8. Forms

[0] Chapter Contents

[1] Forms Intro & Directions

Available Forms

A-C | D-I | J-P | Q-Z | Sample Pictures

Table of Contents

[1] Forms Intro & Directions

FORMS IN THE ENCOUNTER SCREEN

• CURRENT FORMS: to view current forms added to the patients chart click on the arrow beside the word current forms & then click on the form you want to view or add to
• ADD NEW FORM: Click on the arrow for a drop-down menu of the forms available and click on the desired form to add to the patient’s e-Chart. Annual cpx - ALPHA - T2 Diabetes - Mental Health Referral - AR1 & AR2 forms.
• OLD FORMS: when you create a second type of form that has already been created, the current form will move down to OLD FORMS. (ie annual health review in 2001 will move to OLD forms when annual review is created for 2002)

FEATURES OF FORMS

• Data can be extracted for statistical purposes
• Ease of comparison from year to year
• The program pulls the patient’s demographic information in automatically and will not allow you to enter incorrect data. If a demographic change has to be made, the change can not be made here. The users must go back to the Patients Detail Record to make any changes, preventing loss of important demographic changes.
• Specific text areas allow you to add free flowing text to certain areas
• When you view the OLD FORMS you can see the Created Date and the Edited Date

GENERAL DIRECTIONS FOR USING THE FORMS

• Patients demographic information will be automatically pulled from the Patient’s Detail Record
• Use the TAB key to advance through the form
• Where there is a checkbox, you will have to click with the mouse to check off the appropriate box or press the spacebar
• Be sure to note if the form has more than one page, and SAVE EACH PAGE before proceeding onto the next
• Before exiting, you must SAVE the form. In order to view the forms that have just been completed, refresh the encounter screen by pressing F5

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Available Forms

Sample Forms

A-C

ALPHA FORM

Developing the Patients Antenatal Psychosocial Health Assessment

ANNUAL HEALTH REVIEW (VERSIONS 1 AND 2)

From Provider View Only

For the basic annual physical. Both forms have a link to the Annual Review Planner, which suggests further actions depending on the patient’s conditions.

ANTENATAL RECORD 1 & 2

From Provider View Only

AR 1 & AR 2

From The Encounter Window

AR1, AR2 and Antenatal Planner are combined and linked in one form accessible through the AR form . The links at the top allow you to flip from one from to the other with pertinent information carried forward to the next form or the planner. There are two versions: AR (the original) and AR 2005 (an updated version).

NOTE: You must fill in the FINAL EDB for future EDB reports and for the Antenatal Planner to work.

1. Complete the form with all the appropriate Pregnancy Summary, Obstetric History, Medical History and Physical Exam. NOTE: All of the 48 underlined topics under ‘Medical History and Physical Exam’ are hot links to further information on each of these topics.
2. At the bottom of the AR1 section there is a text box to add extensive comments about medical history and the physical examination
3. Type the doctors name in the ‘Signature of Attendant’ box
4. When you have completed the form click on the SAVE button at the top or the bottom of the form.
5. To Print, click the PRINT button after you have saved it

• After the EDB entry in the first AR1 report, the program calculates the dates and adds a check list for every 4 week visit in the Antenatal Planner
• NEXT VISIT: In the Encounter window, click on the arrow beside ‘Current Forms’ under the FORMS heading on the left side of the Encounter window and continue to enter the information for the visit
• Every time you go into a ‘Current’ AR form and edit the form, the form with the last visit will move down to ‘Old Forms’ and the NEW Edited form will be in ‘Current Forms’. You can see each edited form in the ‘Old Forms’ list with a Created date and an Edited date for the legal paper trail.

The Antenatal Planner

1. After the FINAL EDB has been filled in on the AR1 form and the form SAVED, you can click on the Antenatal Planner link at the bottom right corner of the form.
2. Check off the appropriate Past OB History, the Resources you have discussed with the patient and the General Nutrition
3. When you click on the SAVE button, the program creates a checklist for each visit based on the check boxes you checked off
4. The notes in blue are points/actions needed for Residents to be aware of when they are caring for an OB patient
5. Each week the patient comes in for a visit, there is an appropriate checklist of tasks or information to discuss with the patient and risk factors for that stage of the pregnancy.

Editing The AR Risks or Check List

For the ADVANCED USER that wants to edit the list to suit their particular practice, there is an EDIT feature for the AR Risks or the Check List topics.

1. In the Antenatal Planner screen, click on the EDIT links in the upper right corner of the screen.
2. This is a simple XML file that you can use to change the words for the discussion topics or check list.
3. There is a link to ‘View the Risk Number’ to give you a reference point
4. Be sure to save your work

• CAUTION: This changes the AR forms for the WHOLE clinic, so this should only be done by those experienced in this format.

COST QUESTIONNAIRE

Study questionnaire assessing the health care costs associated with the patient over a 9 month period. Adapted from SLU cost questionnaire.

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D-I

GROWTH CHARTS

CDC US Growth Charts are used for patients aged 2 – 20 years in order to document their growth. You can print graphs charting their growth in height and weight, as well as in BMI (use the calculator in the patient’s E-Chart).

HOME FAST

The Home Falls and Accidents Screening Tool (Home FAST) is a study tool used to assess the patient’s home for potential fall and accident hazards.

INVOICE FORM

Personal Invoice Form for the patient, with all the relevant information from the patient’s chart filled in.

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J-P

LAB REQUISITION FORMS

From Provider View Only

1. Check off the bloodwork you want to order
2. Users are not able to type in the areas that are ‘Laboratory-only’ fields
3. Click on SAVE when finished to attach to the patients e-Chart
4. Click on the PRINT button to print the form
5. You now only have to sign the form and give it to the patient

MENTAL HEALTH FORMS

From Provider View Only

Requesting a referral to a counselor or psychiatrist

Clicking on any of the numbered text and it will put the number in the box at the bottom of the list. Because numbers are used for these forms, the data can be retrieved for statistics at a later date more accurately than free text.

MINI MENTAL STATE EXAM

From Provider View Only

For assessment of dementia

OVULATION

This form is for tracking a woman’s ovulation, as well as other important factors when attempting to become pregnant??

PALLIATIVE CARE PATIENT CARE FLOWSHEET

From Provider View Only

For developing a palliative care assessment plan

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[5] Q-Z

RISK ASSESSMENT

Self administered questions used in self-report index.

ROURKE RECORD

Tracking the baby’s development up to five years of age

1. Fill in the form for the week of the visit
2. Click the SAVE button after you have made changes
3. Once you have entered the first data with head circumference, weight and height (ALL METRIC MEASURMENTS) the program will calculate the graph.
4. GRAPH LINK: only appears at the top of the form AFTER you have entered and saved the initial height, weight and circumference of head information The graph will plot the child’s (length vs. age, weight vs. age) and (head circumference vs. age, length vs. weight)
5. Hot links give you the description of each topic that was previously on the back of the form

T2 DIABETES FORM

Tracking a patient with type 2 diabetes

TWO MINUTE WALK

Instructions for administering the 2 Minute Walk Test and the Lower Extremity Function Test

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Sample Forms

-adding forms (admin?)

-adding e-forms