HIPAA & new users

User Application

Patient Chart and Previous Encounters

How do I create a new patient record?

There is more than one way to do this. One way to create a new patient record is from the Database Tab to the left of your User screen:

•  Click on Database Tab

•  In the blank bar underneath the label "Patient List" type the new patient's last name and hit enter. If the last name appears in the database already the program will ask you if you want to create a new record. If it does not appear in the database already it will just open the demographics window.

•  The demographics window opens to the right in order to allow you to enter the rest of the patient's information. The cursor will be in the first name box by default and you can finish entering the information.

•  You can come back later and finish the demographics if you need to. The minimum information needed to create the new record is: first and last name, birth date, sex, and registration number. (If you use billing software make sure to use the SAME registration number that will be used with the billing software so that there will be no duplicate charts created.)

•  There are additional tabs to the top of the right-hand screen that will allow you to enter the contact information, and insurance information, etc. To edit the patient's demographic information just double-click on their name in the list and the demographics window will open.

Another way to enter a new patient record is from the Patients Here and Waiting link on your home screen. Click on the Patients Here and Waiting link on your Home window.

•  Type the patient's last name in the search/insert area and hit enter.

•  Now the program will again open up the demographics window where you can enter their information.

And yet another way to create a new patient record is from the Scheduler.

•  Click on the date and time slot for the patient's visit.

•  In the window that opens for the visit creation, now type the patient's last name in the patient area and hit enter.

•  Once again the demographics window will open for you.

How do I mark a patient as here and waiting in the clinic?

If you are using the Praxis Scheduler in your clinic, you simply click on the Scheduler button at the top of your Home screen and then right-click on the appropriate patient's name and select "Patient Here." If you are not using the scheduler, follow the steps outlined below:

From your Home Screen:

•  Left click on the Patients Here and Waiting link towards the top of your window.

•  First check to make sure that the physician's name that appears at the top of this window corresponds to the physician who will be seeing THIS patient today. If it is not the correct name, click on the button to change it and choose the correct physician.

•  Type at least 3 letters of the patient's first or last name into the search/insert area and then, if you don't see their name in the list, hit the spacebar and type the first few letters of their other name into the area.

•  Now, when you see the patient's name in the list, just double-click on their name to mark them as here and waiting

Note:

•  if you have done this while you are logged in as an assistant - the program will automatically open the patient's chart for you to enter their preSOAP information. If you do NOT want the patient's chart to be automatically opened for you see the next option below describing how to add a patient to the scheduler..

•  If you are logged in as a receptionist the patient's name will be added to the assistants screens as ready and waiting to be seen by any available assistant logged into the program.

To mark a patient as Here and Waiting from the Scheduler:

•  Open the Scheduler by clicking on the button at the top of your screen marked "scheduler."

•  If the patient is showing on the scheduler for today, just right-click on their name and choose Patient Has Arrived from the drop-down menu.

•  This will turn their appointment green in the list and they will now appear in the Here and Waiting list on your home screen also.

•  The assistant will now see the patient's name in black on their screen - letting them know the patient is ready to be seen by them. (At this point the physician who will be seeing the patient will see their name in blue on their screen - letting them know they still need to be seen by the assistant first).

How do I open a patient's chart to record the visit?

If you see the patient's name (in black) on your Here and Waiting list on your Home Page, you can just left-click on their name and their chart will be opened for you. If you do not see their name in the list you will need to mark them as here and waiting (see above).

Can I send a patient to the doctor's screen without having an assistant see them first?

Yes, just right-click on their name in the Here and Waiting list and choose to transfer patient to provider.

Can I change the provider the patient is here to see after I have marked them as here and waiting?

Yes, just right-click on their name in the Here and Waiting list and choose to Change Provider.

How do I set the room the patient is in?

From your Home screen - Right-click on their name and choose to Place Room Number. Then just double-click on the right room in the list.

From the Main Page of the Patient Chart - right click on the Room label to the right of the Screen (just below the timers), then double click on the appropriate room.

Can I add rooms to the list?

Yes, just type the new room name into the list that pops up when you clicked on Place Room Number and then hit Enter. Now you can double-click on the room to select it for the patient's visit.

Can I enter a private comment to show up to anyone who rolls over the patient's name in the list? How?

Yes, you can. There are three areas from your Main User window where you can do this: the Database tab, the Scheduler, or the Patients Here and Waiting list. Just right-click on the patient's name and select "Edit Private." This opens a text editor where you can place any comment you would like to about this patient. These comments will be seen when you roll over the patient's name in these areas in a pop up window. These comments/reminders will not print or actually become a part of the patient's chart. They are just there for you and will never be seen by anyone outside of Praxis.

How do I log out?

If you want to totally log out of the program, you can click X that appears to the top right of your screen. If you want to just temporarily lock down the program so you can step out of the room, etc. click F3 - this will lock the program down and you will need to enter your password to reopen it. You can also click F10 to close the program completely.

Can I hide my screen from a patient and lock them out of access so I can leave the room?

Yes - click F3 - this will lock the program down and you will need to enter your password to reopen it.

What do the colors on my home screen mean?

•  If a patient's name in the Here and Waiting list is red, it means one of two things - either the patient has been in the list for quite some time, or the chart is open by someone else at the moment.

•  Otherwise, red generally means urgent (phone calls, nursing tasks, agents, transcriptions, etc.)

•  A blue patient name in the Here and Waiting list - if you are a provider, this means the patient is still with the assistant. If you are an assistant, this means the patient has been sent to the provider.

•  A black patient name in the Here and Waiting list - the patient is ready to be seen by you.

Can I delete a patient's chart if I created one in error?

We can't actually delete a patient record once it has been created, this is to prevent errors of omission. We can "hide" them, however, by changing the first and last name slightly (i.e. XXlastname, XXfirstname). Some clinics even develop a code to denote a deceased patient (i.e. XDlastname, XDfirstname, etc.), or one that has left the practice (XLPlastname, XLPfirstname, etc.). It is up to you how you would like to handle these types of situations. Once the last and first name begin with X's though, these names will not pop up for you unless you actively go looking for them. They really do not take up any significant room either, and this way there will NEVER be the situation where a patient is inadvertently deleted from the database.

Patient's Chart and preSOAP

How do I document the patient's referring provider on their chart?

•  First open the patient's chart by marking them as here and waiting.  This can be done during the visit, or you can actually do this and NOT have to save a visit -- it won't add a visit to the chart, it will just change the referring provider.

•  Now click on the Main tab at the top of the patient's chart.

•  Under the patient's name and to the right of where their picture would be is a label that says "Referring Provider:" just left-click on that label.

•  Now just select the physician's name from the list and double-click on it.  If their name does not appear in the list yet, you will need to add it to the list. (see next)

How to add referring physicians' names to the list?

•  From your User's screen, click on the Database tab to the left.

•  Click on the Referring Provider's tab within this window.

•  In the blank bar, type the new doctor's last name and hit Enter on your keyboard. 

•  The demographics window will open up and you will be able to enter the rest of their information.  If you enter their address, etc. the program will be able to automatically address the referral letters. 

NOTE: if you are in a patient's chart and you realize that you have not added their physician's name to the database, you CAN just left-click on your user button at the bottom of your screen in your Taskbar area and you will be able to then enter it without having to exit the patient's chart.  They are working on a fix to allow us to add new names from within the patient's chart, and that should be up and going soon.

How do I add a note to the patient's chart?

Agents are used to perform these functions. Agents can be purely a textual note, can be used to attach scanned documents, or document interoffice communication regarding a patient in a patient's chart. You will need to create the agent, send it to the provider (the primary provider will be automatically cc'd any patient-related agents for THEIR patients) and as soon as the provider marks the agent as read and checks or leaves checked the box to make the agent a part of the chart, it will be included in the chart. Providers can also set up "Filtered Labels" which will allow the insertion of an agent directly into a patient's chart without having to first be approved by the provider. These are set up by the provider from their agents window. See Instructions for Agents.

How can I set a drug reaction on the chart?

There are a few areas where this can be done. Here are two different ways that these can be set:

•  From the patient's main screen of their chart, you can left-click on the text "Adverse Drug Reactions" which appears just to the right of their photo, and below their name.

•  Where the cursor is blinking, just type the name of the drug and hit the Import button to the right.

•  Now you are in the FirstDrug Database where you can find the name of the drug that the patient has a reaction to. If, for example, it is penicillin and you have typed PCN in the search/insert area, it is not going to show automatically in the drug database. Just hit backspace until PCN is gone and type the first few letters of penicillin.

•  Now when you find the drug in the list, just double-click on it and it will be pasted onto the patient's chart.

•  If you cannot find the drug in the list (possibly due to the fact that this database contains the active ingredients of the drugs only (no brand names will appear in this coder) and the patient may have told you they are allergic to Motrin, for example, and you don't know the drug's active ingredient) - then cancel out of the database window and type the drug name on the reaction editor and then hit your enter key on the keyboard. When you do this Praxis doesn't really know WHICH drug you are referring to, but the physician can fix that when they enter the patient's chart. The drug will appear in red on the Drug RxN editor to let you know it is not linked to the database.

•  You can now enter more drug reactions, if there are any, by following the same steps again.

•  When all of the patient's drug reactions are listed, click on the OK button at the bottom of the screen.

•  There is also a NKADR button (for No Known Allergic Drug Reactions) at the bottom left of this screen.

Another way to achieve this is from the PreSOAP window within the patient's chart.

•  Click on the Adverse Drug Reactions label on the preSOAP screen.

•  This will open a window just like the one described above and you can enter the patients drug reactions here in the same way.

How do I add the patient's current medications to their chart?

You can access a patient's current medications window from the Main page of the patient chart. Simply click on the Medications button toward the bottom right of the Main page. Here you will see any medications that the patient has reported as having previously taken. You can activate the ones that they are currently taking by double-clicking on them in the list. You can also add new medications by following these steps:

•  In the open bar towards the top of the current medications window, type the name of the drug the patient is taking (for example "Zantac") and click on the IMPORT button to the right.

•  This will take you to the Clinic list. If the drug that you are entering appears in this window, simply double-click on it. If it does not appear in the Clinic list, simply click on the IMPORT button again to go directly to the coder.

•  In this window you should see the drug that you are looking for. It is divided into two columns - on the left are the brand names and on the right are the generic names. You want to double click in the column on the drug that you are charting.

•  So in this case you could double-click on Zantac 150mg tablet in the left column.

•  The drug that you just entered will show in the patient's current medications list and you will also be able to enter or activate additional drugs. When you are finished building the current medications, click on the CLOSE button at the bottom of the screen.

You can also add the patient's current medications from the preSOAP window. It works in much the same way. You simply click on the label for "Current Medications" or the word "None" to the right of it and you will then be able to enter the new medications. The main difference from this screen is that you will not see the patient's past medications here. It is most useful for entering new medications to the patient's chart. (You can also access the patient's Current Medications window here, the same window you see from the Main screen, by right-clicking on the word "None" or a drug that appears next to Current Medications and selecting "Open Current Med. Window."

HIPAA & new users

How do I enter the program for the first time?

How do I create new users?

How do I deactivate a user?

How do I reset a user’s password in case they’ve forgotten it?

How do I reset my own password?

How do I designate someone as my transcriptionist?

This may be done from within the Administrative user’s window by right-clicking on the user’s name in the list and selecting “transcriptionist.”

It may also be done from the User’s window of the HIPAA officer by clicking on the HIPAA tab and then right-clicking on the user’s name in the list and selecting “transcriptionist.”

User Application

What do the colors in my User Window mean?

Blue - blue labels on your file folders means that there are items in the folder.  The number that follows the label in parentheses shows the number of items.

Red - If the patient's name in the Here and Waiting list is in red text this means that their chart is currently open by someone, or that they've been in the waiting room for longer than the time set in the Alarms area.  (You can set this time by going to your SETTINGS tab to the left of your User Window and clicking on the ALARMS button.)   You may also see red text in the Unread Messages folder alerting you to the fact that you have unread messages (you can open them by clicking on the Unread Messages text, or the Agents tab to your left).  Urgent messages will also appear in red text           .

Can I 'lock down' Praxis without exiting the program?

Yes, you can do this by pressing the F3 button on your keyboard.  This will lock the program down so that it will require your password in order to be reopened.  The F10 button will log you out of the program entirely.

How do I begin a patient visit if they are not seen by my nursing staff first?

If you left click on the Patients Here and Waiting label on your home screen the patient list will open and you can search for your patient name and then double-click on the name to begin the visit. 

Note: To easily search for your patient's name you can type the first few letters of the first or last name to narrow the list, and then if you hit the spacebar you will put a freeze on what you've typed and then you can type the first few letters of the rest of the name to narrow the list even further.

How do I find a visit I've marked as Unfinished so that I may finish it?

On your Home Screen you have a folder marked Unfinished Records.  All you need to do is to left click on the folder to open a list of your unfinished visits on the right side of your screen. 

On the right of your screen you will see the patient names - to reopen a visit to finish it, all you need to do is to left click on the patient name.  Once the patient chart opens, click on the New Visit tab to be taken back to the visit you marked as unfinished.

Can my office staff batch code my assessments, procedures, labs, etc. for me?  Where?

Yes you or your staff can batch code for you easily.  From the User's Window, click on the SETTINGS tab.  This will open a window where you or your staff can easily batch code.         The assessments, etc. that you see in red text are uncoded.  You can either right-click on them and select "Link to Code" or you can simply single click on them to load that item in the bottom field, where you can type the code directly in to the right.  Note: These elements can be coded here, but they have to be created from within the SOAP note and saved with assessments in order to be added to these lists.

Patient Chart and Previous Encounters

How do I view a patient's past visits?

There is a tab at the top of the patient chart marked CHART.  Click on this tab to access the past visits and inserted notes. 

All of a patient's chart entries are listed in the top portion of this screen.  You can search through them by typing into the blank bar at the top of the list.  You can search by encounter type, label of inserted note, doctor name, assessment, etc.  You can also open individual entries by double clicking on them in the list.

Also at the bottom of this screen the Previous Encounters and Inserted Notes are broken out and stored in separate folders.  You can open these folders by double clicking on them and then selecting the individual entries to open.  Note: The labels of the folders in the Inserted Notes area are determined by the labels of the agents that were sent to the chart carrying the notes.

How do I edit a patient's previous visit?

From the Chart area of the patient's record, simply double click on the visit you would like to edit in order to open it.  Once it is open there is a button to the bottom left marked EDIT, this will open the visit in order for you to edit it.

If you click on the Edit button you will see the SOAP note in its editable form.  If this button is not active - the electronic signature may have been activated preventing any change to the entry, or you may not have been the provider that created the note and in which case, you are not allowed to edit it. 

Why can't I edit a patient's previous visit?

See above question - If the edit button is not active - the electronic signature may have been activated, preventing any change to the entry, or you may not have been the provider that created the note and in which case, you are not allowed to edit it. 

What is the Electronic Signature and how do I use it?

The electronic signature, or timestamp, is the way to "notarize" an entry so that it cannot be edited or deleted after its activation.  The default number of days is three.  Wherever you see the box marked "Electronic Signature" you can right-click on it to change that to anything between 0 and 99 days.  (You will see the Electronic Signature check box at the Report Generator, on your Agents and Insert Notes, and by right-clicking on a chart entry that was not electronically signed in the patient's chart area.)

If you set the electronic signature on your documents (visits, agents, etc.) you will have that amount of time in which you could edit or even delete the entry.  After that period of time has elapsed (you can always see the amount of time left at the bottom of the screen in these documents in which the electronic signature has been triggered but not yet activated) you will no longer be able to delete or edit any of these entries. 

How can I add a patient's chronic conditions to the Main Page of their chart - conditions I will not be doing a SOAP note for, but that I want to be aware of?

The Main Page of a patient chart in Praxis works somewhat as a "one way street."  If you chart a patient's chronic condition in the SOAP note and also tell Praxis that it is a chronic condition by marking that assessment chronic - then that chronic condition will show on their Main Page the next time you open their chart.  You don't have to add it to the Main Page if you are going to do a SOAP workup for that condition.

If you are not going to do a SOAP note for this condition but you would like to be aware of it you can do so by following these steps:

You may also click on individual conditions to move them from list to list.  In the above screen shot, you could mark your patient's low back pain as an active problem by right-clicking on it and selecting "Move to" in order to drop it down into the Active list.  You can also mark problems as "resolved" in this manner.

What do the timers at the top right of the patient's Main Page of their chart reflect?

The timer to the far left will show the number of days that has transpired since the appointment was made - if you are using the Praxis Scheduler.

The timer in the middle (if the user is a Provider) will show the amount of time that the patient spent in the waiting room, combined with the time spent with the nursing staff.  If the user is an assistant it will show the amount of time the patient spent in the waiting room only.

The timer to the far right will show the amount of time that the user has had the patient's chart open, whether you are a Provider or an Assistant. 

Why has the Visit Time turned yellow or red on my patient's chart?

This timer can be set to turn red after a selected number of minutes have elapsed.  The default time is 5 minutes but you can change this to whatever number of minutes you like by right clicking on the time to open an editor box.  This timer also turns yellow first alerting you to the fact that the amount of time you've set is approaching.

How do I add a patient's photo to their chart?

This can be easily done from the Demographics tab, or the Main Page of the patient chart by following these steps: