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Training Exercise for Charting Findings and Planned Treatment
Open a Training patient’s chart in the Rolodex- Open Rolodex module- type in “ training”- select patient from list- click to open the chart (name must appear in status bar at bottom of screen)
Go to the EHR module:
For a New Patient- to chart caries/restorations already there: Add Findings :
click on Create new Record button on top toolbar to open Chart Add tab.
Click on Findings button to add findings for a new patient (existing conditions & restorations) or new findings (caries) for a current patient First chart missing teeth and primary teeth on the odontogram.
Right click on tooth # 1,16, 4 and 32 in odontogram and mark as Missing.
Can choose more than one tooth at a time, then right click and choose Missing. Right click on tooth #13 and hit Age change to change to primary tooth J (baby tooth). Add an existing amalgam restoration on Occlusal surface of tooth #30.
- (choose M-AMAL under Quick List
- choose Occlusal surface on tooth #30 in odontogram
- add finding button Add caries on Occlusal surface of tooth #2 and #14. 1. Choose (C3001) Primary caries in quick list- 2. Occlusal surface on odontogram for teeth 2 and 14- 3. Add finding button.
Add caries and existing restorations as shown on next page.
When all findings have been charted, student/resident will now plan treatment for patient.
To Add Planned treatment :
Choose Dental Txs button to add planned treatment. Add a prophy
- Choose Preventive category-
- Adult Prophy from Quick List and
- Hit planned treatment button (Do not use Add Finding button to plan treatment.) Add 4 bitewings by choosing Diagnostics category- Bitewings,four films from Quick List, hit planned treatment button.
Go back to In progress and Tx history to view planned treatment.
Click on each tab in the bottom half of EHR to become familiar with each one
In Progress tab - pending (planned) treatment and health summary Tx history tab - treatment completed, notes and planned treatment at bottom What color is unapproved treatment?_____________ What color is completed & approved treatment?__________
Forms tab - medical history, consults
To open a new form, click on Add new form button, top right toolbar.Choose new form- by hitting drop down arrow and selecting CNS- consult form, complete form and close Attachments tab - has old medical release letters, photos, biopsy reports Perio tab- shows past perio exams- click on date to see form
To add a new perio exam, click on No to resume perio warning- choose Exam type- Initial exam Go to PD- probing depths- add numbers from keypad on keyboard- 3’s all across to see how charting progresses across mouth Starts in Max Right-Max Left-Mand left- Mand right Important: Save button saves what you entered that day, does not close exam Complete – closes exam, cannot resume exam at later date Incomplete - closes exam, can resume at later date, ask student/resident before closing
Change Planned Treatment to In Process or Complete
Planned treatment is in red text once it is approved and it appears at the bottom of the Tx History. Go to the Tx History or In Progress tab and double click on the planned procedures below- change Status to Complete.
Blue means unapproved treatment, postgrad treatment is automatically approved when they are logged onto axium. Crowns or dentures would be marked as In Progress at each appointment until completed.
Patient Card - click on patient’s name in status bar at bottom of screen to open pt card for additional patient information. This window shows appointments for patient.
Patient Care Module - click on this module to see all records for patient in one place
For assistance with axium: Kathy Hansel Room 2305 504.941. khanse@lsushc.edu
