Patient Treatment and Medical Records Overview

Medical Records and Treatments Management

Did you know? According to research, an average healthcare facility deals with thousands of patient records every year and needs efficient systems to keep them up-to-date and on file. We take medical records and treatments seriously. Every detail from recording diagnoses to treatment data has a purpose in helping healthcare providers deliver great patient care. Here’s what makes managing medical records and treatments easy, accessible and super documented.

Pre-entered and Pre-imported Treatment Options

Our program allows pre-entering or pre-importing of treatment options so you can have multiple treatment options available when recording patient care. No need to enter each treatment every time, you can rely on a database of pre-set options already loaded in the system. Whether in a clinic or hospital, having these pre-configured treatment options will save you a lot of time, so medical staff can quickly access, select or update treatments as needed.

• Treatments can be pre-imported through file uploads, populates the database.

• Options to add, edit or remove treatments within the program.

• Ability to update treatment options when clinical practice changes.

This feature supports daily clinical work by allowing you to focus on the unique aspects of patient care without having to input commonly used treatments every time.

Quick Search for Treatments

When you need to find specific treatments in a patient’s records, quick search is key. In our program, you can find a treatment by typing part of the word—no need to remember the full treatment name! This feature helps you navigate large datasets or patient files and jump to relevant information with minimal effort.

• Type part of the treatment name to pull up matching entries.

• Filter options to refine search results by specialty, patient history or treatment frequency.

• Edit, update or delete treatments within the search view.

Searching is easy so you can find the treatment details in seconds during patient consultations.

Free Text Entry for Unique Treatments

Not all treatments fit into standard categories and for those cases, our program has free text entry. This means healthcare providers can enter unique or less common treatments that may be specific to individual cases or certain patient needs. Free text entry is useful in speciality medical cases where treatment may be experimental or personalized.

• Users can enter custom treatment descriptions directly in the program.

• Free text fields to add patient specific instructions or notes on treatments.

• Treatment entries can be updated as new data becomes available or patient condition changes.

This feature is for non-standard treatments without limits, so practitioners can document care for every patient.

ICD10 and Other Medical Codings

Medical coding is important in healthcare especially when it comes to standardizing diagnoses and treatment plans across facilities. Our system supports ICD10 coding and other coding standards so records are aligned with industry standards and consistent for billing or reporting purposes.

• ICD10 and other codes are available for selection during diagnosis and treatment entry.

• Coding systems makes treatments easily recognizable for healthcare providers and billing department.

• Codes are searchable within patient records and can be updated as needed.

Having medical coding systems in our records makes our records more useful by having all treatment information follow industry standards so reporting, billing and record-keeping is simplified.

Treatment and Pricing and Billing

Our program integrates treatments with pricing and billing. This integration allows users to manage financials without having to switch between different systems, so you can track and bill patient care services easily. Every time you record a treatment, you can link treatments to itemized billing rates so invoices are clear and accurate.

• Treatments automatically go into billing modules for easy invoicing.

• Each treatment entry can be linked to a pre-defined cost or billing rate.

• Billing integration allows cost customization if treatment prices need to be adjusted.

The billing integration matches treatment documentation with financial records so there's no duplicate data entry for patient billing.

Timeline for Patient Treatment History

The Timeline feature gives users a chronological view of a patient's medical history, showing when and what treatments were done. This visual record helps healthcare providers track patient progress and has a structured history of care which is useful for long term or recurring cases.

• Timeline entries show date, time and details of each treatment done.

• Previous treatments are easily accessible for reference during new consultations.

• Editable entries so corrections can be made if needed.

With the Timeline, healthcare providers have a structured view of patient care over time which helps in tracking and long term treatment planning.

Consultation Editor for Treatment Planning

The Consultation Editor is the main interface for documenting treatments during patient visit. Within this tool, providers can record new treatments, update ongoing care plans and link treatments to specific diagnosis so each entry is relevant and accurate.

• ICD10 and other codes for diagnosis and treatment entries.

• Add treatments and link to specific patient symptoms or conditions.

• Editable entries so treatments can be updated or modified as needed based on patient response.

By using the Consultation Editor, medical providers can have a clear and detailed record of every patient visit and ensure all treatments are documented.

Printable and Exportable Treatment Records

For cases where treatment records need to be shared or saved externally, our program allows printing and exporting of records. Users can generate treatment data report which can be saved in PDF or Excel format so it can be shared with patients, colleagues or third-party entities.

• Print entire patient charts or specific treatment records for offline storage.

• Export to Excel or PDF so medical data can be shared.

• Customizable printing options to fit your reporting needs.

The print and export feature helps healthcare providers manage records flexibly so they can store or share treatment details in a format that suits their practice.

Inventory and Treatment Integration

For treatments that require specific medical supplies, the inventory integration feature tracks resources accurately. Each treatment can be linked to inventory items so clinics can monitor stock and have supplies available when needed for patient care.

• Updates inventory levels when treatments are done.

• Track consumable materials used in specific treatments from patient records.

• View available inventory items within the treatment entry form.

Inventory integration with treatment records helps healthcare providers to monitor resources so materials are always available for patient care.

Data Import for Initial Setup and Updates

The data import feature isn’t just for treatments and pricing; it can also import other types of records. Whether it’s patient records, past treatments or diagnosis codes, this feature can save a lot of time for initial setup or updating the system.

• Import files to set up patient demographics, treatment records and more.

• Customize imported data so users can refine entries after import.

• Options to import ICD codes to ensure coding consistency in patient records.

By having data imports, our system allows clinics and hospitals to build a comprehensive database that mirrors their records.

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In summary, the system brings structure and order to medical records and treatment management. Each feature helps healthcare providers manage and document patient care from the moment a treatment is entered in the system to the time it’s billed and added to the patient’s record. Our program makes recording, pricing and coding easy so healthcare providers can focus on what matters most: patient care.