Using the Add Menu

To quickly and accurately add common structured data, you can use the Add menu.

From Consultation Manager, with the patient required selected and a Consultation started, select Add and then select the option required:

• Problem - The Problem - Add screen displays, complete as required, see Adding a Problem for details.
• Medical History - The History - Add screen displays, complete as required, see Adding a Medical History Entry for details.
• Category - The History - Add screen displays with the Type of Characteristic as selected, complete as required, seeAdding a Medical History Entry for details.
  • Presenting Complaint
  • Symptom
  • Examination
  • Diagnosis
  • Intervention
• Notepad - The Notepad - Add screen displays, complete as required.
• Therapy Acute - The Acute Therapy - Add screen displays, complete as required, see Adding and Printing an Acute Prescription for details.
• Therapy Repeat - The Repeat Master - Add screen displays, complete as required, see Adding a Repeat Prescription for details.
• Drug Allergy/Adverse Reaction - The Drug Allergy and Intolerance - Add screen displays, see Adding a Drug Allergy/Adverse Reaction for details.
• Immunisations - The Immunisation - Add screen displays, see Adding an Immunisation for details.
• Blood Presure - The Blood Pressure - Add screen displays, see Adding a Blood Pressure for details.
• Height - The Height - Add screen displays, see Adding a Height for details.
• Weight - The Weight - Add screen displays, see Adding a Weight for details.
• Alcohol - The Alcohol Consumption - Add screen displays, see Adding an Alcohol Entry for details.
• Smoking - The Smoking - Add screen displays, see Adding a Smoking Entry for details.
• Test Results - Select the test result required from:
  • Diagnostic Imaging
  • Biochemistry (Routine)
  • Biochemistry (Hormones)
  • Biochemistry (Other)
  • Haematology
  • Microbiology
  • Serology
  • Other Pathology
  • Diagnostic Tests

  See Adding Test Results Manually.

• External Applications - Select either:
  • Launch - Select either:
    • Choose and Book Website - The eReferral screen displays, see Adding a Referral - England.
    • LabelTrace - The LabelTrace screen displays.
  • Configure
• Advice - The Advice Given - Add screen displays, see Adding Advice Given for details.
• Recalls - The Recall - Add screen displays, see Adding a Recall for details.
• Data Entry Caution - The Caution - Add screen displays, see Adding a Data Entry Caution for details.
• Medication Review - The Medication Review - Add screen displays, see Adding a Medication Review for details.
• Referrals - Select either:
  • Referral - The Referral - Add screen displays, see Adding a Referral - England for details.
  • From Default - The Select Default screen displays, see Setting Up Default Referrals and Requests and Adding a Default Referral for details.
• Requests - Select either:
  • Requests - The Requests - Add screen displays, seeAdding a Request for details.
  • From Default - The Select Default screen displays, see Adding a Default Referral for details.
  • Print Specimen Labels - The Print Labels screen displays, see Printing Specimen Labels for details.
  • Electronic Requests - Your electronic requests screen displays, see Electronic Test Requests for details.
• Contraception - The Contraception - Add screen displays, see Adding a Contraception Entry for details.
• Cytology - The Cytology - Add screen displays, see Adding Cervical Cytology for details.
• Chronic Disease Registers - Select from Asthma Register, Hypertension Register, CHD Register, Stroke/TIA Register, Diabetes Register, Diabetic Annual Check, Epilepsy Register, see What are Chronic Disease Registers? for details.
• Health Promotion Intervention - Select from Smoker, Hypertension, Coronary Heart Disease, Stroke/TIA, Overweight, High Alcohol, FH Cardiovascular Disease, see Adding Health Promotion Intervention for details.
• Correspondence - The Clinical Correspondence - Add screen displays, see Adding Correspondence for details.
• Attachments - The Attachment - Add screen displays, see Adding an Attachment for details.
• Reminder - See Reminders
• Patient Warning - See Adding a Patient Warning for details.
• Prescription Note
• READ Term (Alt-A, S) - Allows a READ term to be selected and then places the entry in the correct structured data area, for example, putting an entry for Peak Flow into the Peak Flow SDA.
• Select Data Entry Form - This displays the list of Summary or Tabbed forms for clinical entries.
• MED3 - Medical sickness certificate.