Working in the Treatment Tab (Clinical Features) in Dental4Windows

Working in the Treatment Tab (Clinical Features) in Dental4Windows

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The Treatment page is used for both clinical & admin purposes. The purpose of this article is for the clinical side of treatment and includes instructions on Treatment plan transfer, Treatment completed, clinical notes (incl fast notes).
Links to the various other related features including the admin sides of treatment is included throughout.

Individual and/or Family View in Treatment

When patients are grouped into a family, the view in Treatment, Invoices, Claims and Receipts tabs can be changed between Individual and Family view. 

View Whole Family

By default, the view is set to Family. This allows for treatment to be entered for all family members in one place, then to invoice/claim/receipt as one. 

  1. Go to Patient Records > Treatment tab
  2. Within Show data on, tick Whole Family
  3. All family members who have had treatment performed will show
  4. Use the drop list in the Member column to select the patient and enter new treatment

View Individual File
  1. Go to Patient Records > Treatment tab
  2. Patient: Select the relevant patient to view
  3. Within Show data on, remove tick from Whole Family

Transfer Items from Treatment Plan to Treatment

When items listed on a Treatment Plan are completed, they need to be moved to the Treatment tab to process the invoice and/or payment.

  1. Go to Patient Records > Treatment tab
  2. Treatment menu > Transfer from Treatment Plans / Click transfer icon 
    1. Select the Date of the treatment plan to view (optional)
    2. Select to Show Only Active Treatment Plans (optional)
    3. Tick to Transfer Plan Notes (optional)
    4. Highlight completed items
    5. If multiple items exist for the one visit, select one and then click Select Visit
    6. Click OK

    7. Items will appear in the Treatment tab

Preview all Clinical Notes

A report of all notes entered into a patient's treatment can be previewed.

Run the Report
  1. Go to Patients > Treatment tab
  2. Treatment menu > Preview all Clinical Notes
    1. All treatment notes entered for the patient will be reported

    2. Click Retrieve to filter Clinical notes
      1. Select date range
      2. Provider: Select provider
      3. Sort by: Select how clinical notes will be sorted by
      4. Item: Select items to be included
        1. All items: All item codes will be included
        2. Non-treatment: Items marked as non-treatment will only be included
        3. Non-Reporting: Items marked as non-reporting will only be included
        4. Table/Grid: To report on table/grid notes only
      5. Include Non-Treatment Items: Tick to include Non-Treatment Items
      6. Include Non-Reporting items: Tick to include Non-Reporting Items
      7. Custom: Click to select a particular item number/s 
      8. Tooth: Enter tooth number 
      9. Surf: Enter tooth surface
      10. Find text: Enter text to search for

      11. Click OK

Filtering Clinical Notes

When viewing Clinical Notes, filters can be applied so only selected data shows. 

Filter Options
  1. All Dates (normal view)
  2. Date Range (last month etc.)
  3. Manual Dates
  4. Providers
  5. All Items
  6. Not – Treatment Items
  7. Not - Reporting
  8. Table/Grid
  9. Custom (selected items)
  10. Tooth Number
  11. Surface
  12. Text (found in notes)
Filter Clinical Notes
  1. Go to Patient Records > Treatment tab
  2. Treatment menu > Preview all Clinical Notes
  3. Click Retrieve

    1. Within the Report's Parameters window, filter based on the above mentioned filter options. The below example will show notes written this year, for

Setup Fast Notes

Fast Notes are designed to help Providers limit the time spent typing Treatment notes. They are often referred to as 'quick descriptions' too.

Fast notes are available in the following areas, providing quick access to regularly used templates.

  1. Charting
  2. Treatment Plan
  3. Treatment
  4. Invoices
  5. Claims
  6. Debtors
  7. Laboratory Works

Add Note to Existing Notes Group

D4W/PSS has a list of default Notes Groups which are commonly used. See Add New Notes Group to add a new one to further categorise notes. 

  1. Go to Location Setup > Fast Notes tab
  2. Notes Group: Select the group to add the new note to
  3. Provider: Select For All Providers or an individual to add the note against
  4. Click Add
    1. Enter the fast note template. Press Enter key to make the note multi-line   

  5. Use the arrows on the left of the screen to move a selected note up/down in the list (optional)

Add New Notes Group

Denatal4Windows/PracticeStudio has a list of default Notes Groups which are commonly used. If the existing groups are not suitable, new groups can be added.

  1. Go to Location Setup > Fast Notes tab
  2. Record menu > Edit Notes Group
    1. Click Add
      1. Name: Enter the name of the new group
      2. Type: Select the type of notes that will be stored against this group
      3. Use in Advanced Notes: Select Yes only if Advanced Notes is included in D4W/PSS version (past feature)
      4. Print in Advanced Notes: Select Yes only if Advanced Notes is included in D4W/PSS version (past feature)
      5. Sort Order in Adv. Notes: Select Yes only if Advanced Notes is included in D4W/PSS version (past feature)
    2. Click Exit  

Copy Notes to another Group

Existing notes can be coped from one Notes Group to another. This is used most when notes saved against an individual Provider should then be shared with others. 

  1. Go to Location Setup > Fast Notes tab
  2. Notes Group: Select the group to copy notes to
  3. Provider: Select the Provider to copy notes to
  4. Record menu > Copy Fast Notes from... 
    1. Provider: Select the Provider to copy from
    2. Select either individual notes, or Select All
    3. Click 
      OK 

Writing Fast Notes

Fast notes are available in all of the following areas, providing quick access to regularly used text templates:

  1. Charting
  2. Treatment Plan
  3. Treatment
  4. Invoices
  5. Claims
  6. Debtors
  7. Laboratory Works

For the purpose of the below instructions, Treatment tab will be used.

  1. Go to Patient Records > Treatment tab
  2. Click in the Nt column against the relevant item
    1. Click the Date/Time stamp icon if Automatically Date/Time Stamp Notes (link coming soon) if not activated 
    2. Select the Provider
    3. Select the Notes Group

    4. Click on the fast note to enter
    5. Click OK to save the note

Clinical Tables and Grids

In addition to clinical notes, extended information can be entered and viewed efficiently for different dental procedures and assessments in the Table and Grid section. 

Data from tables and grids show when previewing clinical notes.

  1. Go to Patient Records > Treatment / Treatment Plan tab
  2. Against the relevant item, click in the Nt column
    1. Click Hide Fast Notes

    2. Select the relevant table/grid to view
    3. Place cursor in field and enter information, press tab to move between fields
Any table that has data entered will appear green.

Ortho Clinical Notes Tables/Grids

Below explains the fields associated with the ORTHO tables and grids. 

ORTHO-EO Exam

  1. Date: Date of the exam
  2. Growth: Assessment of growth
  3. Profile: Assessment of profile view
  4. Nose: Assessment of nose
  5. Lips: Assessment of lips
  6. Lips at Rest: Assessment of lips at rest
  7. Lips Together: Assessment of lips together
  8. Naso-labial angle: Assessment of naso-labial angle
  9. Labio-mental fold: Assessment of labio-mental fold
  10. Intra-Labial Gap: Assessment of intra-Labial Gap
  11. Upper Incisor Exposure: Assessment of upper Incisor Exposure
  12. Speech: Assessment of speech
  13. Tongue Thrust: Assessment of tongue thrust
  14. Breathing: Assessment of breathing
  15. Gingival Display- (mm): Assessment of gingival display (mm)
  16. Upper Incisor Exposure Smile- (mm): Assessment of upper incisor exposure smile (mm)
  17. TMJ Joint: Temporo-mandibular joint assessment

ORTHO-IO Exam

  1. Date: Date of the exam
  2. Dentition: Assessment of dentition
  3. Type of Malocclusion: Assessment of malocclusion
  4. Overjet (mm): Assessment of overjet (mm)
  5. Overbite (mm): Assessment of overbite (mm)
  6. Crossbite: Crossbite present
  7. Functional Shift: Functional shift present
  8. Lower arch length discrepancies (mm): Assessment of discrepancies in the lower arch length (mm)
  9. Upper arch length discrepancies (mm): Assessment of discrepancies in the upper arch length (mm)
  10. Hygiene: Assessment of oral hygiene
  11. Caries: Assessment of caries
  12. Habits: Assessment of habits
  13. Pain: Assessment of pain
  14. TMJ Clicking: Assessment of temporo-mandibular joint clicking
  15. Breathing: Assessment of breathing
  16. Tongue Thrust: Assessment of tongue thrust
  17. Speech: Assessment of speech
  18. Others: Other assessments
  19. Differential Diagnosis: Possible diagnosis

ORTHO-Diag Records

  1. Impression: Impressions taken and assessed
  2. OPG: Orthopantomogram taken and assessed
  3. Lateral cephalometric Radiograph: Lateral cephalometric radiograph taken and assessed
  4. Periapical Radiograph: Periapical radiograph taken assessed
  5. Occlusal Radiograph: Occlusal radiograph taken and assessed
  6. Photos: Photographs taken and assessed

ORTHO-Treat Tools

  1. Impressions: Impressions taken and assessed
  2. Separators: Separators used
  3. Banding: Banding details
  4. Bonding: Bonding details
  5. Arch wire placement: Arch wire details

Surgical Clinical Notes Tables/Grids

Below explains the fields associated with the Surg/OD-EO Exam and Surg/OD - IO exams tables and grids. 

SURG/OD-EO Exam: 

  1. Date: Date of the exam
  2. Facial Symmetry: Symmetry of the face
  3. Cranial Nerve Assess: Assessment of the cranial nerves
  4. Swelling: Swelling present
  5. Lymph Node Assess: Assessment of the lymph nodes
  6. TMJ Assess: Temporo-mandibular joint assessment
  7. Others: Other assessments
  8. Differential Diagnosis: Possible diagnosis

SURG/OD-IO Exam:

  1. Date: Date of the exam
  2. Lips: Assessment of the lips
  3. Gingival: Assessment of the gingival
  4. Mucous Membrane: Assessment of the mucous membrane
  5. Hard Palate: Assessment of the hard palate
  6. Soft Palate: Assessment of the soft palate
  7. Tongue: Assessment of the tongue
  8. Tonsils: Assessment of the tonsils
  9. Floor of Mouth: Assessment of the floor of the mouth
  10. Hard Tissues: Assessment of the hard tissues
  11. Others: Other assessments
  12. Differential Diagnosis: Possible diagnosis

Implant Clinical Notes Table/Grid

Below explains the fields associated with the Implant table/grid.
  1. Tooth: The Tooth ID
  2. System: The type of implant system used (e.g. Straumann, 3I)
  3. Diameter: The diameter of the implant (e.g. 5mm)
  4. Length: The length of the implant (e.g. 25mm)
  5. 1st Stage Date: The date of the 1st implant stage
  6. 2nd Stage Date: The date of the 2nd implant stage
  7. Prosthesis insertion date: The date the implant prosthesis was inserted
  8. Implant Failure Date: The date the implant failed
  9. Implant Failure reason: The reason the implant failed
  10. Extra Procedure: Extra procedures needed to complete the implant (e.g. bone graft)

RCT Clinical Notes Tables/Grids

Below explains the fields associated with the RCT, RCT-tooth and RCT-canal tables and grids. 

RCT

  1. Tooth/ Clamp: The Tooth ID, type of rubber dam clamp used
  2. Canal: The tooth canal (e.g. Mesio-buccal canal)
  3. Length: The length of the canal (e.g. 24mm)
  4. Inst: The instrument used (H or K file, Pro Taper)
  5. Ref: Reference point
  6. WL: Working length
  7. Curve: Is the root curved
  8. Date: The date the canal was cleaned
  9. MAF: Master apical file
  10. Flaring: Flaring of the tooth post initiation of RCT
  11. GP: Gutta percha
  12. Notes: Other relevant information

RCT-Tooth

  1. Tooth: The Tooth ID
  2. Clamp: Type of rubber dam clamp
  3. Pulp Stone: Is pulp stone present
  4. Perforation: Perforation present
  5. Root Fracture: Root fracture present
  6. Resorption: Bone/ root resorption present
  7. Irrigation: Irrigation of the tooth
  8. Dressing: Medicated dressing for RCT

RCT-Canals

  1. Canal: The tooth canal (e.g. Mesio-buccal canal)
  2. WL: Working length
  3. Ref Point: Reference point
  4. MAF: Master apical file
  5. Instruments: The instrument used (H or K file, Pro Taper)
  6. Inst. Tech: Instrument technology
  7. MAC: Master apical come
  8. Obturation: Filling of the canal
  9. Curve Degree: Degree of the root curve
  10. Calcified: Calcification of the tooth canals
  11. Ledge: Ledge formation present
  12. Separated Inst: Broken instrument in the canal

Endodontic Clinical Notes Table/Grid

Below explains the fields associated with the Endodontic table/grid. 

  1. Tooth: The Tooth ID
  2. Cold Test: Tested whether the tooth is sensitive to cold
  3. Radiographic Findings: Findings on the x-ray
  4. Percussion: Tested how the tooth responds to tapping on a surface
  5. Palpation: Tested the sensitivity of the gingival tissue
  6. Other: Other relevant information
  7. Mobility: The mobility of the tooth (loose)
  8. Heat Test: Tested whether tooth is sensitive to heat
  9. Electric PT: Electric pulp test
  10. Selective Anesthesia Test: Whether the tooth has been tested with a specific anesthetic
  11. Transillumination: Test of light through the tooth
  12. Pulp Polyp: Pulp polyp present or not
  13. Perio involved: Periodontitis involved with the tooth