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Add Well Visit Templates

Version 14.19

Path: Clinical tab > Well Visit Templates

Overview

All of the Office Practicum Well Visit Templates were created by our Medical Director, Susan Kressly, M.D., F.A.A.P.  These templates are based off of the Bright Futures Guidelines and contain Bright Futures Anticipatory Guidance, Developmental Milestones, Pre-Visit Surveys, Developmental Surveys, Patient/Parent Educational Handouts, and other items following Bright Futures recommendations.

Note: It is not our best practice for an office to create more than one template for each age group. This can make it difficult for your staff to choose the appropriate template for a patient.

  1. Navigate to the Well Visit Template Editor window using the path above.
  2. Click the Add button.

Complete the Well Visit Template Properties

  1. Add the template properties using the table definitions below. 
PropertyDescription
TemplateName given to a template.
Appt TypeThe default appointment type. This will be applied when an appointment with this template is scheduled. This is not a requirement to save the template.
Min Age (Months)The minimum age a child must be to receive a prompt for use. This only occurs if the template was not chosen at the time of making an appointment.
LocationAssignment can be made to view templates by location.
ArchivedSelection if template is no longer used.
Default place of serviceA place of service can be selected in this field and will populate the Place of service on the Visit Info window when charting. This is not a required field.

Complete the Well Visit Notes Tab

  1. Click the Well Visit Notes tab if not already selected. Add information using the table definitions below. 
FieldDescription
SexSelection of gender
Interval HistoryAge appropriate information for what has happened since last well visit.
Developmental AssessmentDevelopmental Milestones are charted during a visit. Information entered in this field can be used in place of or with the milestones charted.
Anticipatory GuidanceAge appropriate questions and discussion points.
CounselingInformation entered includes counseling that is commonly done during the visit.
Assessment/PlanThis describes what will be done to treat the patient – ordering labs, referrals, procedures performed, medications prescribed, etc. This should address what was discussed with or advised to the patient as well as timings for further review or follow-up.
Patient InstructInstructions entered will be visible on the Patient Portal when the template is selected. Instructions are typically a summary of the visit written for understanding by the reader.
  1. Add a diagnosis code:
  1. Click the Add button.
  2. Click the Prim? checkbox if the code is the primary diagnosis.
  3. Click into the ICD10 Description field.
  4. Click the Search button. The ICD10 Search window displays.
  5. Enter a description or code in the ICD10 Code/Description field.
  6. Select the diagnosis code.
  7. Click the SNOMED link button.
  8. Select the SNOMED code.
  9. Click the Save Entry button.

Complete the Detailed ROS Tab

  1. Click the Detailed ROS tab.
  2. Click the Expand button to expand an ROS group.
  3. Set the ROS Questions/Symptoms using the following:
  • First click indicates NL (normal).
  • Second click indicates ABNL (abnormal).
  • Third click indicates Pert (pertinent)
  • Fourth click indicates N/A

Complete the School Exam Tab

  1. Click the School Exam tab. 
  2. Set the School Exam answers. 
  3. Enter the Developmental answers.

Complete the Detailed Exam Tab

  1. Click the Detailed Exam tab.
  2. Click the Expand button.
  3. Set the Detailed Exam questions using the following: 
  • First click indicates NL (normal).
  • Second click indicates ABNL (abnormal).
  • Third click indicates Pert (pertinent)
  • Fourth click indicates N/A

Complete the Orders/Workflow Tab

  1. Click the Orders/Workflow tab.
  2. Complete the Medications, Diag Tests, Immunizations, Resources, Surveys, Followup, and Other Tasks tabs using the controls at the bottom of the window.

Complete the Procedures Tab

  1. Click the Procedures tab.
  2. Select the CPT Codes that apply to the template.
  3. Click the Save button  to save your template changes.
Version 14.10
Utilities > Manage Clinical Features > Well Visit Template Editor

Overview

All of the Office Practicum Well Visit Templates were created by our Medical Director, Susan Kressly, M.D., F.A.A.P.  These templates are based off of the Bright Futures Guidelines and contain Bright Futures Anticipatory Guidance, Developmental Milestones, Pre-Visit Surveys, Developmental Surveys, Patient/Parent Educational Handouts, and other items following Bright Futures recommendations.


It is not our best practice for an office to create more than one template for each age group. This can make it difficult for your staff to choose the appropriate template for a patient.
  1. Click the Utilities button on the menu toolbar .

Menu Toolbar: Utilities

  1. Select Manage Clinical Features.
  2. Select Well Visit Template Editor. The template list will display.
  3. Click the Create a new template button .
  4. Add the template properties using the table definitions below. 

Well Visit Template Editor: Template Properties

PropertyDescription
TemplateName given to a template.
Appt TypeSelection of a default appointment type when scheduling. Not a requirement to save the template.
Min Age (Months)The minimum age a child must be to receive a prompt for use. This will only occur if the template was not chosen at the time of making an appointment.
LocationAssignment can be made to view templates by location.
ArchivedSelection if template is no longer used.
  1. Click the Well Visit Notes tab if not already selected. Add information using the table definitions below. 

Well Visit Template Editor: Well Visit Notes Tab

FieldDescription
SexSelection of gender
Interval HistoryAge appropriate information for what has happened since last well visit.
Developmental AssessmentDevelopmental Milestones are charted during a visit. Information entered in this field can be used in place of or with the milestones charted.
Anticipatory GuidanceAge appropriate questions and discussion points.
CounselingInformation entered includes counseling that is commonly done during the visit.
Assessment/PlanThis describes what will be done to treat the patient – ordering labs, referrals, procedures performed, medications prescribed, etc. This should address what was discussed with or advised to the patient as well as timings for further review or follow-up.
Patient InstructInstructions entered will be visible on the Patient Portal when the template is selected. Instructions are typically a summary of the visit written for understanding by the reader.
  1. Add a diagnosis code:
  1. Click the Add button.
  2. Click the Prim? checkbox if the code is the primary diagnosis.
  3. Click into the ICD10 Description field.
  4. Click the Search button. The ICD10 Search window displays.
  5. Enter a description or code in the ICD10 Code/Description field.
  6. Select the diagnosis code.
  7. Click the SNOMED link button.
  8. Select the SNOMED code.
  9. Click the Save Entry button.
  1. Click the Detailed ROS tab.
  2. Click the Expand button .
  3. Set the ROS Questions/Symptoms using the table descriptions below. 

Well Visit Template Editor: Detailed ROS Tab

SettingDescription
PertRelevant symptom/question to display when template is opened.
ConfirmsConfirmation of the symptom/question
DeniesDenies the symptom/question
N/ANot applicable for the template. Removes from the group list.
  1. Click the School Exam tab. Set the School Exam answers. Here is a list of what is defaulted in the pre existing Well templates.

Well Visit Template Editor: School Exam

  1. Enter the Developmental answers.

Well Visit Template Editor: Developmental

  1. Click the Detailed Exam tab.
  2. Click the Expand button .
  3. Set the Detailed Exam questions using the table definitions below. 

Well Visit Template Editor: Detailed Exam Tab

SettingDescription
PertRelevant symptom/question to display when template is opened.
ABNPositive/abnormal finding.
NLNegative/normal.
N/ANot applicable for the template. Removes from the group list.
  1. Click the Orders/Workflow tab .
  2. Click the Procedures tab .
  3. Click Save Changes to template button .