Referral Workflow: Create a Tracking Entry

Version 14.19

Overview

A tracking entry is typically created when a report is sent to the practice from an ER or Urgent Care visit. It can also include a specialist report where a referral was not initiated by the practice. The steps below will walk you through scanning and completing the tracking entry. 

Note: The tracking entry workflow may be different than your practice workflow. Always follow you practice policy and procedure.

Scan and Save the Report

  1. Navigate to Manage Documents: Clinical tab or Practice Management tab > Document Mgmt button.
  2. Click the New Document button on the Manage Documents window.
  3. Click the Page Scanner button or Import Documents button (if saved).
  4. Select the Image in the Sketch panel and move to the Thumbnails panel.
  5. Search for a patient in the Document Details panel by typing the patient name in the Patient ID field and select the patient
  6. Click the drop-down arrow in Item Type and select Referral Letter.
  7. Click in the Item category field and click the Attach icon. The Choose a Medical Record to Attach to a Consent Record window appears.

  1. Click the Add button. The Referral/Care Transition Detail window appears.
  2. Complete the tracking entry by following the steps below:
  1. Click the Tracking entry (care transition) radio button.
  2. Type or search the Address book for where the report originated in the Received from field.

Note: If you selected from the Address book you will receive a Confirm window to add the selected provider to the patient's Coordination of Care network. Click Yes if this will be a continued relationship or No if this will not be ongoing.

  1. (Optional) Search for and enter a diagnosis code in the DX 1 and DX 2 fields.
  2. Enter the reason in the Reason for care transition field.
  3. Click the Save button.
  1. You are returned to the Manage Documents window.
  2. Complete the Document Detail confirming the scanned document is addressed to a provider for review. Follow the instruction below.
  1. Reviewed?: Leave the checkbox deselected.
  2. Addressed to: Click the drop-down and select the provider to review the scanned document

  1. Click the Save button.

Review and Medication Reconciliation

  1. Click Documents on the Main Navigation Panel.
  2. Click to highlight a patient in the Referral Letter type.
  3. Click the Patient Chart button and select Referrals/TOC.
  4. Click the scanner icon to the left of the Tracking entry to be reviewed.

  1. The scanned document appears in the Manage Documents window.
  2. Once the scanned document is reviewed, click the Mark Reviewed button then the OK + Close button. You are returned to the Referral / Care Transition List.

  1. Highlight the tracking entry and click the Edit button to complete the reconciliation section.
  1. From the Reconciliation section, select the radio button for Performed or Not Required.
  2. The Reconciled by will default to the user logged into the OP software if Performed was selected. To change the provider or if Not required was selected, click the Provider button and select the provider from the list.
  3. The Reconciliation date will default to the current date and time if Performed was selected. To change the date or if Not required was selected, click the drop-down arrow and select the date from the calendar.

  1. Click the Save button.

Note: If a new medication was prescribed, a medication allergy or problem was noted on the document, it is the responsibility of the practice to update the patient chart.

Version 14.10

Overview

A tracking entry is typically created when a report is sent to the practice from an ER or Urgent Care visit. It can also include a specialist report where a referral was not initiated by the practice. The steps below will walk you through scanning and completing the tracking entry. 

Note: The tracking entry workflow may be different than your practice workflow. Always follow you practice policy and procedure.

Scan and Save the Report

  1. Click the Docs button on the Smart Toolbar.
  2. Click the New Document button on the Manage Documents window.
  3. Click the Scanner button or import the document (if saved).
  4. Move the document to the Preview Panel.
  5. Click the Patient Search button in the Patient ID field.
  6. Select a patient.
  7. Click the dropdown arrow in Item Type and select Referral Letter.
  8. Click in the Item Category field and click the Attach icon. The Choose a Medical Record to Attach to a Consent Record window appears.
  9. Click the Add button. The Referral/Care Transition Detail window appears.
  10. Complete the tracking entry by following the steps below:
  1. Click the Tracking entry (care transition) radio button.
  2. Type or search the Address book for where the report originated in the Received from field.
Note: If you selected from the Address book you will receive a Confirm window to add the selected provider to the patient's Coordination of Care network. Click Yes if this will be a continued relationship or No if this will not be ongoing.
  1. (Optional) Search for and enter a diagnosis code in the DX 1 and DX 2 fields.
  2. Enter the reason in the Reason for care transition field.
  3. Click the Save button.
  1. Review the remaining information on the Document Details Panel. Confirm the document is addressed to a provider for review. Click here for additional information.

Review and Medication Reconciliation

  1. From the Schedule/Practice Workflow window, click the Documents tab.
  2. Navigate to and expand the heading titled Referral Letter.
  3. Click to highlight a patient.
  4. Click the Chart button.
  5. Click the Referrals/Trans button.
  6. Click the scanner icon to the left of the Tracking entry to be reviewed.

  1. The scanned document appears in the Manage Documents window.
  2. Once the scanned document is reviewed, click the Mark Reviewed button.
  3. Click the OK + Close button. You are returned to the Referral / Care Transition List.
  4. Highlight the tracking entry and click the Edit button to complete the Med reconciliation section.
  1. Select the radio button for Performed or Not Required.
  2. The Reconciled by will default to the user logged into the OP software if Performed was selected. To change the provider or if Not required was selected, click the Provider button and select the provider from the list.
  3. The Reconciliation date will default to the current date and time if Performed was selected. To change the date or if Not required was selected, click the dropdown arrow and select the date from the calendar.

  1. Click the Save button.
Note: If a new medication was prescribed for the patient, you are required to enter the medication in the Medications tab of the patient chart.