The Doctor very often needs to send a letter with assessment and Plan to the Referring Doctor. Like wise he could be communicating with the Patient, Insurance company amongst others. He could also be sending a note referring the Patient to a specialist.

This option facilitates making letters quickly, using predefined templates. This is with reference to the current Encounter, so all the details are available.

Letter To: This can be To Referring Doctor, Referred to Doctor, Patient, Employer, Primary Insurance, Secondary Insurance,Emergency Contact, Spouse/Legal Guardian, Subscriber of Primary Insurance, Primary Care Physician1, Primary Care Physician2, Primary Care Physician3, Primary Care Physician4, Primary Care Physician5.

Date: Is set to run date.

To/Cc: Select the desired option from the list i.e. either To or Cc. The first row is always saved as To.

Name, e-mail, Fax and Address: Name is a mandatory field. If the check boxes for Referring Doctor or Referred to Doctor or Patient were checked, these text fields are automatically populated. If one or more Medics or Patients were selected using the search button, their names along with the stored fields in the database are populated. User can also enter an adhoc name with the email and/or fax and/or address fields.

Email Type: The column is displayed if the property, prognocis.n2n.enable is SET to Y. If any of the email recipient's email address (selected either from the Email Type drop-down list, or by click of the Email icon, or entered directly in the field) is non-Secured then the following prompt is displayed, “Sending patient health data over email is not advisable for HIPAA compliance reasons. Do you want to Continue?”. The conditions when an email would be sent as secured or non-secured depends on Clinical messaging being SET as ON or OFF for the Clinic. Consider the following table,

Table: Conditions to send email secured or non-secured

• Entered on clicking Save by a user who has been assigned entry rights only.
• Approved on clicking Save by a user who has been assigned approval rights.
• Sent on clicking Send.

Attach Button: Click on this button to attach additional file(s) with this letter. Checking the "Sel" Checkbox in the view, allows user to make multiple selections to be attached. On selection, the program displays a row of icons, one for each selected Document. User can click on any icon to view the contents in a pop up Or to Detach it.
Note:

Selecting an earlier Letter-Out, will Not select its Attachments. Fax of the letter will include all Attachments selected (provided the Letter template is PDF enabled). Print of the letter will print only the Body of the letter.
Delete of the Letter will fail if it has been attached to some other Letter-Out.

In case CCD file is attached then it prints the HTML of CCD file along with combined single PDF; In case CCD file is attached then it downloads XML and HTML both discretely. When a User clicks on download then the CCD HTML file and CCD XML file is downloaded separately in the same folder.; In case it's a non secured email and if user is attaching CCD file while sending letter then both XML and the HTML are sent discretely; In case CCD is attached while sending the letter then the HTML of CCD file (after converting to PDF) is sent.

Select Tags : To add new contents at any position, move the cursor to that position and click there. Now select any Tag from the List Box. The program selects the tag, generates the relevant contents and inserts them at the cursor position. The generated contents can be a small string (like a Patient Name) or could be a multiple line string like (List of Current Medication).
The cc list and subject can be printed as part of the Letter by using special Tags.
Use [LETTER_SUBJECT] to print Subject and [LETTER_CC] to print CC.

Append: The feature 'Append' on the Letters- Out screen enables the user to send multiple letters at a time. Here,

• Select a template from the list 'Letter'. This will be the default template.
• Click on next to 'Append'.
• A new window will display a list of the available templates, from which the user can select multiple templates by clicking on the checkboxes against each template name.
• Click ok to append these selected templates to the default template selected from the list in 'Letter'.
• The multiple letters are separated by Page Break in the body. The user can edit these letters.

Note:

1. The letters would be displayed in the order that they were selected.
2. The default template is selected fromt he list 'Letter'.
3. If any other default template is selected, the existing contents are overwritten.
   

Select Tags and Template will be disabled in case the selected Patient does not have a single encounter.

Letter Contents: The Text of the letter generated based on the template and the Tags used is shown here. The user can add / delete / change the contents. The text editor tool bar provides a wide range of functionality, with standard buttons, tool tips and functionality.

Search: Displays a list of all letters for the current Patient in reverse order of date.

Send: A letter cannot be send until it is approved by the doctor.

Hint:

1. When Clinical messaging is enabled in a Clinic, in the Letters-Out screen a warning is displayed, “Do NOT include private or sensitive information (PHI) in the subject line. It will be displayed in the recipient's personal non-secure email inbox”. Also, option of “Sure scripts Directory” is available to Users from wherein it is possible to select Clinical messaging recipients.

2. Consider the following conditions with regard to the CCD file:

•  In case CCD file is attached then on print, it prints the HTML of CCD file along with combined single PDF.

•  In case CCD file is attached then on download, it downloads XML and HTML both discretely. When a User clicks on download then the CCD HTML file and CCD XML file is downloaded separately in the same folder..

• In case it's a non secured email and if user is attaching CCD file then while sending letter then both XML and the HTML are sent discretely.