Surgery Management Workflow

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Administration > EMR setup > Surgical Procedures.

Select Add New Procedure then scroll down.
Provide the necessary details.
1. In the Item Name you may enter the CPT code or the description of the code then select from the dropdown list.
Once you have added all other details, select Save.

Surgical procedures done by the practice needs to be added in the Surgical Procedures page to easily create a surgery form.
Some information added in this page will be reflected in the surgery form.

Patient Name > Right Click > Schedule New Surgery.

Add Procedure from the practice list – The list will include all procedures added in Surgical Procedures
1. Select the Procedure from the list.
2. Select Add to Procedure List – You can add modifier and laterality.
3. Select the box beside the name.
4. Select Save.
Diagnoses – This will include all ICD codes added in the note Assessment and Plan page prior scheduling the patient. You can delete and add ICD code manually.
Current Allergies – This will include all Allergies documented by the practice prior to scheduling the procedure. You can add allergies manually.
Consent for – Name should be based on the procedure for tracking purposes. (e.g., Rhinoplasty Consent Form)
Date of Surgery
1. Select Search for Available Time – This will pull up the Available Time Search where you can search for all available time for Surgery. Make sure to provide the correct information in the filter.
2. Complete the form.
3. All Documents – It will open all documents that are uploaded. You can send multiple documents through this page.
4. After completing the form, select Save and Sign off.
5. You can print or fax and send it to the facility.

EMR > Surgery Management

Use the filter to search for scheduled Surgery Procedures. Make sure to set the applicable DATES.
Select Search. The patient’s name should be found on either of the following folders, note that there is no need to manually move the patient’s name because this is automatically done by the system based on the date of surgery.
1. Preoperative – The patient will be in the preop folder until 24 hours before the surgery.
2. Perioperative – This is the period of procedure/surgery.
3. Postoperative – After surgery, the patient’s information will remain in this folder for the remainder of Global days, until it is satisfied.
4. Completed – Patients with Global Days satisfied will be moved to Completed.

To modify the surgery form, select the date.
By right clicking the patient’s name, you can update the surgery form, close, defer or modify the schedule, and/or create operative report.
Procedure – This will include the consent form name. This will indicate what procedure should be done for the patient. Users can move patients to “completed” manually, as necessary. Right click on patient’s name > select close.

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