Document a Posterior Exam
Ophthalmic providers can document Posterior exam findings in the Physical Exam panel. A more detailed Posterior exam can be documented on the Posterior Exam Detail template.
- You can document a posterior exam in the following areas.
- In the Physical Exam panel, navigate to the Posterior section.
- For a more detailed exam, click the Posterior link.
Previosuly documented findings appear in the current encounter fields. - Review and update the exam findings.
- To exclude an examination of the optic nerve:
- Select the Exclude check box in the Disc (ON) section.
An Exclusions window appears.
- Select an option in the Reason section.
- Select a specific reason from the list that appears, and click Save & Close.
Data fields for Disc (ON) are hidden, and the selected reason for not performing an exam of the optic nerve appears.
- Select the Exclude check box in the Disc (ON) section.
- To save the documented values as the default values, click the Quick Save, and enter a name for the template. This feature enables you to use the same values while documenting the same template during future encounters.
- To load the previously documented default values into the current template, click the Quick Load . For more information on the Quick Load and Quick Save functionalities, go to NextGen Healthcare Success Community, and download the latest Getting Started User Guide for NextGen® Adaptive Content Engine.
Note: The Quick Save and Quick Load functionalities enable you to save and load up to a maximum of two findings for an exam.
- To close the detailed template, click OK.