Document the Excision of a Skin Cancer

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Document Excision Procedure Care Details

On the SOAP template, go to the bottom of the template and select the Procedures icon. The Udp Procedure Picklist opens. Click Excision/Repair and click OK. The Procedure dermatology excision 1 template opens. In the Today's Assessment grid, select or add a finding to be excised. The Procedure Excision panel is populated with a diagnosis for the selected finding. In the Procedure Excision panel, do the following:. Select the appropriate option for Benign or Malignant. Examine the excision site location with the patient and select the Patient verified site check box. To document the number of the room in which the excision took place, click RM#. If collecting a sample for pathology, type the name of the lab in the Path Lab field. Type the accession number received from the pathology lab in the Accession # if excising a biopsied finding. To add an indication, select from the Indication 1 picklist or click the blank line and type a non-listed indication. To add additional indication, clic

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Document Excision Repair Details

On the SOAP template, go to the bottom of the template and select the Procedures icon. The Udp Procedure Picklist opens. Click Excision/Repair and click OK.The Procedure dermatology excision 1 template opens. In the Today's Assessment grid, select or add a finding to be excised.The Procedure Excision panel is populated with the diagnosis for the selected finding. In the Repair panel, do the following: To select the type of repair performed, click Repair Type. Select the anesthesia being used from the picklist and enter the amount used in milliliters. To add Undermining details, select the No or Yes option as appropriate. If you select Yes, indicate the size of the undermining in centimeters in the cm field. To add a dermal suture type, select from the Dermal suture 1 picklist or click the blank line, and type a non-listed dermal suture type. To add an additional dermal suture type, click Dermal suture 2. To add an epidermal suture type, select from the Epidermal suture 1 picklist or cl

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Record Skin Cancer History

Open the Histories - Dermatology template. In the Skin Cancer Log panel, in the Treatment History section, click Add.The Skin Cancer History Log - Derm template opens. In the Treated? section, select the N option. Type the year the cancer was diagnosed in the Year of DX field. To select the characteristics of cancer as reported on the pathology report, click Characteristics. In the Accession field , type the accession number from the pathology report. Select the correct specimen id from the Specimen ID list. Note: This is essential if the report includes multiple specimens. To open the Diagnosis template, click Diagnosis, and then locate and select the diagnosis as reported on the pathology report. Select the location where the patient is identified with cancer in the Location field. Select the treatment needed for this patient in the Recommended treatment field. Note: Information about the actual treatment needs to be reported after you have completed the procedure. When you complete

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Record Cancer Staging Details

Open the Histories - Dermatology template. In the Skin Cancer Log panel, in the Staging section, click Add.The Cancer Details template opens. In the Cancer Type section, do the following: Select the cancer type as Primary or Secondary. Do one of the following: To enter the details in all the fields, select Enable free text check box. To select the options from the respective picklist for each field, clear Enable free text. Select a diagnosis or click Add common assessment to select a diagnosis. Click Cancer Type / Site and select the cancer type from the Cancer Type Details template. Enter or select the Status and Behavior value from the picklist. Enter or select the Histology and Laterality value from the picklist. In the Cancer Staging section, do the following: If staging details are not available, select the appropriate option: Staging pending Insufficient data No staging system If the staging details are available, verify and update the date and time of cancer staging. Select the

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Skin Cancer Treatment Workflow

When the pathology report indicates the presence of skin cancer, you must first record the pathology results on the Skin Cancer History Log - Derm template. The application then places a record for the skin cancer in the Skin Cancer Log Treatment History grid and the Untreated Skin Cancer alert appears in the patient's chart and will remain until you report that the skin cancer has been treated. You can document when and how a patient was notified of pathology results on the Biopsy Log or the Order Management templates. This information is visible in order. After the lesion has been treated, the application updates the Skin Cancer Log Treatment History grid to indicate that the lesion has been treated and removes the Untreated Skin Cancer alert, if there are no other untreated skin cancers. Record Skin Cancer History You can document this procedure when you receive a pathology report that indicates that the patient has skin cancer. Record Cancer Staging Details You can document cancer

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Record an Excision Procedure

On the SOAP template, go to the bottom of the template and select the Procedures icon. The Udp Procedure Picklist opens. Click Excision/Repair and click OK.The Procedure dermatology excision 1 template opens. Select No for the Are you performing a procedure on a biopsy proven malignancy? question. In the Today's Assessment grid, select or add a finding to be excised.The Procedure Excision panel is populated with a diagnosis for the selected finding. In the Pre-Procedure Care panel, after explaining the details of the procedure to the patient select the relevant options. Note: To add more information about the consent, select the Consent link. In the Procedure Excision panel, document the required information. In the Repair panel, document the required information. In the Post Procedure panel, record if complications occurred, select how the patient tolerated the procedure, the suggested time for the follow-up visit and other details. Click Submit to Procedure Billing. Click Save & Clos

Document the Excision of a Skin Cancer

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Document Excision Procedure Care Details

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Document the Excision of a Skin Cancer

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Record an Excision Procedure