Edit a Diagnosis Template

Version 14.8
Utilities > Manage Clinical Features > Encounter Template Editor


You will have an understanding of the content of a typical symptoms template.  You will be instructed on methods of customization to ensure the symptom templates reflect the workflow of the practice.

  1. Click the Utilities button on the menu toolbar. 
  1. Select Manage Clinical Features.
  2. Select Encounter Template Editor. The template list displays.
  3. Click the plus to expand System group. 

Encounter Template Editor: Diagnosis Template Group Expanded

  1. Select a template and click the Edit button .
  2. Review the template properties.

Encounter Template Editor: Template Properties

Name given to a template.  Should be named for ease of searching.
Method of organizing like templates.
Assignment of a template to a specific user.  Templates assigned an author may only be edited by that user.
Appt Type
Selection of a default appointment type.  Not a requirement to save the template.
Ability to restrict who can view the selected template.  All Diagnosis templates should have a visibility of at least Provider.
Assignment can be made to view templates by location.
Finalize Status
Selection set to who may finalize.  Most templates will be set to Providers only.

  1. Click the tab if not already selected.
  2. Review and edit the fields of the Encounter Note tab.
Counseling (optional)
Information entered includes counseling that is commonly done during the visit.
Coordination of care (optional)
Information entered includes activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services.  Typically the information in this field is entered at time of visit.
Assessment (optional)
The likely diagnosis should be included in this section of the note. If a conclusive diagnosis has not been made yet, some possible diagnoses can be charted. It may include additional diagnoses that need to be ruled out.
This describes what will be done to treat the patient – ordering labs, referrals, procedures performed, medications prescribed, etc.  This should address what was discussed or advised with the patient as well as timings for further review or follow-up are generally included.
Instructions 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.
  • Click the Add button  .
  • Click the Prim? checkbox if the code is the primary diagnosis  
  • If the diagnosis code involves laterality, severity, etc., you can add multiple Primary Diagnosis codes that will create a pop-up when the template is applied to select the most specific code for that visit.
  • Click into the ICD10 Description field
  • Click the Search button. The ICD10 Search window displays.
  • Enter a description or code in the ICD10 Code/Description field.
  • Select the diagnosis code.
  • If the diagnosis is one that you will want to add to the chronic Problem List:
  1. Click the SNOMED link button.
  2. Select the SNOMED code.
  3. Click the Save Entry button.    

  1. Click the Detailed Exam tab. Set the exam points.
Relevant symptom/question to display when template is opened.
Positive for the finding
Negavie for the finding
Not applicable for the template.  Removes from the group list.

Note: To expand an exam group click the heading. To see additional Exam groups, select the checkbox Show all groups.
  1. Click the Orders/Workflow Tabs.
  2. Click the Procedures tab.
  3. Click Save Changes to template button .