking or arrange a more suitable one as the patient departs the practice. It is advisable to book the appointment at this time so that the patient is in the system.

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1. Right-click the Appointment header line.
2. From the right-click menu, select Mark Appointment Incomplete...
3. In the Treatment Plan Completion screen, click OK.

   EXACT then moves the completed actions to history with an AutoNote showing that it is incomplete, sets the actions as un-editable, and creates a New appointment populated with the incomplete Actions:

   

   NOTE: Although these assessment actions are now split across multiple appointments, EXACT is still able to correctly calculate the cumulative fields for the Summary Full Risk Assessment.

4. Continue the treatment or appointment as necessary.

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Charting the Required Treatment

After completing the Full Risk Assessment you need to chart any treatment that is required, if you have not done so already.

Image Modified

Conducting an NHS Assessment for Edentulous Patient

Base charting must be completed in order for EXACT to calculate the DMF correctly.

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Base charting must be completed in order for EXACT to calculate the DMF correctly.

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1. Proceed as for a normal assessment by starting from the Chart tab > Add COT button
2. EXACT will identify from the Patient Details that this patient is under 3 years old, and will specify domains accordingly:

   

   Notice that only the Caries domain is compulsory.

3. Make a clinical decision on whether to include Tooth Surface Loss, Perio and Soft Tissue domains (tick any that apply).
4. Click OK to continue.
5. Work through the actions that are listed under the Appointment.

   Notice that you only need to complete fields that relate to the compulsory Caries domain plus any domain/s that you optionally chose to include.

   The Full Risk Assessment Summary will only score for the Caries domain plus any domain/s that you optionally chose to include.

   A BPE is not required for under 3 year old patients, so will not appear as an action in the Appointment list. However, if you choose to conduct a BPE, add it to the Appointment from the Service List:

   

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Base charting must be completed in order for EXACT to calculate the DMF correctly.

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1. Proceed as for a normal assessment by starting from the Chart tab > Add COT button
2. EXACT will identify from the Patient Details that this patient is under 7 years old, and will specify domains accordingly:

   

   Notice that the Caries, Perio and Soft Tissue domains are compulsory.

3. Make a clinical decision on whether to include Tooth Surface Loss domain (tick to apply).
4. Click OK to continue.
5. Work through the actions that are listed under the Appointment.

   Notice that you only need to complete fields that relate to the compulsory domains plus Tooth Surface Loss, if you choose to include it.

   The Full Risk Assessment Summary will only score for the compulsory domains plus plus Tooth Surface Loss, if you chose to include it.

   A BPE is not required for under 7 year old patients, so will not appear as an action in the Appointment list. However, if you choose to conduct a BPE, add it to the Appointment from the Service List:

   

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When Patients Don't Complete the Care Pathway

These are procedures to follow when patients do not complete their Care Pathway. For example, a patient does not return for the Interim Care (IC) appointment.

Scenario: The patient has completed some appointments, but is not going to return to complete the Care Pathway, which you now need to finalise.

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Booking IC Appointments via Appointment Workflow

EXACT suggests an approximate appointment date in the patient chart:

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Because Interim Care (IC) Appointments are not integrated into EXACT's record system and automated processes, best practice is to book them in advance in order to save time and effort later.

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• The Appointment Workflow is defaulted to ON for NHS Pilot/Prototype practices, with all default configuration items already checked/ticked.

  Configure > Practice Settings:

  

• The IC interval is pre populated into the Appointment Workflow next appointment booking interval field for IC appointments.
  (The IC interval is the system-calculated interval between the Assessment and the Recall, calculated across all four Domain assessment scores)
• The Appointment Workflow expected time for IC appointments defaults to 15 mins if no time is shown already.

  NOTE: EXACT allows the practice to manually edit recall (OHR) dates, because the period at which patients should be seen is always best established by clinical judgement.

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• Run an EXACT Appointment Summary Report for the previous contract year.
• Run an EXACT Appointment Summary Report each month during the new contract period.

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Practitioners with Superuser rights can review and approve other Practitioners' COTs.

NOTE: Any COTs listed in the Provider Overview Screen in red text are more than 3 months old and require URGENT attention.

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1. When the Provider goes to complete the last appointment of the day, an Unapproved COTs screen appears:

   

   IMPORTANT: It is strongly advised that you complete the Approvals at the time of prompting.

   (If you cannot do it at this time you can postpone the Approval process until later. Refer to the procedure below: To later Review and Approve COTs for the day)

2. Click Yes to continue.

   In the Provider Overview Screen you will see a list of days, each with outstanding COTs to be approved.

   To approve, select COTs and Dates (optionally use the Select All / Select None buttons), and click the Approve button:

   

   (Optional) If you need to first check a COT, select it and then click the View COT button to display the View NHS Assessment COT screen. Here you can check that all details are correct:

   

   If it is a completed course of treatment, you can also open FP17 details for the selected transaction:

   

3. When you click the Approve button to approve the COTs and Dates, you will be prompted to enter a Validation PIN for the current Provider (this PIN is unique to each NHS Dentist, and is required in order to process the Approvals):

   

   In the validation process EXACT checks all required fields and pops up a warning if any are missing. For example:

   

4. Once approved, the COTs are removed from the Provider Overview screen.
5. See Automated daily data transmission to the BSA

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The transmission does not affect normal activity within the EXACT software or the practice.

It is fully automated through the EXACT Scheduler, so personnel need take no action.

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• Authorised data from the previous day.
• Authorised data from any prior days that hasn't already been transmitted.
• COTs that have changed since they were originally transmitted .

  IMPORTANT! It is essential that you continue to transmit bundles of FP17 forms as you did prior to the Contract. This is a separate process to the Pilot/Prototype data, which is transmitted automatically every day. If you need more information on this, please contact the SoE Support team.

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