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Well Visit: Document Interval History and Review of Systems (ROS)

Version 20.7

Overview

The Interval History and Review of Systems (ROS) sections of the Well Visit Exam are used to document the patient's overall health and changes since their last visit.

Document Interval History

  1. From within an open Well Visit Note, click Interval Hx in the Window Navigation panel.
  2. Review the information in the Interval History section.
  3. To make changes:
  • Click in the text field and modify or add additional information.
  • Select the Phrase Construction button and select phrases to insert.

Document Review of Systems (ROS)

  1. From within an open Well Visit Note, click Detailed ROS in the Window Navigation panel. 
  2. To change the selected question or symptom, click the word in the Conf/Deny column. 
  • Click Pert once to change to Confirms and click again to change to Denies. If the question or symptom is not applicable, leave the item as Pert.

NoteAny question or symptoms left as pertinent (Pert) will not be seen on the final note. If a question or symptom is marked as Reports or Denies, and should not appear on the note, click through until you see Skip.

  1. Add additional information, if needed by typing in the Comment field or by clicking the Phrase Construction button.

Version 14.10

Overview

This section will introduce the users to the section of the Preventive Exam used to document the overall health and changes since last visit. The user will be guided through the fields to easily review and document additional information.

  1. Click the Interval Hx tab.

  1. Click into the Interval History field and make changes to the questions presented.
    or
    Select the Phrase Construction button and select phrases to insert.  
  2. Proceed to the Detailed ROS tab and click to change the selected question or symptom to Confirms or Denies (click once to mark as Confirms, twice to mark as Denies).