diff --git a/library/clinical_rules.php b/library/clinical_rules.php
index c56ad5f65fa..dd5596e03a9 100644
--- a/library/clinical_rules.php
+++ b/library/clinical_rules.php
@@ -172,6 +172,12 @@ function test_rules_clinic($provider='',$type='',$dateTarget='',$mode='',$patien
       $dateCounter = 1; // for reminder mode to keep track of which date checking
       foreach ( $target_dates as $dateFocus ) {
 
+        //Skip if date is set to SKIP
+        if ($dateFocus == "SKIP") {
+          $dateCounter++;
+          continue;
+        }
+
         //Set date counter and reminder token (applicable for reminders only)
         if ($dateCounter == 1) {
           $reminder_due = "soon_due";
@@ -189,6 +195,7 @@ function test_rules_clinic($provider='',$type='',$dateTarget='',$mode='',$patien
           $pass_filter++;
         }
         else {
+          $dateCounter++;
           continue;
         }
 
@@ -245,6 +252,12 @@ function test_rules_clinic($provider='',$type='',$dateTarget='',$mode='',$patien
           $dateCounter = 1; // for reminder mode to keep track of which date checking
           foreach ( $target_dates as $dateFocus ) {
 
+            //Skip if date is set to SKIP
+            if ($dateFocus == "SKIP") {
+              $dateCounter++;
+              continue;
+            }
+
             //Set date counter and reminder token (applicable for reminders only)
             if ($dateCounter == 1) {
               $reminder_due = "soon_due";
@@ -464,6 +477,11 @@ function test_targets($patient_id,$rule,$group_id='',$dateTarget) {
   $target = resolve_target_sql($rule,$group_id,'target_proc');
   if ((!empty($target)) && !procedure_check($patient_id,$target,$interval,$dateTarget)) return false;
 
+  // -------- Appointment Target ----
+  // Appointment Target (includes) (Specialized functionality for appointment reminders)
+  $target = resolve_target_sql($rule,$group_id,'target_appt');
+  if ((!empty($target)) && appointment_check($patient_id,$dateTarget)) return false;
+
   // Passed all target tests, so return true.
   return true;
 }
@@ -716,6 +734,46 @@ function procedure_check($patient_id,$filter,$interval='',$dateTarget='') {
   return $isMatch;
 }
 
+// Function to check for appointment
+// Parameters:
+//   $patient_id - pid of selected patient.
+//   $dateTarget - target date.
+// Return: boolean if appt exist, otherwise false
+function appointment_check($patient_id,$dateTarget='') {
+  $isMatch = false; //matching flag
+
+  // Set date to current if not set (although should always be set)
+  $dateTarget = ($dateTarget) ? $dateTarget : date('Y-m-d H:i:s');
+  $dateTargetRound = date('Y-m-d',$dateTarget);
+
+  // Set current date
+  $currentDate = date('Y-m-d H:i:s');
+  $currentDateRound = date('Y-m-d',$dateCurrent);
+
+  // Basically, if the appointment is within the current date to the target date,
+  //  then return true. (will not send reminders on same day as appointment)
+  $sql = sqlStatement("SELECT openemr_postcalendar_events.pc_eid, " .
+    "openemr_postcalendar_events.pc_title, " .
+    "openemr_postcalendar_events.pc_eventDate, " .
+    "openemr_postcalendar_events.pc_startTime, " .
+    "openemr_postcalendar_events.pc_endTime " .
+    "FROM openemr_postcalendar_events " .
+    "WHERE openemr_postcalendar_events.pc_eventDate > ? " .
+    "AND openemr_postcalendar_events.pc_eventDate <= ? " .
+    "AND openemr_postcalendar_events.pc_pid = ?", array($currentDate,$dateTarget,$patient_id) );
+
+  // return results of check
+  //
+  // TODO: Figure out how to have multiple appointment and changing appointment reminders.
+  //         Plan to send back array of appt info (eid, time, date, etc.)
+  //         to do this.
+  if (sqlNumRows($sql) > 0) {
+    $isMatch = true;
+  }
+
+  return $isMatch;
+}
+
 // Function to check lists filters and targets
 //  Customizable and currently includes diagnoses, medications,
 //    allergies and surgeries.
@@ -1153,6 +1211,15 @@ function calculate_reminder_dates($rule, $dateTarget='',$type) {
   // Set date to current if not set
   $dateTarget = ($dateTarget) ? $dateTarget : date('Y-m-d H:i:s');
 
+  // Collect the current date settings (to ensure not skip)
+  $res = resolve_reminder_sql($rule, $type.'_current');
+  if (!empty($res)) {
+    $row = $res[0];
+    if ($row ['method_detail'] == "SKIP") {
+      $dateTarget = "SKIP";
+    }
+  }
+
   // Collect the past_due date
   $past_due_date == "";
   $res = resolve_reminder_sql($rule, $type.'_post');
@@ -1164,6 +1231,12 @@ function calculate_reminder_dates($rule, $dateTarget='',$type) {
     if ($row ['method_detail'] == "month") {
       $past_due_date = date("Y-m-d H:i:s", strtotime($dateTarget . " -" . $row ['value'] . " month"));
     }
+    if ($row ['method_detail'] == "hour") {
+      $past_due_date = date("Y-m-d H:i:s", strtotime($dateTarget . " -" . $row ['value'] . " hour"));
+    }
+    if ($row ['method_detail'] == "SKIP") {
+      $past_due_date = "SKIP";
+    }
   }
   else {
     // empty settings, so use default of one month
@@ -1181,6 +1254,12 @@ function calculate_reminder_dates($rule, $dateTarget='',$type) {
     if ($row ['method_detail'] == "month") {
       $soon_due_date = date("Y-m-d H:i:s", strtotime($dateTarget . " +" . $row ['value'] . " month"));
     }
+    if ($row ['method_detail'] == "hour") {
+      $soon_due_date = date("Y-m-d H:i:s", strtotime($dateTarget . " -" . $row ['value'] . " hour"));
+    }
+    if ($row ['method_detail'] == "SKIP") {
+      $soon_due_date = "SKIP";
+    }
   }
   else {
     // empty settings, so use default of one month
diff --git a/sql/database.sql b/sql/database.sql
index 3726a503e39..7628abea89c 100644
--- a/sql/database.sql
+++ b/sql/database.sql
@@ -3550,6 +3550,11 @@ INSERT INTO `clinical_rules` ( `id`, `pid`, `active`, `active_alert_flag`, `pass
 --
 INSERT INTO `clinical_rules` ( `id`, `pid`, `active`, `active_alert_flag`, `passive_alert_flag`, `cqm_flag`, `cqm_code`, `patient_reminder_flag` ) VALUES ('rule_inr_monitor', 0, 1, 0, 1, 0, '', 1);
 
+--
+-- Rule for appointment reminder
+--
+INSERT INTO `clinical_rules` ( `id`, `pid`, `active`, `active_alert_flag`, `passive_alert_flag`, `cqm_flag`, `cqm_code`, `patient_reminder_flag` ) VALUES ('rule_appt_reminder', 0, 1, 0, 0, 0, '', 1);
+
 -- Clinical rule titles
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('lists' ,'clinical_rules','Clinical Rules', 3, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('clinical_rules', 'rule_htn_bp_measure_cqm', 'Hypertension: Blood Pressure Measurement (CQM)', 10, 0);
@@ -3580,6 +3585,7 @@ INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('clinical_rules', 'rule_cs_colon', 'Cancer Screening: Colon Cancer Screening', 640, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('clinical_rules', 'rule_cs_prostate', 'Cancer Screening: Prostate Cancer Screening', 650, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('clinical_rules', 'rule_inr_monitor', 'Coumadin Management - INR Monitoring', 1000, 0);
+INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('clinical_rules', 'rule_appt_reminder', 'Appointment Reminder Rule', 2000, 0);
 
 -- --------------------------------------------------------
 
@@ -3721,6 +3727,11 @@ INSERT INTO `rule_filter` ( `id`, `include_flag`, `required_flag`, `method`, `me
 INSERT INTO `rule_filter` ( `id`, `include_flag`, `required_flag`, `method`, `method_detail`, `value` ) VALUES ('rule_inr_monitor', 1, 0, 'filt_lists', 'medication', 'coumadin');
 INSERT INTO `rule_filter` ( `id`, `include_flag`, `required_flag`, `method`, `method_detail`, `value` ) VALUES ('rule_inr_monitor', 1, 0, 'filt_lists', 'medication', 'warfarin');
 
+--
+-- For appointment reminder
+--
+-- no filter
+
 --
 -- Associated lists
 --
@@ -3918,6 +3929,11 @@ INSERT INTO `rule_target` ( `id`, `group_id`, `include_flag`, `required_flag`, `
 INSERT INTO `rule_target` ( `id`, `group_id`, `include_flag`, `required_flag`, `method`, `value`, `interval` ) VALUES ('rule_inr_monitor', 1, 1, 1, 'target_interval', 'week', 3);
 INSERT INTO `rule_target` ( `id`, `group_id`, `include_flag`, `required_flag`, `method`, `value`, `interval` ) VALUES ('rule_inr_monitor', 1, 1, 1, 'target_proc', 'INR::::::::ge::1', 0);
 
+--
+-- For appointment reminder
+--
+INSERT INTO `rule_target` ( `id`, `group_id`, `include_flag`, `required_flag`, `method`, `value`, `interval` ) VALUES ('rule_appt_reminder', 1, 1, 1, 'target_appt', '', 0);
+
 --
 -- Associated lists
 --
@@ -3989,6 +4005,7 @@ INSERT INTO `rule_action` ( `id`, `group_id`, `category`, `item` ) VALUES ('rule
 INSERT INTO `rule_action` ( `id`, `group_id`, `category`, `item` ) VALUES ('rule_cs_colon', 1, 'act_cat_assess', 'act_colon_cancer_screen');
 INSERT INTO `rule_action` ( `id`, `group_id`, `category`, `item` ) VALUES ('rule_cs_prostate', 1, 'act_cat_assess', 'act_prostate_cancer_screen');
 INSERT INTO `rule_action` ( `id`, `group_id`, `category`, `item` ) VALUES ('rule_inr_monitor', 1, 'act_cat_measure', 'act_lab_inr');
+INSERT INTO `rule_action` ( `id`, `group_id`, `category`, `item` ) VALUES ('rule_appt_reminder', 1, 'act_cat_remind', 'act_appointment');
 
 -- --------------------------------------------------------
 
@@ -4023,6 +4040,7 @@ INSERT INTO `rule_action_item` ( `category`, `item`, `clin_rem_link`, `reminder_
 INSERT INTO `rule_action_item` ( `category`, `item`, `clin_rem_link`, `reminder_message`, `custom_flag` ) VALUES ('act_cat_assess', 'act_colon_cancer_screen', '', '', 1);
 INSERT INTO `rule_action_item` ( `category`, `item`, `clin_rem_link`, `reminder_message`, `custom_flag` ) VALUES ('act_cat_assess', 'act_prostate_cancer_screen', '', '', 1);
 INSERT INTO `rule_action_item` ( `category`, `item`, `clin_rem_link`, `reminder_message`, `custom_flag` ) VALUES ('act_cat_measure', 'act_lab_inr', '', '', 0);
+INSERT INTO `rule_action_item` ( `category`, `item`, `clin_rem_link`, `reminder_message`, `custom_flag` ) VALUES ('act_cat_remind', 'act_appointment', '', '', 0);
 
 --
 -- Associated lists
@@ -4035,6 +4053,7 @@ INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action_category' ,'act_cat_inter', 'Intervention', 40, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action_category' ,'act_cat_measure', 'Measurement', 50, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action_category' ,'act_cat_treat', 'Treatment', 60, 0);
+INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action_category' ,'act_cat_remind', 'Reminder', 70, 0);
 
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('lists' ,'rule_action', 'Clinical Rule Action Item', 3, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action' ,'act_bp', 'Blood Pressure', 10, 0);
@@ -4052,6 +4071,7 @@ INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action' ,'act_colon_cancer_screen', 'Colon Cancer Screening', 130, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action' ,'act_prostate_cancer_screen', 'Prostate Cancer Screening', 140, 0);
 INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action' ,'act_lab_inr', 'INR', 150, 0);
+INSERT INTO `list_options` ( `list_id`, `option_id`, `title`, `seq`, `is_default` ) VALUES ('rule_action' ,'act_appointment', 'Appointment', 160, 0);
 
 -- --------------------------------------------------------
 
@@ -4190,6 +4210,11 @@ INSERT INTO `rule_reminder` ( `id`, `method`, `method_detail`, `value` ) VALUES
 INSERT INTO `rule_reminder` ( `id`, `method`, `method_detail`, `value` ) VALUES ('rule_inr_monitor', 'patient_reminder_pre', 'week', '2');
 INSERT INTO `rule_reminder` ( `id`, `method`, `method_detail`, `value` ) VALUES ('rule_inr_monitor', 'patient_reminder_post', 'month', '1');
 
+-- Appointment Rrminder
+INSERT INTO `rule_reminder` ( `id`, `method`, `method_detail`, `value` ) VALUES ('rule_appt_remind', 'patient_reminder_pre', 'hour', '72');
+INSERT INTO `rule_reminder` ( `id`, `method`, `method_detail`, `value` ) VALUES ('rule_appt_remind', 'patient_reminder_post', 'SKIP', '0');
+INSERT INTO `rule_reminder` ( `id`, `method`, `method_detail`, `value` ) VALUES ('rule_appt_remind', 'patient_reminder_current', 'SKIP', '0');
+
 --
 -- Associated lists
 --