Clinical Item Attributes

Clinical items have other attributes determined by their Clinical Item Class.

Admissions

  • Admitted to - the institution the patient was admitted or referred to (see Address Book for information about maintaining this list)
  • Transport mode - the mode of transport used when admitting the patient (see Transport Mode for information about maintaining this list)
  • Alcohol related - the clinical item was caused by or related to alcohol consumption
  • Emergency - An Admission may be marked as an Emergency. Emergency admissions may be considered to be evacuations.

Conditions

  • Episode - defines the episode of care as First, New or Ongoing.
  • Alcohol related - the clinical item was caused or related to alcohol consumption

History

(No additional fields)

Immunisations

  • Actual duration (minutes) - the time spent in minutes performing the clinical item
  • Route and Site - records the route and site of the immunisation
  • Dose (this course) - specify if the immunisation is the first, second, or so on in a course
  • Dose Number - specify the immunisation dose number until now
  • Performed at - set if the immunisation was performed at the clinic. This field is read for the ACIR (Done Here) report.
  • Vaccine batch - record the batch number of the vaccine
  • Vaccine expiry date - record the expiry date of the vaccine

Procedures

  • Actual duration (minutes) - the time spent performing the clinical item in minutes

Referrals

  • The patient is referred - record referrals to another organisation or referrals to this organisation. If the Referral Management module is enabled:
    • This field is disabled and you can create only outgoing referrals
    • Create incoming referrals from the Referrals menu.
  • Organisation - the professional or institution the patient was referred to or from (see Address Book for information about maintaining this list)
  • Provider referred to - free text to record a particular name
  • Appointment Date - record the date and time of an appointment
  • Escort - free text to record the name of an escort for the patient
  • Transport mode - the mode of transport used when the patient is to attend an appointment (see Transport_Mode for where to maintain this list)
  • Referral Complete - the date the referral is deemed to have been completed
  • The referral is Critical - set if the referral is critical for reporting purposes
  • The referral is an Emergency - set to mark the admission as an emergency admission or evacuation
  • The referral is Alcohol related - set to mark the clinical item as caused by or related to alcohol consumption
  • Current Referral status is - a label showing the current status of the referral

Acute Medications and Chronic Medications (Prescribing not enabled)

  • If Prescribing is not used, the 'Comment' field for Acute Medications is labelled Acute medication and the Date is labelled Date prescribed
  • If Prescribing is not used, the 'Comment' field for Chronic Medications is labelled Chronic medication, the Date is labelled From Date, and there is an End Date field

Alert

  • Status - set the alert status to Active, Inactive, Resolved, Entered In Error