The Provider very often needs to send a letter with assessment and Plan to the Referring Provider. 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: The drop-down list displays the following values depending upon the conditions as mentioned:

1. Referring Provider:Visible if any of the following conditions are fulfilled: i. If Billing module is ON then the name of Referring Provider at the Billing end is displayed. ii. If Billing module is NOT ON then name of the Referring Provider of the current encounter at EMR end is displayed. Note: In case system is not able to pick the value from the patient’s current encounter then the value is picked from patient’s registration details.
2. Referred to Provider: Visible if there is a Referred to Provider set from Edit Encounter screen.
3. Patient:The currently selected name of the Patient, this is a default value that is displayed in the drop-down list.
4. Others:
5. Employer:Visible if the Employer details has been entered for the Patient (via tab: Patient à Register à tab: Contacts à Employer and relative fields) then the value is displayed on the To drop-down list. Note: Employer name could either be selected from the search or be added manually.
6. Patient’s Primary Insurance:Visible if Patient’s Primary Insurance details are available on Insurance popup.
7. Patient’s Secondary Insurance:Visible if Patient’s Secondary Insurance details are available on Insurance popup.
8. Patient’s Tertiary Insurance:Visible if Patient’s Tertiary Insurance details are available on Insurance popup.
9. Emergency Contact:Visible if the patient’s Emergency contact details have been entered in the system (i.e. on Patient Registration screen à section: Emergency Contact Details).
10. Spouse/ Parent/ Legal Guardian (SPL) :Visible if any of the patient’s relation details have entered in the system (from Patient Registration screen à section: Spouse/Parent/Legal Guardian details).
11. Subscriber Primary Insurance:Visible if the name of the policy holder or Subscriber of Patient’s Primary Insurance is other than self as entered in the system via the Insurance popup.
12. Subscriber Secondary Insurance:Visible if the name of the policy holder or Subscriber of Patient’s Secondary Insurance is other than self as entered in the system via the Insurance popup.
13. Subscriber Tertiary Insurance:Visible if the name of the policy holder or Subscriber of Patient’s Tertiary Insurance is other than self as entered in the system via the Insurance popup.
14. Primary Care Physician 1:Visible if the name of the first Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
15. Primary Care Physician 2:Visible if the name of the second Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
16. Primary Care Physician 3:Visible if the name of the third Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
17. Primary Care Physician 4:Visible if the name of the fourth Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
18. Primary Care Physician 5:Visible if the name of the fifth Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
19. Responsible Person:Visible if the patient’s Responsible Person entered is NOT equal to self. Responsible Person is added from the Billing tab on Patient Registration screen.
20. Primary Insurance Attorney:Visible if the Primary Insurance of the Patient has the Attorney details entered from the Insurance popup.
21. Secondary Insurance Attorney:Visible if the Secondary Insurance of the Patient has the Attorney details entered from the Insurance popup.
22. Tertiary Insurance Attorney:Visible if the Tertiary Insurance of the Patient has the Attorney details entered from the Insurance popup.
23. Primary Insurance Adjustor:Visible if the Primary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
24. Secondary Insurance Adjustor:Visible if the Secondary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
25. Tertiary Insurance Adjustor:Visible if the Tertiary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
26. Patient Attorney:Visible if patient’s attorney’s name has been entered in the Billing Info tab on the Patient Registration screen
27. Patient Adjustor:Visible if Patient Adjustor’s name is entered in any Case associated to the patient from the Case Management popup.
28. Case Manager 1:Visible if the first Case Manager’s name has been added from Case Management popup.
29. Case Manager 2:Visible if the second Case Manager’s name has been added from Case Management popup.
30. Case Manager 3:Visible if the third Case Manager’s name has been added from Case Management popup.
31. Rendering Provider (Billing):Visible if Billing module is ON and Rendering Provider’s details is available with Patient’s Claim details.
32. Attending Provider (Billing):Visible if Billing module is ON and Attending Provider’s details is available on the Patient’s Registration screen.
33. Operating Provider:Visible if Billing module is ON and the UB04 form details have Operating Provider’s name or details entered.
34. Operating Assistant Provider 1:Visible if Billing module is ON and the UB04 form details have the first Operating Assistant Provider’s name or details entered.
35. Operating Assistant Provider 2:Visible if Billing module is ON and the UB04 form details have the second Operating Assistant Provider’s name or details entered.
36. Case Insurance Company:Visible if a case is present for the patient and if Insurance has been assigned to this case from the ‘Insurance/Employer/Patient’ Section on the Case Management popup.
37. Case Insurance Attorney:Visible if an Attorney has been assigned for the case from the Case Management popup.
38. Case Insurance Adjustor:Visible if an Adjustor’s detail has been entered for the Insurance in the case from the Case Management popup.
39. Case Patient Attorney:Visible if an Attorney has been assigned for the patient from the Case Management popup.
40. Case Patient Adjustor:Visible if an Adjustor’s detail has been entered for the patient in the case from the Case Management popup.
41. Collection Agency:Visible if a Claim has been sent to a collection agency.
42. Encounter Case Employer:Visible if a case has been assigned specifically to an Encounter via Edit Encounter.
43. Encounter Case Employer Job:Visible if Employer Job has been associated to a case from the Insurance popup.
44. Claim Case Employer:Visible if Employer Job has been associated to a case from the Insurance popup.
45. Claim TPA (Third Party Agency): Visible on process of Claim having Employer details and also the third-party agency details associated (from the Employer’s TPA Master screen).
46. Claim Employer TPA Contact:Visible if the associated TPA agency has a contact person’s name entered in records.

Displays the Patient's name. To select another Patient, click the Patient search icon. A click on Patient Info icon: displays the selected Patient's demographic details.

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

Note: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.

• 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 Provider.

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.

• Fax: In case CCD is attached while sending the letter then the HTML of CCD file (after converting to PDF) is sent.