Help / Clinics and appointments
The appointment
Press a patient's name on the schedule, or the appointment in their record.
The Clinical entry box is open on the day of the appointment. After the day it stays closed, except to the practitioner who held the clinic and to the people who act for them, for whom it opens with a line saying when the appointment was; what they write is marked at its foot with who wrote it and the day and time. Nobody else can add an entry to a past appointment, and the other clinical panels (diagnoses, medicines, allergies and the rest) are still closed after the day.
A patient with flags has a red flag at the top right of the card at the top of the appointment, with the number of flags on it. Press it and the list opens just below, each flag by name, with the ones that change what you do in the room, such as blacklist, unfit and complication, in red; press it again to close it. A patient with no flags shows nothing there.
Under This appointment, Note shows what was typed when the appointment was booked, the purpose and any note together, such as a wound review by video; on an appointment you can still change it is a box, empty when nothing was written, and whatever you type is saved when you leave the box. The old words are kept on the patient's log, and clearing the box removes the note. A note is one line of up to 500 characters. The purpose and note are first typed on Start when the appointment is booked.
Publishing consent, where the organisation has Social, is for a patient who agrees in the room to their photographs being published. Tick what they agreed to and press Agreed: ask to sign. Fedelsoft notes who heard it and emails them a link to read and sign it, on a page in the name of the organisation asking, signed off by you; QR code opens the same page on their phone so they can sign before they leave. The link works for thirty days, and Email again sends a fresh one. A signed consent is also kept in their portal. Choose photographs opens Social's Add already on them, so the draft can be made straight away; it waits in Ready and cannot be approved until they have signed, and once their signature covers words from the consultation the caption is drafted for it.
Discharge, beside Outcome under This appointment, records the outcome Discharge - treatment completed and completes every pathway the patient still has open, in one press, so their portal stops showing a further appointment. Undo in the same place puts back the previous outcome and reopens only the pathways it completed.
Single visit, not a consultation pathway, also under Outcome, is a tick for an appointment that was a one-off, such as a single treatment, rather than a consultation that might lead somewhere. It saves as soon as it is ticked or cleared, and each change goes on the patient's log. The same mark is Single visit beside the patient's name on the day's clinic list on Start, so reception can set it without opening the appointment. Seen once leaves a marked appointment out, and its check-in message is not sent for it.
What has been made for each patient seen in a clinic, the letter, the quote and the photographs, is on the Post-clinic list, under Patients on Start, and no longer on the day's clinic list.
A letter ready to email has To and Copy to boxes beside Send: To empty sends it to the patient. Where the signatory practises through more than one organisation, a From box beside them chooses which one the letter is emailed as, which sets its letterhead and sender address; it starts on the organisation the clinic belongs to. Once sent it reads Send again, to the patient or anyone else. On the photographs, Share all shares every file on the appointment with the patient's portal at once, and Unshare all takes them back.
The page arrives with everything about the appointment already on it, and the note is typed in the room and saved as you go. Appointment details opens as a sheet in the middle of the page. Date, Appt, Location, Clinic and Practitioner at the top are fields: change one and only this appointment changes. Date, Clinic and Practitioner move the appointment to the clinic that matches, and say so if there is no such clinic or more than one, leaving the appointment where it was; they never change the clinic itself. Move, under them, takes the patient to another empty time on any day, this day included, so a patient on a 10:00 session can go to a 14:00 session of the same clinic day without being cancelled and booked again: choose the day, then press one of the empty times listed under each clinic. It makes the same checks as Move on Start, frees the old time, takes the new one, and the appointment then opens at the new time. A time or a stretch that overlaps a patient already booked, or a blocked time, on that clinic is refused. They are offered on today's and later appointments that are not over or cancelled. Under Status, Arrived, Consulting, Departed and DNA are one row of choices on the day, with the appointment's real status picked; an appointment with no status has none picked. Cancelled sits beside them: press it, then By patient or By clinic, and the status is recorded with the patient left on the time. The cross beside those two keeps the appointment. A cancelled appointment shows its status and Reinstate, which clears it. Arrived and Departed also set themselves: a patient signing in at reception becomes Arrived for the appointment they have come for, and signing out makes them Departed. When a patient becomes Arrived, the practitioner of that clinic is texted that they have arrived and when their appointment starts, unless the practitioner marked them Arrived themselves. Starting a consultation, a recording or a treatment with your next patient marks your earlier patient Departed where they were still Consulting; a patient who has only arrived is left as they are, because they may still be waiting. Each change is written on the patient's log with what caused it. Ahead of the day, Cancelled takes the patient off the time and keeps the time for someone else.
Notes, under Status on the appointment sheet, is for what you learn about the visit that nothing else records, such as why a patient did not attend or that no voicemail could be left. It is on any appointment with a patient, past or future and whatever its status, a DNA or a cancelled one included. Type the note and press Add: it is listed with your name and the day and time, and goes on the patient's log. A note cannot be edited once added; write a second one to correct it.
Cancel, on the card at the top of the appointment beside Record, takes the patient off the time and leaves the time free for somebody else to be booked into. It opens Appointment details with By patient and By clinic showing. Ahead of the day, choosing one takes the patient off the time and frees it for somebody else, and says if a late cancellation fee may apply. On the day, choosing one records the status and keeps the patient on the time. Cancel is offered on today's and future appointments that have a patient on them and are not already cancelled.
The page is laid out around the note. Above it, what you need before writing: the clinical details, the pathway and previous attendances. Below it, what comes out of the consultation: letters, quotes, treatments, consent and information, photographs, sketches, the recording and the appointment's own details. Each is a tile showing where it stands; press one and it opens in a panel over the page, with everything in it that was there before. Close, the Escape key, a tap outside it and the browser's Back button all close the panel, and you come back to where you were.
The Pathway tile shows only the pathways the patient is still on, each with the stage reached; once all are finished it says how many are completed. Pressing it lists the open pathways under Open and the finished ones under Completed, so a pathway that has ended never crowds out the one the patient is on now. On the day of the appointment, Advance a stage moves it on by one. Complete, on any appointment, ends the pathway, for a patient who is not going on with it or has finished, and their portal then stops showing the steps still to come; Reopen, which takes its place, puts it back. Each change is written on the patient's log with your name, and is the same change as Complete on the patient record. Where the patient has exactly one open pathway that was started from their record and has no appointment yet, the search under it opens already set to that pathway, and Start this pathway gives the pathway to this appointment instead of starting a second one. With more than one open pathway the choice is yours, and a completed pathway is never chosen for you.
A Prescriber sees Prescriptions under the patient's medications, which opens the patient's prescription list with this appointment as the way back, so a prescription is written during the consultation and the list page returns here when it is done.
Recording that a patient has no allergies is something you do, not something you leave blank. Under Allergies, where nothing has been recorded yet, Record: no known allergies states it, and the closed clinical heading then says so. Smoking works the same way through its own options, including Non-smoker. Where nobody has recorded an answer either way, both say that plainly rather than looking empty.
Under Medications, Search the formulary finds a medicine by its name or an alternative name, and picking one fills its usual dose, unit, route and frequency for you to change. A medicine that is not in the list is typed into the same box: Add it as a new medicine in the formulary appears under the matches, and pressing it adds the medicine to the list once, picks it, and writes a line on the patient's log; type the dose and press Add medication as usual. Days says how many days the medicine is for, and Notes takes anything else worth recording; both are shown beside the medicine in the list. A medicine already in the list under that name is picked rather than added twice. Once a medicine is picked, its name is a link to the medicine's own page, where its details (red flag, usual dose, unit, route and frequency, alternative names and dispensing notes) are read, and changed by a Prescriber or a holder of Reference Data.
Occupation lists what has been recorded for the patient, at any appointment. Search occupations finds one by its title or an alternative title, and Record occupation records it on the patient as their current occupation, against this appointment. An occupation that is not on the list is typed into the same box and recorded with the same press: it is added to the list once, so the next person can find it, and one already on the list under that title, in any capitals, is picked rather than added twice.
PMH is the patient's past medical history across every visit, so each diagnosis appears once however many times it has been filed. No past medical history is offered only while the list is empty, and is not shown once anything else is on it. Adding a diagnosis that is already there says so instead of filing it a second time.
Under Diagnosis, on the day of the appointment, the likely diagnoses for the patient's pathway stage are listed as suggestions beneath today's diagnoses, each with Confirm and Dismiss. Nothing is recorded until you press Confirm, which files that diagnosis on today's appointment as Provisional and moves it into the list above with its own remove; Dismiss only hides the suggestion while the page is open, and it is offered again next time. A diagnosis already on the appointment is not suggested, and an appointment whose pathway stage has no likely diagnoses shows no suggestions.
Attendees lists the people who came with the patient, each with Remove beside them on the day. Remove takes that person off this appointment only: they stay on the patient's record under Family and can be picked again. Present offers the patient's family and contacts to mark as present, and Add a new contact puts somebody not yet on file onto the patient's record and marks them present in the same press.
A letter printed or emailed carries its signatory's stored signature above their typed name, in the space left for it; where the signatory has none stored, the space is left as it is.
Sick note, beside Create letter, is drawn only for a doctor or a nurse. Press it, give the first and last day the patient is unfit for work and a short reason, and press Create: a letter in your name is made on this appointment, to whom it may concern, with the sick-letter wording already in it. Read it, change what you like and tick Approved, which signs it. Nobody who is not a doctor or a nurse sees the button, and the same letter can be made from the patient's record.
Letters shows each of the patient's letters as a sheet of paper, newest first: who it is to, its date, the practice and what the appointment was for, the opening of the letter, its number and whether it is approved. Press a sheet to open the letter beneath its row, and press it again to close it; only one is open at a time. A letter on another appointment is written on the appointment it belongs to, and one started on the patient's record is written there. Until something is written in a letter it shows no Save letter button and no Approved tick; both appear as soon as there is text. An approved letter has Print, for the person it is addressed to, and Print for GP when it is to the patient and the patient has a GP on the record. Anyone who may open the patient can print it. The letter opens as a document in a new tab, addressed to the patient or the GP surgery, and the letter then says who printed it, for whom and when.
On an appointment's own letter, where Ask is on for the organisation, Generate letter sits above the writing. Tick what to write it from: Transcript, Attachments (the documents and pictures filed on the appointment), Today's entry, or All entries, which is every entry on the patient's record oldest first and includes today's. Press it and the draft appears in the letter, addressed to the patient or the GP as the To box says, and saves as you go. Nothing is approved for you, so read it and change what you need. If the letter already has writing in it you are asked before it is replaced. A line under the button says what the draft was written from and what was left out, such as an appointment with no transcript.
Record, on the card at the top of an appointment, starts recording at once, in the card itself and not in another tab. A strip takes the place of Record and Cancel: a red dot and a running time, with Pause and Stop. Under it, Afterwards chooses between Transcript and Transcript and letter, Letter by chooses who drafts the letter, and Letter for chooses whether it is written for the patient or for the GP, which starts as the patient each time; all three can be changed while recording and apply when you press Stop, and each person starts from what they chose last time, which is Claude until they choose otherwise. The recording goes up in small pieces as it is made, and the screen is kept awake where the browser allows it. If the screen locks, the app is switched or the microphone is lost, the time turns amber with the reason, and the strip shows how much has been saved; Resume carries on the same recording and Stop finishes it. While a recording is running or being saved, any link on the page opens in a new tab so the recording is not interrupted, and the browser warns before you close the page. Stop replaces the strip with a row for the transcript, giving the length of the recording, and one for the letter if you asked for one, headed Patient letter or GP letter, giving who is writing it. Only that one letter is written, and it is filed straight into the appointment’s letters, not into the transcript, ready for you to read and approve. The transcript row says Ready when it is done, the letter row says Filed on the appointment, and Open on it opens the letter. The writer on the letter’s row can still be changed before the draft has started; if the draft fails, Retry tries again. Record and Cancel come back below the rows, and Record starts a further recording on the same appointment.
If saving a recording does not work first time, the page keeps trying on its own while it says so. Storage occasionally refuses a request for a few seconds and then works again, and that is what is usually happening. If it still has not saved after several attempts there is a Retry button on the transcript's row. Whatever reached Fedelsoft is kept, and a recording that is still not saved about half an hour after its last audio is transcribed and filed on the appointment automatically, even if the page was closed or lost; any part that never arrived is a gap in the transcript, which is why the page should be kept open and in front until it says Saved.
Recording and transcript holds the consultation recording and the transcript made from it, and what was recorded somewhere else can be brought in here. Type a transcript files one you already have, and Bring in a recording takes a sound or video file, transcribes it and files the transcript on the appointment. Both work on an appointment of any age, which is the point of them; recording a consultation live is offered only while the appointment is still running, because a consultation that has already happened cannot be recorded. A transcript made from a recording is cut into turns, each headed Clinician, Patient, Other or Unclear, with a blank line between turns. The speaker is worked out from what was said, never from the voices, so a heading can be wrong and the note at the top of the transcript says so; the words themselves are exactly what was heard. If that step could not be done, the transcript is filed in plain paragraphs without headings. A transcript filed earlier has a Tidy button beside Draft letters from this, which does the same to it. Revert to original takes its place once a transcript has been tidied, and puts the words back exactly as they were first filed. A transcript brought in says at the top that it was made elsewhere and is dated the day of the appointment rather than the day it was filed. Once it is there, Draft letters from this works on it exactly as it does on one recorded here. The sound itself is not kept: once the transcript is on the patient's record, the recording is deleted and only the transcript stays. If a recording could not be transcribed, it is kept so it can be tried again. On today's appointment the page keeps watch while it is open, so a transcript filed a few minutes after the recorder stops appears in Recording, and on its tile, without anything being pressed.
Photographs and documents takes photographs, video, scans and letters, from this computer or from your phone. On a phone or tablet, Camera takes a photograph and puts it straight onto the appointment; press it again for the next, as many times as you like, and each appears as it is taken. From a computer, a small code for your phone is shown beside Camera and Upload as soon as the fold is open, with Larger to fill the screen with it: scan it with the phone and the phone's page does the same, Camera for one photograph after another and Choose for ones already taken, for as long as the consultation lasts, and each file appears on the computer as it arrives. Each file is a tile: a photograph shows itself, and a video, PDF or document shows what kind of file it is. Pressing a tile opens the file. The arrow in a tile's top left corner moves that file to another patient or appointment: type the patient's name, choose the appointment or Patient record, and it goes there. The bin in the top right corner deletes the file, taking it off the appointment and out of storage, which it asks you to confirm because it cannot be undone. A photograph brought in by Photo import shows the day it was taken on its tile. Files from the patient's other appointments, further down, are tiles too and have neither control.
Under this appointment's own photographs, the same panel lists the patient's photographs and documents from their other appointments and operations, newest first and each headed with what it was and when. They are there to look back at, so they open from here but are added and removed on the record they belong to. A patient with a long history shows the most recent dozen records and says how many more there are; their own record lists them all. Anything still held only in the practice's own folders is on the appointment it belongs to and on the patient's record rather than here.
Treatments lists this appointment's treatments first and then what was recorded at the patient's other appointments, each with its date, what was treated, where, what was used and any notes, so a course of treatment can be followed without leaving the room. The earlier ones are read here and changed from their own appointment, and the twenty most recent are shown.
Build invoice, at the top of Treatments where the appointment has no invoice yet, makes an invoice for the patient, linked to this appointment, with every treatment recorded here on it at the price list's price for the payer. Nothing is invoiced until it is pressed. Where an invoice is already linked, the line at the top names it and each treatment chosen goes onto it as it is chosen, unless something of the same description is on it already.
Under Medicines and consumables used, photographing the packets and labels, on this computer or with your phone by scanning the code, reads each label and lists what it found on the shelf for you to tick and record. A packet that matches nothing on the shelf says not in stock, with the product, lot and expiry its label gave. Find it in the list above if it is there under another name; otherwise check what was read, correct anything wrong, say how many and press Record anyway. It is added to the organisation's stock holding just those packets and recorded on the treatment exactly as one picked from the shelf is, so what is left is to say how much was used. A packet whose label says it has expired is refused.
A remote appointment is marked Remote on the schedule on Start, in amber, and a clinic whose appointments are remote says so on its own heading: the patient is not coming in. It is worked out the same way the appointment itself works it out, from where the appointment is and what kind of place that is, so the two screens always agree.
The appointment's date and time, and the clinic it is in, are the first line under the patient's name, so they can be read at a glance.
Surgery is a tile of its own above the note, beside the pathway. Under Coming it lists the patient's operations booked for today or later: what each is, the day, the hospital and theatre, and where its booking form stands, in the same words as the booking form's own strip of steps. After them come the patient's booking forms that are not yet on an operating list, marked Unlisted with the day each was added, newest first; one added more than a year ago is not shown. Under Earlier come the operations that have already happened, newest first, with the day and where. A coming operation's name opens its booking form; an earlier operation's name opens its operation note. The tile itself says the next date, or that a booking form has no list yet, and how many operations have happened, so it can be read without opening it. A cancelled operation, or one in the recycle bin, is never shown.
Portal, beside the patient's date of birth at the top, opens the patient's record on its Patient portal card, where the invitation, the QR code and the patient's messages are. It is there only where the practice has the patient portal switched on.
While the appointment is on, from fifteen minutes before it starts until it ends, the line beside Portal says whether the patient has signed in to the portal: Signed in to the portal at 13:52, or No portal sign-in as at 14:10, the time the page was read. A patient who saved the portal to their phone may already be in without signing in again, so it reads as no sign-in rather than as not on the portal. Refresh at the foot of the appointment reads it again.
At the foot of the appointment is the time the page was read, and Refresh reads it again where you stand. Anything typed in the note is saved first, so refreshing never costs you a sentence.
A virtual appointment offers Join and its meeting link until it is over: once the patient has departed, did not attend or cancelled, or half an hour after the finishing time, the link is no longer shown, and Record goes at the same moment. Beside the link, Invite emails the patient the invitation now, with the practitioner's own choice of our Zoom or their own link, exactly as the morning run would; it says Invitation sent, or why not (already sent, no email address on the patient, the practitioner has not chosen how they take video consultations). While the patient is marked Consulting both stay for two hours after the finishing time, so a clinic running late is not cut off. The closed clinical heading says medications not recorded or allergies not recorded where nothing has been entered, and no medications only where that has been recorded.