Help : Signing

When you're completely finished with a note, click "Save and Sign" to finalize. Once a note is signed, diagnoses, plan items, and text are no longer editable, and additional diagnoses, plan items, or text cannot be added without first unsigning the note. However, signing does not affect your ability to add or edit charges. You can also append comments to signed notes

If you have the Patient Portal enabled and have opted to have encounter summaries visible to patients on the Portal, signing a note finalizes it and makes the encounter summary available to the patient. The encounter summary shows everything in the note except (1) the text (i.e., your subjective and objective notes) and (2) the charges.

Help: Co-signing

Any user can be set up as someone who must or may have his or her encounter notes co-signed by another provider. This can be useful to allow a physician's assistant, nurse, or nurse practitioner, for example, to complete and sign notes that are then placed in a queue for review and co-signing by a supervising doctor.

Co-signature can be set up in one of several ways for a particular provider:

  • Co-signature options never appear when the provider signs a note.
  • Co-signature options always appear when that provider signs a note, but co-signature is always optional, at the option of the provider making the request for co-signature.
  • Co-signature options always appear when that provider signs a note, and co-signature is required for some notes that contain designated charge types (CPT codes that you have specified), e.g., for particularly complex encounters.
  • Co-signature options always appear when that provider signs a note, and co-signature is always required.

Where co-signature options appear, the provider requesting co-signature will generally have the option to submit the request to any other provider with the power to co-sign. These are doctors (or more experienced providers of any type) that we have set up as available co-signers at your request. A single provider may also be designated as the default or required co-signer for another user.

When co-signature is requested, the note appears signed with a "Pending Co-Signature" label, and the co-signature request appears in the designated co-signer's task list, or in the task list of each provider who is authorized to co-sign if "Request Co-Signature From: Any Authorized Provider" is selected. When the note is co-signed, it will show in the top right-hand corner both the signed date and user and the co-signed date and user.

Co-signing cannot be undone. But if the note is unsigned, both the signature and co-signature will be cleared.

Help: Unsigning

If unsigning is enabled for your practice, you can unsign a signed encounter note, for example to add or edit a diagnosis or fix any other mistake or omission. Depending on how your build is configured, you will do this in one of two ways.

If confirmation is not required to unsign, you simply click the unsign button that appears in the note, explain why you are unsigning in the pop-up window that appears, and click "Submit Unsign Request". For records-keeping and auditing purposes, a copy of the original note will be attached to the unsigned note as a "previous signed version."

On the other hand, if your practice is set up to require confirmation from another provider, the note will initialy remained signed with a note indicating that an unsign request has been submitted. A task will appear in the task list of each other provider with authority to confirm unsigning. When the unsign request is confirmed, the note will be unsigned. A copy of the original note will be attached to the unsigned note as a "previous unsigned version" if the practice has opted to do this in addition to using confirmation of unsigning.