2. NEXTGEN ATTENDING (PRECEPTOR) SIGNOFF DEMONSTRATION This demonstration reviews some recommendations for Attending physician signoff of resident notes. Workflow may vary depending upon departmental policies, and whether the primary care exemption is observed. This has been prepared with EHR 5.6.5.61 and KBM 7.9.1. Subsequent updates may display cosmetic and functional changes. Use the keyboard or mouse to pause, review, and resume as necessary.

3. On the working templates for most specialties, at the Finalize step, there is a check box to allow residents to submit the note to the supervising physician. They will select the clinic Attending at the time, and a task will be generated, notifying the Attending of that signoff request.

4. These tasks arrive in the Attending’s inbox. Select one, then click the ->Chart button.

5. Click the ACCEPT button in the ensuing popup.

6. The chart will open to the template the resident attaches. Why doesn’t it open to the visit note? That would be nice, but the note doesn’t yet exist at the time the resident is making the submission, so it can’t be attached.

7. You may wish to take a moment to note the patient’s insurance, since it can affect the nature and detail of your signoff notation. Insurance information can be viewed at several spots, which may vary a bit among specialties. Here you see it on the SOAP tab of the Advanced Template Set.

8. Insurance also displays on the Diagnostic Studies and Referrals tabs in all specialties.

9. Now we’ll review the resident’s note. Click on the visit note from the History Bar. The name will differ among specialties, but it will be easy to find by the appearance of the document icon.

10. Scroll through the note to review it. If it is satisfactory, open the Template Module.

11. Double-click on USAPreceptor. (This will be among the recommended Preferred templates during the setup of your user preferences.)

12. The Preceptor template opens. Depending on your screen size and resolution, you may have to scroll down to see all of it.

13. This template provides the Attending with the opportunity to document as much or as little supervision as desired, dictated by department policy, or mandated by the patient’s insurance. At a minimum, you will want to click Accept assessments and plan as presented.

14. Select other checkboxes as desired to document your level of review and/or participation in the encounter.

15. You’ll note several areas where you can add comments. In this example, we’ll add a comment to the Assessment/Plan section. Click Add Comments.

16. Type your comments, then click Save and Close.

17. Your comments display here. While minor comments, corrections, and additions are appropriate using these comment boxes, keep in mind that they will become part of the patient record, and that even tasks you generate to the resident, while not part of the visit note, will be discoverable. If you have major issues with the resident’s note, discuss them with the resident offline, and have the resident correct and regenerate the note.

18. Note that all of the encounter templates are available for viewing, if you need to see more details before approving the note.

19. When you are done making selections, click E-Signature, then the Print Document button.

20. The document will generate quickly. Since it already has your E-signature, it will not go to your PAQ. You have completed signoff of this encounter, so you may close the chart.

21. Back in your task list, click the Completed checkbox.

22. Another note: On some Finalize templates, you may see checkboxes that give you another option to countersign resident notes; on other templates these are absent or removed.

23. We do not recommend using these checkboxes for two reasons: 1)They are not as comprehensive as the Preceptor Note. 2)If you click them, they will cause the note to immediately regenerate, replacing the resident’s name on the note with your name, and preventing you from continuing to work for several seconds, or even minutes, while the note regenerates.

24. This concludes the NextGen Attending Signoff demonstration. Do they use sterilized needles for lethal injections?

25. This concludes the NextGen Attending Signoff demonstration. Do they use sterilized needles for lethal injections?