Customizing Chart Forms  
Customizing chart forms as per specialty needs is an important task. But before moving on to customizing chart forms you need to understand the organization of data within a chart. Every chart contains three forms; one for demographic/insurance information called the General form, one for historical medical data called the History form and one for patient visit data called the Encounter form. There is always one copy of General and History form associated with a chart whereas Encounters can be unlimited. When a new chart is added to the system, it contains General and History form but no Encounters are appended to it. The encounters are added to a chart as and when needed.

Once an encounter is added, a new tab for Encounters appears directly below the History tab. All later encounters are also grouped together under this same Encounters tab and you can move back and forth using the small arrow buttons associated with it. As mentioned in the above paragraph, there is no limit to the number of encounters that may be added to a chart.

Every encounter is further associated with a set of encounter-centric documents such as prescription, orders, encounter note and referral/consult letters and patient invoice etc. Users just have to fill-out the underlying encounter form and the system automatically populates these documents on the basis of information entered on the encounter form.

Please note that our system is designed around a single encounter form template for all types of patient encounters. This implies that all providers of a clinic would be using the same encounter form template and therefore, if there are more than one physicians in the clinic, the encounter form template should be customized in a way acceptable to all. And this means that you need to structure an encounter form that has the necessary fields and blocks to cover all clincial scenarios relevant to your specialty. Assuming you have structured such a multi-purpose encounter form using the template editor discussed further below, the providers/staff would just need to add encounter to a patient's chart, select the visit type and document what is relevant to that particular patient visit.

The fields or blocks not relevant to a visit are simply to be left blank at the time of documentation. Any blank item on the encounter form would be filtered out automatically when generating an encounter note or referral/consult letter.

Now that you know the charting workflow, let us move on to the customization of forms contained within the charts. First of all, be aware that even though history and encounter forms default to CMS guidelines for evaluation and management services, this is just to provide the physicians with a starting point. The history and encounter forms are extremely customizable and, as such, adaptable to any specialty or clinical setup to which you may belong. This level of customization is accomplished through the use of versatile form templates that not only allow modification of blocks and fields within a form but also allow alteration in the structure of the form itself.

You can edit every default block on the History and Encounter forms using the respective template of that form, down to each and every bullet item and dropdown therein. As an example, the screenshot below shows the extent of customizations possible with the default Physical Examination block that exists on the Encounter form.

Not only you can edit or delete default blocks on the history and encounter forms but also add any number of your own custom blocks to cover specialized procedures and evaluations. And while adding a new custom block you can choose from nine different block designs and select the one that best suits your documentation style and needs.

Apart from the chart forms, a number of settings with respect to the encounter-centric documents mentioned in the second paragraph are also available in the customization area. These settings vary from the content and format of generated documents to the font type and font size to be used in printing. We recommend you review all of these settings and try the ones that you think may be useful or seem relevant to your clinical setup.

Please note that any change in settings will reflect on notes and letters that you may save then onwards. To apply the changes on any previously saved encounter-centric document, you must bring it in editable mode by clicking Edit button and then hitting Refresh button next to it. The same applies to the information entered on the underlying encounter form. Suppose you initially enter two ICD codes on the encounter form and then proceed to save a visit note, that note will duly contain those two ICD codes. But if you later add another ICD code on the encounter form, the new third ICD will not automatically show up on the saved visit note unless you bring the note in edit mode and refresh its content.

Finally, you may define up to ten custom encounter-centric documents (fifteen in the case you have the certified version of EMR software) within the EMR system. This is in addition to the default encounter centric documents such as encounter note and referral/consult letters mentioned up to this point.

The custom documents feature may be used to generate procedure reports, letters of medical necessity or any other document user deem fit. A cardiologist, for example, would like to generate stress test reports. Now if he/she has added a block Exercise Stress Test on the encounter form to document stress test findings, he/she may then define a new document named "Stress Test", title it "Stress Test Report", paraphrase opening/closing sentences and select the block Exercise Stress Test to populate its body.

Once a custom document is defined, it appears in the print section right alongside default encounter-centric documents. Furthermore, the custom documents follow the same workflow rules as far as saving, editing and printing of the document is concerned.

The custom document example shown above is a stress test report that will be structured dynamically using the data contained within Exercise Stress Test block on the encounter form. However, this feature can also be used to define static documents that are relevant to the care but may not necessarily require inclusion of any data from the underlying encounter form. An example of such a document would be a patient educational handout relevant to your specialty.

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