In this article:
The Clinical tab of a patient's file is where all of their clinical information, including consult notes, are stored.
The Clinical tab is where you can manage the clinical aspects of the patient's health record.
On the right hand side of the Clinical tab you will see the Latest Measurements, Adverse Reactions, Medications, Diagnoses and Past Procedures tables where these details can be stored.
You can expand or hide each section to view its contents by clicking the drop down arrow just to the left of these headings.
Latest measures will display the most recent measurements added for the patient. This includes height, weight, BMI and BP for a patient.
For information, please see the Clinical Measures page.
Adverse Reactions can be used to record any allergies or reactions the patient is known to experience.
For information, please see the Adverse Reactions page.
The Medications table shows a list of all the patient's current, active medications and prescriptions.
You can quickly add a new medication to the table for record keeping purposes as follows:
- Click the + icon within the Medications table.
- The Add Medication section will open.
- Search for the medication.
- Select it from the results list.
- Press Save.
Please see the Prescribing article for detailed information on:
- adding medications for a patient
- creating and printing prescriptions
- inactivating/re-activating prescriptions
The Diagnoses module can be used to add details of a patient's current and past health conditions.
For information, please see the Diagnoses page.
The Past Procedures module can be used to add details of a patient's previous procedures, which may have been performed by other providers.
For information, please see the Past Procedures page.
You can use Consult Notes to record details of your contact with a patient.
For information, please see the Consult Notes page.
When you create a consult, you can enter the Reason for Encounter - the patient's presenting problem.
If you have a list of common presenting problems, you can record these within your Gentu's Settings.
This will then allow you to more easily choose a reason for encounter from the pre-populated list when clicking into the Reason for encounter field.
You can also begin typing into the Reason for encounter field, and Gentu will search your list for any matching results.
You can add Reasons for encounter within Settings > Reasons for encounter.
Alternatively you can simply freely type into the Reasons for encounter field when adding a new Consult Note.
Type in the reason for encounter, then press Enter to confirm.
You can add as many reasons for encounter as needed.
If you prefer to handwrite your consult notes, you can easily upload your notes into the patient's clinical file.
First, you will need to scan your handwritten notes onto your computer - this must be done outside of Gentu.
You can then add them to Gentu as follows:
- Access the patient's file.
- Select Add > Attachment.
- Click Choose File.
- Browse to the file on your computer and select it.
- If desired, use the File Name field to rename the file.
- From the Category drop down menu, select Consult Note.
- Press Upload.
By selecting the Consult Note category, Gentu will upload the attachment as a Consult Note record, applying all the user role permissions for Consult Notes to it. This is useful if you have set permissions to exclude certain user roles from viewing Clinical or Consult Note information.
The same applies, respectively, to any Category that you select for the Attachment when uploading it.
> Does dictation software work with Gentu?
Gentu does presently work with Dragon Medical Dictation, and we have a projected vision to have other VRS solutions implemented with Gentu in the future.
If you're interested in Dragon, we suggest you contact voicerecognition.com.au, the Australian resellers for Dragon software.
> Can I stop certain users from viewing clinical information?
Yes, the ability to view, edit and add clinical information can be managed from the User Roles within Settings > User Roles.
You can also lock clinical records - please see our Restrict Patient Records article for more information.
> Can I use Macros in Gentu to help with writing my consult notes?
In August 2020, Gentu released a Text Shortcuts feature which will allow you to set shortcuts for commonly used phrases. These are currently only available in Consult Notes.