This lesson will demonstrate how to document in the Summary Family History field.
Summary Family History Field
The Family History field in the Summary is used to record the patient's family medical history.
Placing of the Insertion Point
With a patient chart open and the Summary chart section visible:
- Place the insertion point to the right of the field header.
- Left-click the mouse to insert your cursor.
If the bold green brackets appear (as shown above), then the field is active and ok to begin entering data.
Entering the Family History Pick List
To enter the Starter Pick List for Family History, Type the shortcut code "fam-" into the Family History field then press the spacebar.
The Family History Starter Pick List will expand to include the information shown above. The Family History Starter Pick List should be used as a guide. It may not contain all the items used while charting.
*Note: The first time this pick list is used, it must be downloaded from the SOAPware Online Library. To download the pick list, Type "fam-" into the Family History field and Press Shift + F11 on the keyboard. Double-click on the appropriate item in the search results window to download the Pick List to the database.
Choosing Items from the Family History Pick List
In SOAPware, text that appears Blue and Underlined indicates that a Pick List is attached to the SMARText Item.
To select items from a Pick List:
- Left-click on top of the item (ie: "Positive family history for").
- A list of items will appear in the SMARText Quick Access dialog.
- Users should place a check box in the "Selected" field next to each of the items that he/she wishes to insert into the Family History field.
Attaching Item Comment to Family History
To attach a free text comment to the SMARText item:
- Left-click on top of the SMARText item (ie: Asthma - see above).
- Begin typing desired comments (ie: Mother, as shown above). An "Item Comment" box will appear for the user to type in.
- Save the comments.
The item comment will be inserted next to the SMARText item (see Diabetes - Type 2 example above).