Topics History of Present Illness Search:  
Introduction: The HPI screen displays a summary of all complaints reported by a Patient and their details. If no complaint is entered, then on clicking on this menu option, a Complaint popup is displayed. The HPI screen then appears with all complaints selected on this popup.

Field Descriptions:

Reason for Visit: If the Patient had a scheduled appointment, then the complaint specified while scheduling the appointment is displayed here. If the encounter was directly created from the Start Encounter option, the reason entered there appears here. This field can be edited by the user.

Add Complaint: This is an auto-complete field where a user can type a complaint. Alternately, the user can click on the Search icon to invoke a Complaint search popup and select a complaint from the popup. These complaints are defined under Settings → Configuration → Masters → Codes. In the definition, a template and ICD Codes are associated with the complaint. The Complaint search popup also provides an option to add new complaints on the fly (However no ICD Code gets assigned to it, and the assigned HPI template is the default one). If the entered complaint name could not be auto-completed then it can be added as a new complaint.

Past ICD icon : Click to invoke the View Past ICD codes popup and view a list of all Past ICDs associated to an encounter.

Copy icon : Click on this icon to invoke the Patient Encounter List popup which displays a list of encounters for the patient with pre-existing complaint names. On selecting an encounter, the complaint and its associated template and tests will be copied (only if the selected complaint was not present in the current encounter). This icon is enabled only if the encounter is live OR User has modify rights OR save button is disabled.

COMPLAINTS:

Del: Check this checkbox and click on the save button to delete the selected complaint.

Complaint: Displays the name of the complaint. The default complaints that are defined in the Encounter Type screen are available on the HPI screen.
Note:
  • If an Encounter's type is changed then the default complaint list displaying on HPI screenwill also change accordingly.
  • If an Encounter's type is changed after any updates to the original and default complaint list then the HPI screen would not only display complaints of the latest Encounter type but also the updated list of the first Encounter type.
Chief? checkbox: One or more selected complaints can be marked as Chief Complaints using this checkbox.

TESTS:

Click on any complaint in the Complaints table to make it current. The background color of the selected complaint changes from grey to blue, and the elements corresponding to the template associated with the complaint and the tests applicable to the sex of the patient are displayed on the right side of the screen. Users can enter details for the listed elements. If the Result Type selected from Tests Master is Master Search and its value is ICD, then ICD10 information is displayed in the tooltip.

Checkbox: This checkbox before the Test name is checked as soon as the test is answered.

Elements: Displays the names of all the tests in the selected template.

Result: Allows the user to select or enter the required result for the respective Test.

Abn checkbox: The checkbox is selected automatically if the Test's result is abnormal. A User can also select the checkbox manually, if required.

Remarks: Allows the user to enter the remarks for the respective Test. Users can click on the Remarks icon and select remarks from the popup.

Notes: Allows users to enter notes with more details about the complaint in this field. Click on the Search Notes icon to add, edit or select pre-defined phrases from the History of present Illness Phrases popup and add them as notes. The different types of Phrases used in PrognoCIS are displayed as per category in the History of present Illness Phrases popup and users can search for phrases based on category, phrase title and/or textual search or search based on keywords. Users can add single or multiple phrases to the notes from this popup by selecting the required checkboxes and clicking the ok button. The notes entered in this Notes field are displayed in the History & Physical section in the patient's Health Summary.

GRID TESTS:

When the template contains Grid defined in the system then, depending on the number of grids defined, the icons: are enabled. Clicking on these icon, a popup with matrix of selected tests and occurrences is displayed.
See Also: Test Execution | Grid Tests