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Complaints

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The patient makes an appointment for a complaint mentioned in brief and in layman's terms. During the HPI, the patient is likely to elaborate on many more problems, many of which may imply the same problem to a doctor. The doctor needs to list all the complaints and attend to them in a systematic manner. The complaints will depend on the specialty of the doctor, and a list of complaints can be made here. Besides noting the complaint, the doctor needs to ask valid questions relevant to the complaint. The HPI templates, also defined under the Configuration option, provide a set of questions, tests, and elements under a user-defined template. This option allows associating a Template with a Complaint. Also, the default diagnostic ICD code for the Complaint is to be defined. Note that more than one Complaint can refer to the same template. One template containing elements like Location, Severity, and Quality can be relevant to both headaches and backaches. Once this master is defined, during an encounter, the doctor needs to select a Complaint. All questions within the associated template will pop up, and the Assessment will have the associated ICD codes assigned by default. The Assessment and Plan notes can be predefined for a particular ICD code associated with a Complaint. The Complaint, when selected by a user in an encounter, has the associated ICD code, Assessment, and Plan notes directly added to the encounter. While it is necessary to have one HPI template associated with the Complaint, the user may associate, if required, a ROS, Physical, Specialty, and Social History template with the Complaint. The character limit of the Complaint field is 100 characters. The full Complaint Name is displayed in the tooltip when hovering the mouse over the Complaint.