NextGen KBM Dermatology User Guide. Version 8.3

NextGen KBM Dermatology User Guide Version 8.3

Copyright 2013 NextGen Healthcare Information Systems, LLC. All Rights Reserved. NextGen and NextPen are registered trademarks of QSI Management, LLC, an affiliate of NextGen Healthcare Information Systems, LLC. All other names and marks are the property of their respective owners. Notice: This document contains information that is confidential and proprietary to NextGen Healthcare and is intended for use solely by its authorized clients. This document may not be copied, reproduced, published, displayed, otherwise used, transmitted or distributed in any form by any means as a whole or in any part, nor may any of the information it contains be used or stored in any information retrieval system or media, translated into another language, or otherwise made available or used by anyone other than the authorized client to whom this document was originally delivered without the prior, written consent of NextGen Healthcare. By retaining or using this document, you represent that you are a client or an authorized representative of a client of NextGen Healthcare who is authorized to use this document under one or more agreements between you and NextGen Healthcare now in force, and that you will use this document and the information it contains solely as and to the extent those agreements permit. Any other use or distribution of the contents of this document, as a whole or in any part, is prohibited. Adobe and Acrobat are registered trademarks of Adobe Systems Incorporated in the United States and/or other countries. Microsoft, SQL Server, Windows, Windows Vista, Internet Explorer, Office, Word, Excel and Outlook are registered trademarks of Microsoft Corporation in the United States and/or other countries. Although a Microsoft trademark may appear in certain images within this document, Microsoft Corporation is not responsible for warranty support on the NextGen software products. In as much as possible, default procedures in this guide were developed using the most current Microsoft operating system and most current Microsoft server operating system. When required, procedures in this guide were developed based on the Microsoft Windows 7 operating system and/or Windows Server 2008 and SQL Server 2008, unless otherwise noted. Screen shots in this document were primarily developed using the Windows 7, Windows Server 2008 and SQL Server 2008 systems. Note: Other Windows operating systems that support this product may work differently. All other names and marks are the property of their respective owners. The examples contained within this publication are strictly present to show functionality of the software and are not intended to be guidelines for medical decisions or clinical approaches. Although NextGen Healthcare provides accurate documentation at the time of publication, it cannot guarantee going forward that Web site links to third-party vendors listed in this document do not become obsolete. NextGen Healthcare is not responsible for the contents of any such linked sites or any link contained in a link site, or any changes or updates to such sites. The inclusion of any link does not imply endorsement by NextGen Healthcare of the site and is solely being provided to you as a convenience. Use of any such linked Web site is at the user s own risk.

Although we have exercised great care in creating this publication, NextGen Healthcare Information Systems, LLC assumes no responsibility for errors or omissions that may appear in this publication and reserves the right to change this publication at any time without notice. Notice: The following are all registered trademarks or trademarks of NextGen Healthcare Information Systems, LLC: NextGen Ambulatory EHR NextGen Dashboard NextGen EHR Connect Insight Reporting NextGen HIE NextGen HQM NextGen KBM NextGen Mobile NextGen Patient Portal NextPen NextGen CHC Reporting Module NextGen Population Health NextGen Remote Patient Chart Synchronization NextGen Appointment Scheduling NextGen Document Management NextGen Practice Management NextGen Billing Services Management NextGen Optical Management NextGen Real Time Services The following terms may be used interchangeably throughout this document: NextGen Ambulatory EHR and NextGen EHR NextGen Practice Management and NextGen EPM NextGen Optical Management and NextGen Optik NextGen Document Management and NextGen ICS NextGen Patient Portal and NextMD NextGen Remote Patient Chart Synchronization and NextGen PatientSync NextGen Real Time Services and NextGen Real-time Transaction Server NextGen CHS and NextGen HIE

Document Revision History App Version Build Number Date Document Version Summary of Changes 8.3 NA 11/8/2013 2.0 General Release 8.3 NA 6/1/2013 1.0 Initial Release of Document 8.3 NA 05/09/2013 0.1 Initial Draft

NextGen KBM 8.3 Dermatology User Guide Contents Chapter 1 Introduction 9 Requirements... 9 Configuration and Setup Procedures 11 The Joint Commission Standards Configuration... 11 Reason for Visit Configuration... 12 Sub-Navigational Links... 13 General Office Visit Workflow 15 Patient Information Bar... 15 Active Text Links (NextGen KBM 8.3 Dermatology)... 17 Alerts... 21 Panel Controls... 22 Quality Buttons and CQM Information Pop-up Templates... 23 Care Guidelines... 24 Global Days... 25 Screening Tools and Document Library... 26 Intake Staff Workflow 29 Home Page - Dermatology Template... 29 Home Page Sub-Navigational Links... 30 Demographics Sub-Navigational Link... 30 Call/Communication Sub-Navigational Link... 31 Provider Test Action Sub-Navigational Link... 32 Orders Management Sub-Navigational Link... 33 Document Library Sub-Navigational Link... 34 Risk Indicators (NextGen KBM 8.3 Dermatology)... 35 Intake Template... 35 Intake Sub-navigational Links (NextGen KBM 8.3 Dermatology)... 35 General Panel... 42 History of Present Illness Panel... 42 Medications... 43 Medication Reconciliation for a Patient... 44 Allergies... 45 Vital Signs Panel... 46 Health Promotion Plan Template... 47 Orders Panel... 51 Point of Care Tests... 53 Review of Systems (NextGen KBM 8.3 Dermatology)... 54 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 5 of 116

Contents Intake Note Generation (Intake template)... 55 Histories Template... 55 Histories Sub-navigational Links (NextGen KBM 8.3 Dermatology)... 55 Skin Cancer History Log... 57 Problem List Panel... 58 Problem List Panel... 61 History Summary Panel... 62 Social History Tobacco Template... 63 Family History... 66 Diagnostic Studies... 68 History Review... 69 Intake Note Generation... 70 Patient Tracking... 71 Provider Workflow 75 Patient Tracking... 75 Home Page - Provider Review... 75 Panels on the Dermatology Home Page Template... 75 History Summary Panel on the Home Page Template... 78 Allergies Panel on the Home Page Template... 78 Medications Panel on the Home Page Template... 78 Vital Signs Panel on the Home Page Template... 79 Orders Panel on the Home Page Template... 79 Communication Panel on the Home Page Template... 79 Document SOAP (NextGen KBM 8.3 Dermatology)... 79 Compose Introduction... 80 Quick Note... 80 Reason for Visit on the SOAP Template (NextGen KBM 8.3 Dermatology)... 80 Review of Systems on the SOAP Template (NextGen KBM 8.3 Dermatology)... 82 Vital Signs on the SOAP Template... 83 Physical Exam Panel (NextGen KBM 8.3 Dermatology)... 83 Create Assessment/Plan (NextGen KBM 8.3 Dermatology)... 84 SOAP Link Icons... 86 Save Quick Note... 86 Generate Note... 87 Finalize Template... 87 Finalize Tab Sub-Navigational Links (Derm)... 88 Tobacco Cessation Sub-Navigational Link... 88 General Panel... 89 Today's Assessment Panel (NextGen 8.3 KBM Dermatology)... 89 Provider Sign Off Panel... 89 Evaluation and Management Coding Panel... 89 E & M Level Summary Panel... 92 History Details... 92 Evaluation and Management Guidelines... 93 95 Physical Exam Details Panel... 93 97 Multi System Physical Exam Details Panel... 93 Page 6 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide 97 Single System Physical Exam Details Panel... 93 Dermatology Procedure Billing Panel... 94 Checkout Staff Workflow 97 Checkout Template (NextGen KBM 8.3 Dermatology)... 97 Today's Orders Panel... 98 Send Tasks... 99 Given to Patient/Verified Panel... 100 Patient Tracking - Check Out... 101 Generate Note... 101 Procedure Template and Skin Cancer History Grid 103 Using the Procedure Template and Skin Cancer History Grid... 103 Derm Quick HPI 105 Using the Derm Quick HPI... 105 New Codes for Dermatology Assessment 107 New Codes on Dermatology Common Assessment... 107 Excision Template 109 Using the Excision Template... 109 Biopsy Log 111 Using the Biopsy Log... 111 Mohs Templates 113 Using the Mohs Templates... 113 Index 115 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 7 of 116

Contents This page is intentionally left blank. Page 8 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide C HAPTER 1 Introduction This user guide contains an overview of the NextGen KBM 8.3 framework for the Dermatology specialty. It provides users with instructions on using the templates. This document is not intended as instructions for entering patient information or using the system for a live patient but rather is designed to explain how to use the templates. This chapter provides information about the organization and purpose of this user guide. It defines the audience, provides a general overview of the topics covered in this guide, and lists assumptions about the level of knowledge required for this guide. This guide assumes that you have basic knowledge and skills for all of the following: Microsoft Windows operating systems Microsoft Office applications All applicable NextGen ambulatory products Requirements The prerequisites for completing the instructions in the guide include: 1 Installation and configuration of the NextGen Ambulatory EHR. 2 A valid user ID and password to log on to the system. Note: This guide was created using NextGen Ambulatory EHR, Version 5.8.0.100 and NextGen KBM Version 8.3. Slight variations in the steps performed and the graphic images and screens depicted may occur depending on what versions of NextGen Ambulatory EHR and NextGen KBM you may be using. The fundamental concepts will remain the same. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 9 of 116

Chapter 1 Introduction This page is intentionally left blank. Page 10 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide C HAPTER 2 Configuration and Setup Procedures This section provides information on the necessary settings that are required to begin the office visit workflow for the specialty, including configuration of the Joint Commission standards and the Reason for Visit/History of Present Illness (HPI) template. The Joint Commission Standards Configuration The Joint Commission standards configuration setting for all NextGen KBM templates is found on the Ngkbm Config practice template. If you enable the Joint Commission standards in the Ngkbm Config practice template, all fields and links related to the Joint Commission are enabled. When you enable the Joint Commission standards, you need to document and review the patient allergy information before recording any other patient data during the encounter. To set the Joint Commission standards settings: 1 Log on to NextGen Ambulatory EHR. Reference: For more information on how to log on to the NextGen Ambulatory EHR, refer to the NextGen Ambulatory EHR and Practice Management Logon Guide. 2 From the File menu, select System/Practice Template. The Select Template dialog box displays. 3 Click the Practice tab. 4 In the Show section, click All. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 11 of 116

Chapter 2 Configuration and Setup Procedures A list of templates displays. 5 Double-click Ngkbm Config. The Practice Preferences template displays. 6 In The Joint Commission Standards row, clear or select the Enable The Joint Commission requirements check box. 7 Close the Practice Preferences template and click Yes when prompted to save the changes. Reason for Visit Configuration A practice can customize the Reason for Visit panel of the Intake and SOAP templates in the Ngkbm Framework Content system template. To configure the reasons for visit: 1 Log on to NextGen Ambulatory EHR. 2 From the File menu, select System/Practice Template. The Select Template dialog box displays. 3 In the Show section, click the All option. A list of system templates displays in the System tab. Page 12 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide 4 Double-click Ngkbm Framework Content to access the Ngkbm Framework Content template. 5 Click the Specialty list to access the picklist. 6 Select your specialty to view all of the configurable content. 7 In the Reason for Visit panel, click the all option for Filter. 8 Click the first drop-down arrow to access the Ngkbm Udp Custom Link Filter picklist. 9 Highlight the reason for visit, linked to the appropriate HPI, that you wish to add to the Reason for Visit list. 10 Click OK. 11 Click the second drop-down arrow to access the Gender picklist. NOTE: Gender is required in order to add a reason for visit to the list. 12 Select All from the picklist to indicate that the selected reason applies to all genders or select a specific gender. 13 Click Add. The newly added reason for visit is included in the data grid. 14 Click the Save icon on the top toolbar. The selected reason for visit displays in the Reason For Visit pop-up template launched from the Additional/Manage active text link in the Intake template. Sub-Navigational Links NextGen KBM 8.3 includes sub-navigational links that appear beneath the tabs. If you click a subnavigational link, the corresponding pop-up template opens. The links can be customized by the following: 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 13 of 116

Chapter 2 Configuration and Setup Procedures Specialty Practice Provider Specialty and practice Specialty and provider The sub-navigational links are associated with a particular tab so that different links can appear on various tabs. To configure the sub-navigational links, go to the Ngkbm_framework_content system template. Page 14 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide C HAPTER 3 General Office Visit Workflow This section describes about the general office visit workflow for this specialty. It also provides: Steps to set the Home Page template as the default template. Overview of the Patient Information Bar. Brief description of Panel Controls, Care Guidelines, and Global Days. The general office visit workflow includes the intake staff workflow, provider workflow and checkout staff workflow, which involves: Documenting the Reason for Visit/HPI, Vital Signs, Medications, Allergies, Physical Exams, and Assessment Plans for the patient. Finalizing the workflow and generating a detailed report of the encounter. Patient Information Bar The Patient Information bar displays in NextGen Ambulatory EHR above the current open module or template. The bar remains visible regardless of the module or template that is open. To access the Patient Information bar, you must first make it available and configure it in the Patient Information Bar Practice Preference. Reference: For information on how to configure the Patient Information bar, refer to the Patient Information Bar Practice Preferences section in the NextGen Ambulatory Products Administrator Guide. The arrow beside the Medications field is used to minimize or maximize the view of Patient Information bar. The Patient Information bar includes patient's first name, middle initial, last name followed by the gender, date of birth and age. The Patient Information bar is divided into the following parts: 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 15 of 116

Chapter 3 General Office Visit Workflow Patient Summary Medical Information Patient General Information Patient Demographic Information Encounter Based Information Patient Summary Medical Information - This includes the list of Allergies, Problems, Diagnoses, and Medications of the patient. You can click the number beside the Allergies, Problems, Diagnoses, and Medications fields to display the respective modules. When you hover your mouse over the number beside each field, the label changes color and displays the corresponding lists of allergies, problems, diagnosis, and medications. The Alerts button is used to add or view patient alerts. If the patient has any alerts, the Alerts button will display in red. Patient General Information - This includes Send Email, Telephone Call, To Do, and Patient Tracking icons, which allows you to send an email, document a phone conversation or a walk-in patient encounter outside a visit, send a task to someone, or track the time that the patient spent in the office. The Patient General Information section also includes the patient's address and contact information. Reference: For more information on these icons, refer to the Patient General Information section in the NextGen Ambulatory EHR Getting Started Guide, Version 5.8. Patient Demographics Information - This includes information on Insurance, Enterprise Chart Indicator, MRN, Parent/Guardian, etc. Encounter Based Information - This includes information on the primary care provider, referring provider, and rendering provider. The bottom portion of the Patient Information bar includes the following active text links: Sticky Note Referring Provider HIPAA Advance Directives Screening Summary OBGYN Details (available for female patients over 12 years of age) You can also includes any three fields from the demographic templates, which are set up by the practice in File Maintenance. Page 16 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Active Text Links (NextGen KBM 8.3 Dermatology) The patient header includes various active text links to document additional information about the patient. Nxmd Demographics The Nxmd Demographics active text link displays the Patient Portal - Demographics template where you can document the patient's address and contact details, including emergency contact information. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 17 of 116

Chapter 3 General Office Visit Workflow Order Administration The Order Administration active text link displays the Order Administration template, which displays a list of the orders and their status. When you highlight an order in the Order section, the details of the order display in the Order details section. OBGYN Detail The OBGYN Detail active text link is available for female patients above 12 years of age and launches the OBGYN Synopsis template. You can document menopausal status, hysterectomy details, gynecologic history, pregnancy history, and safer sex information/contraception information. Page 18 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Sticky Note The Sticky Note active text link displays the Patient Information dialog box where you can enter social information about the patient. The information entered in the Patient Information dialog box is not printed on the chart note. Referring Provider The Referring Provider active text link displays the Patient Providers dialog box that includes the details of the primary care provider and encounter provider. You can also enter additional referring provider details and select the providers whose details should be listed at the bottom of the chart note. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 19 of 116

Chapter 3 General Office Visit Workflow HIPAA The HIPAA active text link displays the HIPAA Disclosure Information dialog box where you can document the authorization provided by the patient or the legal guardian to disclose protected health information. The HIPAA Information section in the HIPAA Disclosure Information dialog box is completed by the intake staff. Advance Directives The Advance Directives active text link displays the Advance Directives dialog box where you can document the discussion had with the patient about advance directives. You can also document name and contact information for a healthcare proxy and durable power of attorney. Page 20 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Screening Summary The Screening Summary active text link displays the Screening Summary dialog box. In the Screening Summary dialog box, you can document pain severity and assessment method. The Social History section enables you to document information on patient's nutrition, tobacco use, alcohol use, caffeine use, and drug abuse. The Counseling/Educational Factors active text link in the Counseling section allows you to document details about the type of counseling offered to the patient. In the Screenings section, you can document when the patient had the last PAP smear, hearing screening, and last mammogram. Alerts The Patient Information Bar includes the Alerts button to inform providers of the specific concerns about the current patient. To document specific concerns about the patient: 1 Click the Alerts button to access the Add Alert pop-up template. 2 Select the appropriate check boxes to provide alerts to the providers. For example, select the Bedridden check box to add an alert for possible fall risk. 3 If the required alert is not available, select the Other check box and then select a value from the Alerts other picklist. If the appropriate alert does not appear in the list, click on the top blank row of the picklist to enter a value in the associated field. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 21 of 116

Chapter 3 General Office Visit Workflow Note: The Pregnant field is available for female patients. This is used in multi-specialty practices to alert non-obstetric providers that the patient is pregnant. The Suicide/Homicide Risk active text link opens the Safety Risk pop-up template, which is used by some specialties to document suicide or homicide risk during a patient encounter. Panel Controls Panels display information according to type such as Vital Signs or Allergies. Templates can contain one or more panels used for viewing existing information and documenting new information. Panels allow users to customize the order that information appears on a template. To change the order of the panels, users can click on the title bar of a panel and drag it to a different position on the template. If a user changes the order of the panels, they will remain in that order from patient to patient until the order is changed again. Users can expand and collapse panels so that they can view the panels containing only the most pertinent information. Users can also use Cycle buttons to scroll through all of the panels on the template. The Panel Controls section includes two pairs of icons. The Toggle icons expand and collapse all the panels and the Cycle icons rotate the panels through all positions from top to bottom, one position at a time. The Expand All icon is used to open all of the panels at once and the Collapse All icon is used to close all of the panels in the template. Page 22 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The Cycle Down icon is used to move the bottom panel to the top and expand it while collapsing all other panels. The Cycle Up icon is used to move the top panel to the bottom and expand the panel that moved to the top position. If you visit another tab in the workflow and return to the one on which the Cycle feature has been applied, the panels remains in the applied order. To reset the panels to the original state, right-click in the blank area to the right of the template and select Panel Defaults. Quality Buttons and CQM Information Pop-up Templates Quality buttons have been added to various places in NextGen KBM 8.3. When clicked, the Quality buttons launch information pop-up templates containing information about documenting the associated clinical quality measure. For example, all templates with the Patient Status - Transitioning into care and Patient Status - Summary of care received check boxes have a Quality button. When you click the Quality button, the Patient Status information pop-up template opens. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 23 of 116

Chapter 3 General Office Visit Workflow Care Guidelines The Care Guidelines active text link is available from all of the templates. The Care Guidelines pop-up template allows you to verify or update information related to lab or radiology order processing, clinical guidelines, screening questions, vital signs, immunizations, nutrition, and drug therapy. Page 24 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The CQM check runs when you open the Care Guidelines template. When you click the CQM Check button in the blue panel on the left side, the CQM Results template opens. On the Care Guidelines template, a description of the measures and what passed and failed appears below the button. Reference: For detailed information on Care Guidelines, refer to the NextGen KBM Clinical Guidelines, Protocols and Recommended Care Version 8.3 White Paper. Global Days The Global Days feature tracks the number of post-op days remaining for a patient who has had a recent surgical procedure. This feature displays the procedure or surgeries for a patient with the associated post-op days. The calculation of Global Days is based on the CPT 4 code and the post-op days configured in NextGen File Maintenance. The Global Days active text link opens the Global Days pop-up template where you can verify, add or update information related to assessment code, procedure, and procedure dates. To manage global days: 1 Click Global Days active text link to access the Global Days pop-up template. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 25 of 116

Chapter 3 General Office Visit Workflow You can use the Global Days pop-up template to verify, add, or update information related to assessment, code, procedure, and procedure dates. 2 Click Save & Close. Screening Tools and Document Library The Screening Tools pop-up template contains various screening and assessment tools that can be used during a patient encounter. Click the Screening Tools active text link on the left side navigation bar to open the Screening Tools pop-up template. The assessments in the Interactive Screening Tools section automatically calculate the results. Page 26 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide If you use the screening tools in the Website Screening Tools section, you must calculate the results and enter the score manually on the template. To generate a screening tool in the Website Screening Tools section, click the Web button and then click the Print button or the Print icon. Document Library You can generate the screening tools results documents by clicking the Document Library active text link on the left side navigation bar to access the Document and Letters template. The Document and Letters template allows you to generate documents for self-assessments, SLUMS and cognitive assessment. Quality Button on Screening Tools Template Click the Quality button on the Screening Tools pop-up template to open the CQM - Screening Tools information pop-up template. The CQM - Screening Tools information pop-up template displays additional information about documenting CQM measures and the screening tools associated with each measure. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 27 of 116

NextGen KBM 8.3 Dermatology User Guide C HAPTER 4 Intake Staff Workflow The intake staff workflow for an office visit involves documenting the patient encounter in the Intake and Histories templates. The information documented by the intake staff is used by the provider for reference and to proceed with the encounter. Home Page - Dermatology Template The Intake Staff workflow begins on the Home Page - Dermatology template. The Home Page - Dermatology template allows you to view and add information about the patient. To access the Home Page - Dermatology template: 1 Select Dermatology from the Specialty fields. 2 Select Office Visit from the Visit Type fields. 3 Select Home Page - Dermatology using the template module to open the Home Page - Dermatology template. The Home Page - Dermatology template contains the following panels, allowing you to view or change patient information: 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 29 of 116

Chapter 4 Intake Staff Workflow Skin Cancer Log panel Summary panel Assessment History panel History Summary panel Allergies panel Medications panel Vital Signs panel Orders panel Communication panel Home Page Sub-Navigational Links The Home Page - Dermatology template includes the following sub-navigational links: Demographics Call/Communication Provider Test Action Order Management Document Library Demographics Sub-Navigational Link The Demographics sub-navigational link displays the Patient Demographics template to document patient information such as contact information, address details, Primary Care Physician (PCP) details, insurance or pharmacy details, provider details, emergency contact details, and employment details. Page 30 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

Call/Communication Sub-Navigational Link NextGen KBM 8.3 Dermatology User Guide The Call/Communication sub-navigational link opens the Telephone Call template to record information gathered during a telephone conversion. The Telephone Call template can also be accessed by clicking the Telephone Call icon on the Patient Information Bar. To enter details in the Telephone Call template: 1 Click the Call/Communication sub-navigational link. The Telephone Call template displays. The Specialty field displays the current specialty. 2 In the Communication panel, click the required communication category active text links to display the corresponding pop-up templates. a) Enter the call information, communication history, medication, and allergy details in the popup template. b) Click Save & Close to return to the Telephone Call template. c) In the Display field, select a communication category. The details documented in the selected category display in the Communications grid and in the Medication and Allergies grids in the Medications and Allergies panel. Note: Instead of using the active text links in the Communication section, you can double-click a blank row in the Communications, Medication, and Allergies grid to enter the required information. In the Protocols panel, the data grid displays guidelines that exist for the current patient documented in the Care Guidelines pop-up template. The grid displays any health maintenance or disease management testing that the patient is due for. When you select the Show due within check box, you can filter items so that only those items, which are due, within a specific time frame are displayed in the grid. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 31 of 116

Chapter 4 Intake Staff Workflow 3 If applicable, click the Comments active text link at the top-right of the template to enter the details of a conversation. The Comments - Telephone pop-up template includes Provider comments and Nursing comments sections. When you click the Provider comments field, the Provider, Date and Time fields are automatically populated based on who is logged into the NextGen Ambulatory EHR, current encounter date, and current system time. Similarly, when you click the Nursing comments field, the Nurse, Date and Time fields are automatically populated. The Telephone Call template includes the following buttons: Button Patient Contact Info View/Scheduled Appointments Telephone Call Summary Preview Document Provider Communications Offline Action Click to view patient's contact information and document patient's support relationships, and pharmacy details. Click to add or view the patient's appointment with provider. Click to view a comprehensive communication history. Click to generate a written summary of the telephone call details in runtime. Click to document all of the details concerning a communication by the provider. Sends the telephone_communication document offline. Provider Test Action Sub-Navigational Link The Provider Test Action sub-navigational link opens the Provider Test Action template to document and/or view the patient's appointment, contact, and medication details along with any orders and the corresponding results. Providers can enter brief action details or notes and the tasks for future encounters, and manage all action items or tasks. Page 32 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Orders Management Sub-Navigational Link The Order Management sub-navigational link displays the Order Management template, which allows you to update the required order details. To manage the order details: 1 Click the Order Management sub-navigational link. The Order Management template displays. 2 Select any of the following options: View of All Orders Diagnostic Lab Orders Office Services Procedures Referrals Other Orders A list of orders associated with the selected category of order displays in the data grid. 3 Select an order whose details have to be updated. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 33 of 116

Chapter 4 Intake Staff Workflow The details of the selected order displays in the respective fields in the Manage selected order section. 4 If required, click the Status (step) field and select the appropriate status from the Select status of referral picklist. 5 Click the Action/comment field and select a value from the picklist. 6 Click Save to display the updated order details in the data grid in the Order status detail/action section. The following are the buttons available in the Order Management template: Button Dexa Scan Requisition Cosign Orders This Encounter Provider Communication My Plan/Orders Save & Task Description Displays the Dexa scan results in the Dexa scan results section at the bottom of the template Generates the requisition document displaying the details of the selected diagnosis. The Requisition button appears when you click the Diagnostic option. Displays the Cosign/Review Orders pop-up template to review or sign off the required orders. Displays the Provider Communication pop-up template to document details of provider's communication with the patient. Displays the My Plan pop-up template to select a diagnosis and associate the required orders to it. Saves the updated order and displays the To Do pop-up template to send notification to the desired recipients. The Save & Task button appears when you select an order from the grid. Document Library Sub-Navigational Link The Document Library sub-navigational link displays the Documents and Letters template. The Documents and Letters template includes active text links that generate the formatted letters and assessment templates where you can enter the required data. The Details button, available for some of the active text links, enables you to enter detailed information. The information is included in the document generated from the corresponding active text links. Page 34 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Risk Indicators (NextGen KBM 8.3 Dermatology) The Risk Indicators for Dermatology are visible on all of the templates. NOTE: Use the Derm Risk Indicators Config pop-up template to indicate the patient's current conditions. If you want to indicate that the patient is at high risk for developing a certain condition, you can do so by going to the Care Guidelines pop-up template. The Config icon displays the Derm Risk Factors Config dialog box to document risk indicators, including risk indicators for diabetes and other conditions. In the Tobacco section, you can document the smoking status of the patient. The Tobacco Usage active text link enables you to document tobacco consumption details such as Tobacco type, usage per day, etc. You can also document smoking cessation efforts and passive smoke exposure. If you click the Yes radio button for a risk indicator, a red circle with white exclamation mark displays next to the corresponding risk indicator icon. If you click the No radio button for a risk indicator, a circle with backward slash displays next to the corresponding risk indicator icon. If you click the Unknown radio button for a risk indicator,a circle with question mark displays next ot the corresponding risk indicator icon. Intake Template The intake staff use the Intake template to begin documenting a patient's chief complaint, vital signs, medications, allergies, orders and various other findings. Intake Sub-navigational Links (NextGen KBM 8.3 Dermatology) The Intake template includes the following sub-navigational links below the navigational tabs: Standing Orders Adult Immunizations Peds Immunizations My Plan Procedures Orders Management 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 35 of 116

Chapter 4 Intake Staff Workflow Standing Orders The Standing Orders active text link displays the Office Services dialog box. The Office Services dialog box is used to update or place orders and document details of diagnosis. Adult Immunizations The Adult Immunization active text link displays the Immunization - Adult template where you can add vaccine, medication, and allergies details of an adult patient. To view the vaccination details: 1 Click the Adult Immunization active text link. Page 36 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The Immunization - Adult template displays. 2 In the Alert field, enter the alert information. 3 To view vaccination details, select an item in the data grid. To add the vaccination details: 1 In the Immunization - Adult template, click the New Order button. The Create New Immunization Order dialog box displays. 2 Click the Search All button to search the desired vaccines. The Search Vaccines dialog box displays. 3 Enter the search criteria and click Find. Note: You can click the Search all vaccines radio button at the bottom of the Search Vaccines dialog box to displays all the vaccines matching the search criteria. 4 Select the desired vaccines from the search result and click OK. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 37 of 116

Chapter 4 Intake Staff Workflow The selected vaccine displays in the Assign Diagnosis to Selected Vaccines section. 5 Click the Vaccine Details tab at the bottom of the Create New Immunization Order dialog box. 6 Highlight a vaccine and enter its details in the required fields. 7 Click any of the following buttons: Save - Saves the vaccination details. Save & Task - Saves the vaccination details and enables you to assign the task to the NextGen Ambulatory EHR Work Group. Save & Print - Saves the vaccination details and prints the VIS information. Save & Send - Saves the vaccination details and sends the details to registry. The details display in the data grid in the Adult Immunization template. Following are the buttons available at the top of the data grid in the Immunization - Adult template: Button Refresh Print Fax Historical Exclusions Web Links Action Click to refresh immunization status data. Click to print immunization summary. Click to fax the immunization summary. Click to manually enter patient immunization. Click to review immunization exclusions for the selected group. Click to display a list of Web links for additional information about immunization. To document vaccine adverse event report: 1 In the Immunization - Adult template, click Add in the Vaccine Adverse Event Report section. The Vaccine Adverse Event Report dialog box displays. Page 38 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

2 Enter data in the required fields. 3 Click OK to return to the Create New Immunization Order dialog box. NextGen KBM 8.3 Dermatology User Guide The Encounter date and Reaction date display in the Vaccine Adverse Event Report section. To add Medication and Allergies details, double-click the data grid in the Medication and Allergies sections to display Medication and Allergies modules respectively. Peds Immunizations The Peds Immunizations active text link displays the Immunization - Pediatric template where you can add the vaccine, medication, and allergies details of a pediatric patient. The process for the Immunization - Pediatric template is the same as for adult patients. My Plan The My Plan active text link is used to select a diagnosis and the associated orders and then place the order. To place an order for a diagnosis: 1 Click the My Plan active text link. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 39 of 116

Chapter 4 Intake Staff Workflow The My Plan dialog box displays. 2 In the Today's Assessment section, select a diagnosis. OR If the required diagnosis is not available in the data grid, click the Add Common Assessment active text link and select the desired diagnosis. 3 Select the desired orders available under the following labels: Lab orders Diagnostics Office medications Office procedures Office labs Instructions Additional orders Follow-up/referral If the required order is not available under a label, click the down arrow and select the desired order from the picklist. 4 Click the Place Order button. 5 Click Save & Close. The Lab/Diagnostics/Radiology Order Module Processing active text link is used to select the vendor and submit the lab or radiology orders to the selected vendor. Page 40 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Procedures The Procedures active text link displays the Procedures template, which allows you to access several procedure templates associated with various systems. To access a procedure template: 1 Click the Procedures active text links. The Procedures template displays. 2 In the Pre-procedure care section, select the following check boxes after explaining the preprocedural care details to patient: Procedure/Risks were explained Questions were answered Consent was obtained 3 Click the active text link for the desired procedure, and the corresponding procedure dialog box displays. 4 Enter the required details. 5 Click Save & Close to return to the Procedures template. 6 Click the Offline Proc Note button. The procedure note document is generated. Following are the buttons and active text link available in the Procedures template: Field Consent active text link Description Displays the Consent - Procedures dialog box to document the procedure and consent details. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 41 of 116

Chapter 4 Intake Staff Workflow Field Consent button Alerts button Patient Education button Preview Proc Note button Description Generates the procedure consent document for preview. You can print the document and take the signature of the person who consented the procedure. Displays the Add Alert dialog box to view and add the alerts. Displays the Patient Education Browser which contains a library of patient education documents. Displays the preview of the procedure note document. Order Management The Order Management active text link displays the Order Management template. General Panel The General panel displays whether the encounter is being documented for a new or established patient. The Established patient option is selected by default if the patient has previous encounters. You can manually change the selection if necessary. You can also select the person providing the patient information from the Historian list or select the top blank line to type a value in the field. History of Present Illness Panel The History of Present Illness panel on the *Intake template displays the top ten reasons for visit. The Additional/Manage link found at the bottom of the list launches the Reason For Visit template with additional reasons. Page 42 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide To add reasons for visit: 1 In the History of Present Illness panel, select the Do not launch HPI check box. 2 Select the appropriate reasons for visit. The selected reasons for visit display under the Chief Complaint column. 3 To document any details, click the Intake Comments active text link and enter your comments, which display in the intake note document. The Diagnostics button opens the Office Services pop-up template to enter various diagnostic tests and results. The Show All button displays the HOPI Notes template. Medications The Medications panel is used to view the patient's current medications, enter additional prescriptions that the patient is taking, and reconcile the medications listed with what the patient is actually taking. If there are no known medications for a patient, select the No medications check box above the grid. Select the Transitioning into care check box and/or the Summary of care received check box to document patient status. To document the patient's medications: 1 If the patient is currently taking any medications, click the Add/Update button below the Medications grid or double-click within the Medications grid. The Medication Module opens. 2 Click Prescribe New. 3 The Medication Search pop-up template opens. 4 Search for and select a medicine from the list and click Select. 5 Enter the Sig, Quantity, Refills, and Start date from the corresponding list. 6 If this medication had been prescribed elsewhere, select the Prescribed elsewhere check box. 7 Click Accept. 8 Close the Medication Module. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 43 of 116

Chapter 4 Intake Staff Workflow NOTE: If applicable, click the Comment active text link to launch the Medication Comment pop-up template. This pop-up template should not be used to list medications that the patient is taking. If a medication has been prescribed elsewhere, enter as much information about the dosage and Sig as possible. Medication Reconciliation for a Patient Medication reconciliation is a review of patient adherence to prescribed medications. This may be performed in situations including, but not limited to, the following: New patients Periodically for established patients After a hospitalization or emergency department visit After care by another provider Whenever the provider thinks necessary Medication reconciliation can be performed manually or electronically. To review the patient's medications and perform a medication reconciliation, click the Reconcile button. The Medication Review pop-up template opens. The Medication Review panel contains two grids. The Medication List grid displays a list of current medications that need to be reviewed for patient adherence. The Medication Review grid displays reviewed medications. To review medications manually: 1 Select the Review adherence check box above the Medication List grid. 2 In the Review adherence picklist, select a patient adherence comment or select the top blank line and manually type a comment. 3 To review all the medications in the Medication List, click the Review All Taken As directed button and the medications will move to the Medication Review grid below the Medication List. NOTE: To review one medication at a time and select a different adherence for each, select one row at a time in the Medication List. Each medication selected will move to the Medication Review grid. To move a medication from the Medication Review grid back to the Medication List, select the medication and click Remove. 4 To update the adherence of a medication in the Medication Review grid, do the following: a) Select the medication in the grid. b) Select the adherence you want in the Adherence picklist. c) Click Update. 5 In the Reconciliation Type panel, select the Manual reconciliation was completed check box. To review medications electronically: 1 Click the Electronic Reconciliation button. The Clinical Reconciliation Module opens. Page 44 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

2 On the Import tab, select the Surescripts medication history file. 3 Document who confirmed the medication list. NextGen KBM 8.3 Dermatology User Guide 4 Perform a reconciliation between the medications in the EHR panel and the Surescripts file medications. 5 Click Confirm. 6 DUR interactions will display, if appropriate. 7 Click Close. The Medication List in the Medication Review panel displays any updates or additions. 8 Document the patient adherence, if necessary. After completing a manual or electronic medication review, select the Transitioning into care check box and/or the Summary of care received check box to document patient status, if applicable. Click Save & Close. The Medications reconciled check box in the Medications panel should be selected. Allergies The Allergies panel is used to add and review the allergy information of a patient. If there are no known medication allergies for a patient, select the No allergies check box. If the allergies are listed in the grid for this patient but the patient does not have any new information to add, click the Reviewed, no change option. To document the patient's new allergy information: 1 If the patient reports a new allergy since the last visit, click Add. The Adult Allergies pop-up template opens. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 45 of 116

Chapter 4 Intake Staff Workflow 2 Select the applicable check boxes and select their reaction from the corresponding picklist. 3 Click Save & Close. 4 Click the Allergies added today option if it is not automatically selected. If the patient s allergy is not displayed on the Adult Allergies pop-up template, close the pop-up template and double-click on any line (empty or not) in the Allergy grid to open the Allergy Module. If applicable, click the Comment active text link to launch the Allergy Comments template. Patient allergies should not be manually entered in the Allergy Comments pop-up template. All allergies should be entered in the Allergy Module. Note: If the Joint Commission standards have been enabled, allergy information must be documented after entering whether the patient is new or established, along with the Visit type and Historian. After documenting allergies, continue entering information for the other panes. Vital Signs Panel The Vital Signs panel allows you to document the patient s or patients' vital signs. You can also edit or remove an entry from the Vital Signs grid. To record Vital Signs: 1 In the Vital Signs panel, click Add. The Vital Signs [New Record] pop-up template displays. The Measured Date, Time, the Measured By or user name and the Last Measured values automatically display. The date and time can be manually changed but the user name cannot be modified. 2 For a female patient, click in the LMP field to enter the last menstrual period, if necessary. NOTE: The LMP field only displays for female patients. 3 Click in the Height (ft) field and use the numeric keypad on the right to enter numbers. If the vital signs could not be taken, select the Unobtainable check box. If the patient restricted the measurement of certain vital signs, select the Patient Refused check box and select a parameter from the Refused picklist. Page 46 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide NOTE: The Exclusions active text link opens the CQM Results pop-up template where you can manage clinical quality measures exclusions for Meaningful Use. The Quality button opens the Exclusions information pop-up template. The Non-MU Exclusions active text opens the Exclusions pop-up template where you can document an exclusion reason not related to Meaningful Use by clicking a Reason option and selecting an item from the corresponding picklist. 4 Click the NEXT button below the numeric keypad or press Tab on your keyboard to move to the next field. 5 To skip to the next field without entering information, click the NEXT button. Note: If a height and weight are not entered on this template, a Body Mass Index (BMI) does not calculate for the encounter. The template does not automatically search for a previous entry. Select the carried forward option to enter a previous height value in the Height field. Carrying forward a previously-entered height and entering a weight for today, causes a BMI status to display below the numeric keypad. If the BMI is out of the normal range (either too high or too low), a statement to this effect will display below the BMI. The BMI Plan active text link opens the Health Promotion Plan pop-up template where you can document a Plan of Care if the patient's BMI is outside of normal parameters. 6 Click in the Pain Score field and select the appropriate value from the picklist for today s visit. 7 Click the Calculate button to calculate the Body Surface Area (BSA), if needed. The calculated BSA value displays in the BSA field. After information has been entered in the Vital Signs [New Record] pop-up template and is saved and closed, the information displays in the Vital Signs grid. Only information documented today displays in the Vital Signs grid. Health Promotion Plan Template The Health Promotion Plan active text link in the Vital Signs panel opens the Health Promotion Plan pop-up template. The Health Promotion Plan pop-up template is used to document: 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 47 of 116

Chapter 4 Intake Staff Workflow BMI plan of care (if BMI is outside normal parameters) Pain level and follow-up pain of care Fall risk screening and falls care plan Functional status care plan The Exclusions active text link on the Pain Management, Fall Risk, and Functional Status panels opens the CQM Results pop-up template where you can manage clinical quality measures exclusions. To document a health promotion plan: 1 In the Vital Signs panel, click the Health Promotion Plan active text link. The Health Promotion Plan pop-up template opens. 2 In the Health Promotion Plan panel: The Patient's age and the calculated BMI values display. a) In the Plan field, click the blue drop-down arrow and select a care plan. b) In the Diagnosis field, search for and select a diagnosis. c) In the Diet field, select a diet plan from the picklist. d) In the Details field, type the details of the care plan. Page 48 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide e) In the Physical activity field, select the physical activity suggested to the patient. f) In the Details field, enter the care plan. g) In the Referrals fields, select the required values. h) In the Details field, enter additional information on referral orders. i) Click Add. The documented data displays in the Today's Diet, Physical Activity & Referral Orders grid. To update the data, select a record in the grid, make the applicable changes in the required fields, and click the Update button. The updated record displays in the Today's Diet, Physical Activity & Referral Orders grid. 3 In the Pain Management panel: a) Click the following fields and select an appropriate value: Pain Scale Method Location Onset Duration Quality b) In the Follow-up plan of care field, enter the follow-up plan made by the provider. 4 In the Fall Risk panel: a) Select the Yes or No option for the following questions: Falls in the last year?; if Yes, enter Number of falls. Did the fall(s) result in injury?; if Yes, enter Details. b) If applicable, enter comments in the Assisted devices field. c) If an exercise program is provided, enter the details in the Balance, strength, and gait training field. 5 In the Functional Status panel: a) Click the Screening Tool active text link. The Screening Tools pop-up template opens. b) Click the required active text links in the Behavioral Health Assessments, Health Status Assessments, and Self Assessments sections and enter data in the required fields to calculate the score. c) Click Save & Close. The documented data displays in the Screening Tool grid. You can click the Web buttons in the Website Screening Tools section to calculate the results and enter the score on the template manually. OR 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 49 of 116

Chapter 4 Intake Staff Workflow Click the Screening instrument field and select an option. Enter appropriate data in the Score, Severity/interpretation, Comments, and Major Depressive Disorder (MDD) pre-treatment fields. Click Add. The data displays in the Screening Tool grid. d) Click Save & Close to return to the Health Promotion Plan pop-up template. e) In the Follow-up plan of care field, enter comments for the follow-up plan. The Task button is used to send the notification to the desired recipients. 6 Click Save & Close at the top of template to return to the Intake template. After entering the systolic and diastolic blood pressure on the Vital Signs panel, you can document the care, screening, and follow-up for high blood pressure on the Health Promotion Plan template. To document a plan for high blood pressure: 1 Select Hypertension Plan from the Plan list. 2 Click the Diagnosis field and select a diagnosis. 3 Click the Diet field to select an option from the list. 4 Click the Diet Details field to select an option from the Diet details pop-up template or enter a comment manually. 5 Click the Physical activity field to select an option from the list. 6 Enter any comments manually in the Physical activity Details field. 7 Complete the Referrals section and enter any comments in the Referrals Details field. 8 Click the Lifestyle field to select an option from the list. 9 Enter any comments manually in the Lifestyle Details field. 10 Click Add to upload the data to the Today's Health Promotion Plan Orders grid. 11 Click Save & Close. Quality Buttons Quality buttons have been added to various sections of the Health Promotion Plan Template in NextGen KBM 8.3. The quality buttons launch pop-up templates containing information about documenting the associated CQM measure. Health Promotion Plan Quality Buttons Click the Quality button on the Health Promotion Plan panel. The dynamic information pop-up template opens based on the plan selected from the Plan list and the age of the patient. Page 50 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Select BMI Plan from the Plan list and click the Quality button to open the CQM - BMI Plan - Adults or CQM - BMI Plan - Peds information pop-up template, depending on the age of the patient. Select Depression Plan from the Plan list and click the Quality button to open the CQM - Depression Plan information pop-up template. Select Hypertension Plan from the Plan list and click the Quality button to open the CQM - Hypertension Plan information pop-up template. Pain Management Panel Click the Quality button on the Pain Management panel to open the CQM - Pain Assessment and Follow-Up information pop-up template. Fall Risk Panel Click the Quality button the Fall Risk panel to open the CQM - Falls Risk information pop-up template. Functional Status Panel Click the Quality button the Functional Status panel to open the CQM - Functional Status information pop-up template. Orders Panel The Orders panel includes the ability to process, manage, add, edit or remove an order. You can also access Immunization, Standing Orders, and the Task functionality. By clicking the Tuberculin Skin Test active text link, you can open the Tuberculin Skin Test template. By default the View of All Orders active text is selected. The other options to view are Labs, Diagnostics, Office Services, Immunizations, Procedures, Guidelines, and Referrals. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 51 of 116

Chapter 4 Intake Staff Workflow To document an order: 1 In the Orders panel, click Add to access the My Plan pop-up template. 2 Click the Assessments, My Plan, A/P Details, Labs, Diagnostics, Referrals, Office Procedures, and Review/Cosign Orders tabs to enter the required information. NOTE: A Quality button has been added to the Diagnostics template. Click the Quality button to open the CQM - Studies for Low Back Pain information pop-up template. 3 Click the Place Order button to process and include items in the Orders module. 4 Click Save & Close. The Orders panel includes active text links to process lab and radiology orders, to open the Order Management template, the Immunizations template, the Standing Orders in Office Services template and create tasks in the To Do pop-up template respectively. Page 52 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

Point of Care Tests NextGen KBM 8.3 Dermatology User Guide In the Orders panel, the intake staff can document point of care office tests with the Office Services pop-up template. To document an office test: 1 Click the Standing Orders active text link (or the Office Diagnostics button below physical exam grid). The Office Services pop-up template opens. 2 Click the Display category field and select an order set from the picklist. 3 In the Orders grid, highlight the row of the order you want to select. 4 Click the Add or Update Assessment button to access the Add or Update Assessments pop-up template. 5 Select an assessment and an assessment code for the order and click Save & Close. NOTE: The practice can pre-populate the assessment codes for Standing Orders so that the intake staff does not have to. 6 Click the Diagnosis field and select a diagnosis for the order. 7 In the Results/Report section, click the Interpretation field and select the result of the diagnosis from the picklist or click the Details active text link to document the result. 8 Select the Submit to Superbill check box. 9 Click the Place Order button. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 53 of 116

Chapter 4 Intake Staff Workflow After the order has been placed, the order is listed in the Today's Orders grid. Review of Systems (NextGen KBM 8.3 Dermatology) The Review of Systems panel enables you to document the findings after reviewing a list of systems. The list of systems can be customized by specialty or by provider. To document the Review of Systems: 1 Click Derm - ROS in the blue pane to access the Dermatology - ROS pop-up template. 2 Click ROS Default field to access the Ngkbm Td Dbp Filter dialog box with default ROS questions. This list can be modified by practice and the content of each ROS default can also be modified by practice. Page 54 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide 3 Click the Quick Load button in the right upper corner to open a list of saved default set names for this provider. 4 Click the Quick Save button. 5 Click the required options in the Review of Systems template. 6 Click Save & Close. Note: If something is not correct, or additional questions need to be asked, a system may be opened individually or the template where the information is entered can be re-opened. 7 Click the PHQ button to launch the Depression Screening - PHQ -2 pop-up template. Intake Note Generation (Intake template) The Generate Intake Note or Intake Note button at the bottom of the Intake and Histories templates is used to generate the Intake Note as the written summary of the encounter. It is recommended that staff create the document after all of the intake activities are complete. It is not necessary to generate the note twice during a visit. Histories Template The Histories template enables you to document a patient's social history, problem list, medical or surgical history, diagnostic study history, and family history. Histories Sub-navigational Links (NextGen KBM 8.3 Dermatology) The *Histories template includes the following sub-navigational links below the navigational tabs: Demographics Order Management Document Library Chart Abstraction 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 55 of 116

Chapter 4 Intake Staff Workflow Demographics The Demographics active text link displays the Patient Demographics template to document patient information such as contact information, address details, Primary Care Physician (PCP) details, insurance or pharmacy details, provider details, emergency contact details, and employment details. Order Management For information on the Order Management sub-navigational link, see Intake Sub-navigational Links. Document Library The Document Library displays the Documents and Letters template. The Documents and Letters template includes active text links that will generate a pre-formatted document where information can be entered. Page 56 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The Details button, available for some of the active text links, displays the corresponding dialog box to enter detailed information. The information is included in the generated pre-formatted document. Chart Abstraction The Chart Abstraction active text link displays the Chart Abstraction template. The Chart Abstraction template displays the allergy, medications, and histories information documented during the encounter. You can add data or modify the existing data. Skin Cancer History Log Information can be added to the Skin Cancer History Log panel using the Pathology Results template. Click the Path Results active text in the upper left navigation pane. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 57 of 116

Chapter 4 Intake Staff Workflow The Pathology Results template opens. The Orders grid contains all pathology orders for the patient. To enter pathology results: 1 Click on the appropriate row in the Orders grid for the pathology order to be resulted and document the following: Accession # Specimen ID Diagnosis Additional Diagnosis Details Recommended Treatment 2 Select an option for Lesion has been treated and click on the Submit to Superbill button to submit the pathology charge. 3 Click on the Add to Skin Ca Hx Log button to add the diagnosis to the Skin Cancer History Log. 4 Click on the Update Order button. 5 Complete the Follow up section. 6 Click Place Order. 7 Click Print Path Document to generate the pathology report document. Problem List Panel To meet Stage 2 Meaningful Use requirements, NextGen KBM 8.3 allows the user to electronically record, modify, and retrieve the patient's problem list over multiple patient encounters. By accessing the Problems module from the Problem List panel, the user can do the following: Page 58 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

Enter the patient's health problems to create the patient's problem list. Change the previously entered problem list data. Display the previously entered problem list data for past encounters. NextGen KBM 8.3 Dermatology User Guide The Problem List panel allows you to document the chronic conditions and secondary conditions of the patient. In the Problem List panel, you can access the Problems module to search and select the chronic and secondary problems. To enter chronic conditions and secondary conditions of the patients: 1 In the Problem List panel, click the Add button to access the Problems module. 2 Click the Add Problem button. A search window appears. 3 Enter the full or partial name of the problem in the field at the top of the search window. 4 Click Search. A list of search records displays under the Description column. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 59 of 116

Chapter 4 Intake Staff Workflow 5 Highlight a problem and click Select. Note: To add the selected problem to the tracked problem list, select the Add to My Tracked Problems check box. The selected record displays in the Description field in the Problems module. 6 From the Problem Status list, select the status of the problem. 7 If the selected problem is chronic, select the Chronic check box, otherwise select the Secondary Condition check box. Note: The Onset Date field displays the current date. You can enter an approximate date if the exact onset date is unknown. 8 In the Resolved Date field, enter the date when the selected problem was resolved. 9 Click Accept. The problem is grouped according to the selected problem status (Active/Inactive/Resolved). Reference: For more information on the Problems module, refer to the NextGen Ambulatory EHR Clinical Modules Guide. 10 Click the Close icon on the top toolbar to close the Problems module and return to the Histories template. 11 Click the Refresh button to update the data in the grid. 12 To indicate that you have reviewed the patient's problem list, select the Reviewed check box in the Problem List panel. To filter the chronic problems from the list of problems in the data grid, select the Show chronic check box. To view only tracked problems in the data grid, select the Show my tracked problems check box. Page 60 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Problem List Panel If a patient has chronic conditions that need to be mapped to SNOMED codes, a link will appear above every problem grid letting the provider know that codes need to be mapped. The Patient Level ICD9 to SNOMED Mapping pop-up template allows the provider to look up information about the patient to help them choose an appropriate ICD-9 to SNOMED code match. To map patient's unresolved chronic conditions to SNOMED problem module: 1 In the Problem List panel, click the View Mapping active text links at the top of the grid. The Patient Level ICD9 to SNOMED Mapping pop-up template opens. The upper grid displays unresolved chronic conditions and the lower grid displays patient's SNOMED problems in module. 2 Click the Show field and select Mapped or Not Mapped from the SNOMED Mapping picklist. The chronic conditions are displayed in the upper grid. Note: The Show field is defaulted to Not Mapped. 3 Highlight a chronic condition in the upper grid. 4 Click any of the following buttons to perform the required action: Button Map to Existing Problem Map to New Problem Resolve Condition Description Displays a picklist of patient's existing SNOMED problems to map the conditions. Displays a search tool to find a new SNOMED problem to map the condition. Enables to select a date to set the conditions as resolved. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 61 of 116

Chapter 4 Intake Staff Workflow The mapped and resolved chronic conditions display in the lower grid. History Summary Panel The History Summary panel allows you to document the patient's past medical or surgical history, social history, family history, and diagnostic history. Note: If there are no medical or surgical history, then select the No relevant past medical/surgical history check box. To document the past medical history of the patient: 1 In the History Summary panel, select Medical or Surgical/mgmt in the left panel. 2 Click the Add button. The Past Medical History pop-up template displays. 3 In the Medical section, select the check boxes to indicate the patient's past medical conditions. 4 Click the Save to Grid button. 5 In the Surgical section, select the check boxes and years to indicate the patient's surgical history. 6 Click the Save to Grid button. To edit a condition: 1 Highlight a row in the Past Medical History Grid panel. 2 Click Edit. The Edit Past Medical History dialog box displays. 3 Click the Disease/disorder text box and select a condition from the picklist. 4 Click the Side text box and select a side. 5 Click the Onset date field and select the date when patient was affected by the selected disease. 6 Click the Management text box and select a therapy from the picklist. 7 Click the Side text box and select a side. Page 62 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide 8 Click the Date field and select the date when patient was diagnosed for the disease. 9 Click Save and then click Close. 10 Click Save & Close. To document the social history of the patient: 1 In the History Summary panel, select Social in the left panel. 2 Click the Add button. The Social History - Tobacco pop-up template displays. Social History Tobacco Template You can access the Social History Tobacco template from the left navigation bar, Risk Factors Config pop-up template, or the Histories template. NOTE: The patient's current smoking status must be recorded to meet Meaningful Use requirements. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 63 of 116

Chapter 4 Intake Staff Workflow To document the patient's current tobacco use details in the Tobacco Use panel: 1 Select one of the following options: No/never Yes Unknown 2 If you select No/never or Unknown, no other documentation is required. You may want to continue recording data on the Passive Smoke Exposure panel. Click Save & Close to return to your previous workflow. If you click the Yes option under the Smoking Tobacco Use and Non-Smoking Tobacco Use sections, select any of the Tobacco type check boxes that apply to the patient. Note: As data is entered, the Smoking status and Tobacco use status fields automatically populate. 3 If appropriate, click Use daily. 4 Enter a value in the Usage per day field. Note: For cigarettes, enter Packs or Cigarettes in the field following Usage per day. 5 Click in the Years used field to enter a number value. The Pack year automatically calculates. Enter the Age Started. 6 If applicable, click the Age Stopped field to document this value. 7 If the entries that populated in the Smoking status or Tobacco use status fields do not accurately reflect the patient's situation, click in the field to select a more accurate description from the list. Smoking Status Current every day smoker Current some day smoker Former smoker Never smoker Smoker, current status unknown Unknown if ever smoked Meaning A patient who has smoked at least 100 cigarettes during his or her lifetime and still regularly smokes every day. A patient who has smoked at least 100 cigarettes during his or her lifetime and still regularly smokes periodically, yet consistently. A patient who has smoked at least 100 cigarettes during his or her lifetime but does not currently smoke. A patient who has not smoked 100 or more cigarettes during his or her lifetime. A patient who has smoked at least 100 cigarettes during his or her lifetime but whether they currently smoke is unknown. A patient whose smoking status is not known. Page 64 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Smoking Status Heavy tobacco smoker Light tobacco smoker Meaning A patient who currently smokes and smokes more than 10 cigarettes (or cigarillo, cigar or pipes equivalent) per day. A patient who currently smokes but smokes less than 10 cigarettes (or cigarillo, cigar or pipes equivalent) per day. Exclusions The Exclusions active text link on the Tobacco Use panel opens the CQM Results pop-up template. You can manage exclusions to the Tobacco Use clinical quality measure on this pop-up template. To view data on the Historical Use panel: 1 If the patient has encounters entered on a NextGen KBM release prior to version 7.9.1, click the Click here to see tobacco history prior to 7.9.1 active text link. The Tobacco Use History template appears. 2 Click Save & Close to return to the Social Histories - Tobacco template. To document tobacco cessation efforts: 1 On the Efforts to Quit Tobacco panel, select from the following options: No/Never Yes Unknown Note: Selecting either No/never or Unknown means that there is no other documentation required on this panel. 2 Click in the Tobacco type field to select from the list. 3 If applicable, enter the Month, Day, and Year (must be four digits) next to Quit. 4 Click the Longest tobacco free field to enter the number of days, weeks, months, or years the patient quit using tobacco. 5 Enter the Cessation method. 6 Type the reason in the Relapse reason field. 7 Click Add to enter the information into the grid. 8 If appropriate, under the Tobacco Cessation Information section, click the Tobacco cessation discussed check box. The Tobacco Cessation Discussed template appears. 9 Click the drop-down arrow for the Tobacco cessation discussion field to select a topic from the list. 10 Click Add. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 65 of 116

Chapter 4 Intake Staff Workflow The selected Discussion type and Completion Date move to the History of Tobacco Cessation Discussions grid. 11 Repeat steps 7-9 until all the necessary tobacco cessation details are added to the grid. 12 Click Save & Close to return to the Social History Tobacco template. To document passive smoke exposure details: Note: Recording passive smoke exposure is not an MU II requirement nor does it satisfy the MU II requirement to record a patient s smoking status. 1 Select any of the following options: No/Never Yes 2 Click in the Tobacco type field to enter as many tobacco types as apply from the list. 3 Click Close when complete. 4 Enter the Length of exposure. 5 Click in the Level of exposure field to select a value from the list. 6 If applicable, enter Comments. 7 Click Save & Close. Family History In the History Summary panel, select the Family active text link to display the family history options. You can select the No relevant family history check box or the Adopted - no family history known check box if the patient's family history is not known. To document family history of the patient: 1 Click the Add button below the data grid. The Family Health History template displays. Page 66 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide 2 Click the Relationship field and select a family member from the Family relation picklist. 3 In the Family member name field, enter the name of the selected family member. 4 If the selected family member is alive and well, then click the Alive and well radio button or else click the Deceased radio button and enter the age at death in the corresponding field. 5 Select a condition and click the corresponding Onset age field. The on-screen numeric keypad displays. 6 Enter the age of diagnosis and click OK. 7 If the family member is dead and the selected condition is the cause of death, select the corresponding check box and click the comments active text. The Family History Comments pop-up template displays. 8 Enter your comments and click Save & Close. 9 Click the Save to Grid button. The documented information displays in the below data grid and template clears so that information about another family member can be entered, if any. 10 Click Save & Close to return to the Histories template. 11 To indicate that you have reviewed the patient's family history, click the Reviewed check box at the top of the data grid. To edit details of a family member: 1 Highlight the row of a family member whose details has to be edited. 2 Click Edit. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 67 of 116

Chapter 4 Intake Staff Workflow The Family History Details pop-up template displays. 3 Make the required changes. 4 Click Save and then click Close. 5 If you want to clear the existing data and add new data, click the Clear For Add button. Diagnostic Studies You can to document a patient's various diagnostic tests and their results in the History Summary panel. To add a diagnostic study: 1 Click Diagnostic in left blue pane. 2 Click Add to open the Diagnostic History Entries pop-up template. 3 In the Diagnostic study type field, select a study type and click OK. Page 68 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

4 In the Diagnostic study field, select a value and click OK. The Procedure Code field automatically populates. NextGen KBM 8.3 Dermatology User Guide 5 If the diagnostic study is performed outside your practice, select the Ordered elsewhere check box. 6 Click the Side and Site fields and select a value from the corresponding picklists. 7 Click the Performed field to select a date. If the exact date is unknown, select the Approx, date performed check box. 8 In the Location field, select the diagnostic locations. 9 In the Performed by field, enter the person name who performed the diagnostic study. 10 Click the Interpretation field and select a status from the Interpretation picklist. 11 In the Result field, enter the result. 12 In the Comments field, enter your comments. OR 13 Click the My Phrase button and select a common phrase from the picklist. 14 Click the Add To Grid button. 15 Click Save & Close. 16 If required, double-click an order in the data grid to add additional details. 17 Enter the required details about the selected order. 18 Click Save. 19 Click Close. History Review The History Review active text link in the Histories template enables you to include detailed information in the generated encounter document. You can also indicate whether the medical, surgical, family, and social histories were reviewed and updated, reviewed without changes, or were unobtainable. To document history review: 1 In the Histories template, click the History Review active text link to launch the History Review dialog box. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 69 of 116

Chapter 4 Intake Staff Workflow 2 Click any of the following options under the Med/Surg/Interim Hx, Family, and Social labels: Option Detailed document Reviewed, updated Reviewed, no changes History unobtainable 3 Click Save & Close. Action Click to display all the details entered in the Histories template in the encounter document. Click if the patient's histories have been reviewed and updated. Click if the patient's histories were reviewed and no changes were made. Click if the information is not obtainable and enter the reason in the corresponding field. Note: Each area that is reviewed (Med/Surg,Family, and Social Histories) contributes to the Evaluation & Management coding. Intake Note Generation When the intake staff completes documenting the patient information, the Intake Note is generated as the written summary of data collected up to this point in the encounter. The provider can also generate the Intake Note to obtain an overview of the collected information and then continue with the physical exam and assessment plan. To generate the Intake Note document: 1 Click the Intake Note button at the bottom of the Histories template. 2 Review the generated document for accuracy. 3 Click the Close icon in the top toolbar. Page 70 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Patient Tracking The Patient Tracking course of the encounter. icon is used to document the location and status of a patient during the To update the patient s status and location for patient tracking: 1 Click the Patient Tracking icon. The Todays Patient Tracking pop-up template opens. 2 In the Room field, select a room from the picklist. 3 In the Status field, select the appropriate status (e.g. "Waiting for provider"). 4 Click Save & Close. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 71 of 116

Chapter 4 Intake Staff Workflow To view a patient's past, present, and future appointments: 1 In the Todays Patient Tracking pop-up template, click the EHR Appointments button. The Patient Appointments pop-up template opens. The When, Provider, and Location fields contain the current date and time, provider name, and practice location respectively. 2 In the View section, click the By Provider option to enable the Add and Search buttons only if given privileges in System Admin to do so. Note: Patient Tracking is optional. The intake staff can proceed with the workflow without documenting the appointment details. If the patient s status has changed, this will be visible on the Inbox. It is generally not necessary to send a task regarding a change in status. Page 72 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

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NextGen KBM 8.3 Dermatology User Guide C HAPTER 5 Provider Workflow The provider reviews the patient's summary information on the Home Page and proceeds to the SOAP and Finalize templates for an office visit workflow. The provider workflow involves: Reviewing the data documented up to this point in the encounter to get an overview of the patient's condition as well as updating and providing additional information as needed Documenting the presenting problem(s) and various physical exam findings Creating a treatment plan Documenting Evaluation and Management (E & M) codes Patient Tracking The provider can use the Patient Tracking icon to indicate that the patient is with the provider by updating the status in the Todays Patient Tracking pop-up template. After updating the status for the patient, click the Save & Close button to close the pop-up template. Home Page - Provider Review The provider starts the visit by accessing the Home Page template and reviewing the information that was entered by the intake staff to determine if any additions or changes should be made. Panels on the Dermatology Home Page Template The first three panels on the Dermatology Home Page are the Skin Cancer History Log panel, the Summary panel, and the Assessment History panel. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 75 of 116

Chapter 5 Provider Workflow Skin Cancer History Log Panel Click the Add button under the Treatment History grid to open the Skin Cancer History Log - Derm pop-up template. Click the Add button under the Staging grid to open the Cancer Type pop-up template. Information can be added to the Skin Cancer History Log panel using the Pathology Results template. Click the Path Results active text in the upper left navigation pane. The Pathology Results template opens. Summary Panel The Summary Panel contains links to the following information: Page 76 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide HPI's Treatment Summary Medications Allergies Labs Procedures Skin Cancer History Problem List Assessment History Communication History Patient Providers Cancer Type Chemotherapy Cancer Staging Pathology Orders Procedure Billing 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 77 of 116

Chapter 5 Provider Workflow Assessment History Panel The Assessment History panel displays information about the patient's assessments. History Summary Panel on the Home Page Template The History Summary panel displays the patient history documented by the Intake staff on the Histories template. The data grid includes a list of categories in the blue pane to select and view the documented data. Provider can review and make required changes in any of the documented patient history data by highlighting a row in the grid and clicking the Edit button. Provider can also add any new patient history by selecting a category in the blue pane and clicking the Add button. The Confidential active text link includes the confidential information provided by the patient to the Intake staff during the course of encounter. When the review of the documented patient history is complete, the provider must click the History Review button at the top of the grid and select the required option in the History Review pop-up template. Allergies Panel on the Home Page Template The Allergies panel displays the patient's allergy information documented by the Intake staff. The Add button enables provider to add any new allergy information. The provider can also edit or delete the existing allergy information by double-clicking a row in the grid and making the required changes in the Medication Allergies pop-up template. If the allergy information is reviewed without any changes, the provider must click the Reviewed, no change option. The Comments active text link at the top of the grid includes any comments added by the Intake staff on allergies. Medications Panel on the Home Page Template The Medications panel displays the patient's medications documented in the Medication module by the Intake staff. Page 78 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The provider can review and make the required changes to the existing medications by doubleclicking the required row in the grid to open the Medication module. The New Prescribe button in the Medication module enables provider to add any new medications. The Reconcile button opens the Medication Review pop-up template to reconcile all medications and document medication compliance. When the medications are reconciled, the provider must select the Medications reconciled check box. The Comments active text link at the top of the grid includes any comments on medications inserted by the Intake staff. Vital Signs Panel on the Home Page Template The Vital Signs panel displays the patient's vital signs documented by the Intake staff. The provider can review and make the required changes to the documented vital signs by selecting a row in the grid and clicking the Edit button. To delete a vital signs record, provider must select the row to be deleted and click the Remove button. The History active text link at the top of the grid displays the vital signs details in a tabular format. The Graph active text link displays graphical views of data based on specialty and patient age. Orders Panel on the Home Page Template The Orders panel displays all the orders placed in an encounter. Providers can select the required categories in the blue pane to view the corresponding orders. To place additional orders, provider must click the Add button and select the required orders on the My Plan pop-up template. To manage or change the status of the existing orders, double-click a row in the grid or select a row and then click the Edit button or Order Management active text link. Communication Panel on the Home Page Template The Communication panel displays the details of communication between a practice and a patient documented in the Telephone Call template. To filter and review the items by category, you have to select the category from the blue pane. Providers can include new communication information by clicking the Add button. The Filter field at the top of the grid allows the provider to filter the communication details based on the status. Document SOAP (NextGen KBM 8.3 Dermatology) The *SOAP template is used by the provider to enter history, exam, assessment, and plan information. The *SOAP template in Dermatology includes the following sub-navigational links below the navigational tabs: 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 79 of 116

Chapter 5 Provider Workflow Standing Orders Adult Immunizations Peds Immunizations My Plan Procedures Order Management Compose Introduction To compose an introduction, edit or enter the patient information in the Introduction field in the Reason for Visit panel. The introduction appears in today s document, and it can be edited for this individual patient. The statement defaults are configurable on a practice template. It can be edited during the course of the encounter and works with voice recognition software. Quick Note Quick Note offers a way to reduce the repetition associated with entering information for large number of patients presenting with similar symptoms and conditions. Quick Note is a useful feature that helps providers to increase their productivity without in any way compromising patient care. Quick Note enables you to save the entire SOAP template, including all data fields, check boxes, options, and associated HPI settings, under a unique name. Only one Quick Note can be applied at a time. If you apply a Quick Note and subsequently apply a second, the data associated with the second Quick Note overwrites all existing data in the template. Reason for Visit on the SOAP Template (NextGen KBM 8.3 Dermatology) In the Reason for Visit panel is an Introduction field. To compose an introduction, edit or enter the patient information in the Introduction field. The introduction appears in today s document, and it can be edited for this individual patient. The statement defaults are configurable on a practice template. It can be edited during the course of encounter and work with voice recognition software. To document the Reason for Visit: 1 In the Reason for Visit panel, click on one of the reasons for visit entered previously to open the HPI pop-up template. Or, Select a complaint from the reasons for visit in the blue pane. Page 80 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The associated HPI pop-up template opens. Note: If you select reason(s) for visit using the Additional/Manage active text, then the reasons are listed in the Chief Complaint column in the data grid. You need to click the reason(s) listed under the Chief Compliant column in the data grid to launch the associated HPI template. 2 In the template, enter the appropriate data. 3 Enter any comments. 4 Click Save & Close. The entered information is displayed in a concatenated paragraph format under the History of Present Illness column in the Reason for Visit panel. The Intake Comments active text link displays comments that the Intake staff might have entered in the Intake tab. If comments had been entered, the color of the active text link changes from blue to magenta and the bullet to the left of the active text changes to a solid magenta diamond. The Diagnostics button opens the Office Services pop-up template to view or enter various diagnostic tests and results. The Comments button launches the HOPI Notes pop-up template to add any additional comments on the selected chief complaints and the Show All button launches the HOPI Notes pop-up template to view the HPI documentation for all chief complaints. To quick save the HPI template: 1 Click the Quick Save icon above the Reason for Visit grid to develop a customized Reason for Visit pop-up template. The Save Template Defaults pop-up template opens. The Default Set Category field is pre-populated with Full Exam. In this case, the lower-right section Templates to Save is unavailable and the option Save All Templates is pre-selected. 2 If you want the default template applicable to all specialties, click the All Specialties option, otherwise click the Current Specialty Only option. 3 In the Default Set Name field, enter a name for the default set. It is recommended to enter name in <your initial> <Gender> <Default Name> format. 4 Click Add. The data displays in the Full Exam Quick Saves grid. 5 Click Save & Close. 6 Click the Quick Load button at top-right corner of the grid to view the saved default set name in the picklist. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 81 of 116

Chapter 5 Provider Workflow Review of Systems on the SOAP Template (NextGen KBM 8.3 Dermatology) Information entered by the intake staff on the Intake tab displays here. To update the Review of Systems: 1 Click a system in the list to launch the associated ROS template or on DERM - ROS to launch the Review of Systems template. 2 Make the required changes and click Save & Close. 3 To remove an item, highlight it, and click the Remove button below the grid. To create a customized review of systems template: 1 Click the Quick Save icon above the Review of Systems grid. NOTE: This is in addition to the one page template that the intake staff used on the Intake tab. This displays the Save Template Defaults template. The default set category is pre-populated as ROS Full Exam. If a quick save were done from the one-page ROS template then the Default Set Category would be ROS Normal. Page 82 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The lower right section Templates to Save is unavailable and the option Save All Templates is selected by default. 2 Enter a default set name that will make the content meaningful. 3 Click Save & Close. 4 Enter the individual active links like Constitutional, HEENT, etc. and select the items the provider wants. A unique, customized Review of Systems is saved. 5 Click the Quick Load button to view the saved template for the patient. To access the PHQ-2 popup: 1 Select the PHQ button to launch the Depression Screening - PHQ-2 template. 2 Document the depression screening questions. 3 Click OK. Vital Signs on the SOAP Template The provider can review the vital signs added by the intake staff in the Intake template and make the applicable changes. To update the vital signs details: 1 In the Vital Signs panel, highlight a record in the grid and click Edit. The vital_signs pop-up template opens. 2 Update the necessary details in the pop-up template. The Clear For Add button is used to clear the existing data and add a new data. 3 Click Save. 4 Click Close to return to the SOAP template. 5 To remove a record from the grid in the Vital Signs panel, highlight a record and click Remove. Physical Exam Panel (NextGen KBM 8.3 Dermatology) The Physical Exam panel displays a list of exam categories in the blue pane. The items that display are customizable by specialty or by provider. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 83 of 116

Chapter 5 Provider Workflow The One Page Exam active text opens the Derm General - PE pop-up template where you can document the patient's physical exam. You can also access the system-specific physical exam templates by accessing the active texts in the blue pane. If the required system is not available in the blue pane, you click the Additional active text and select a system from the picklist. Click the Office Diagnostic button below the Physical Exam grid to launch the Office Services pop-up template to place orders for the tests. To document areas examined: 1 Go to the Areas Examined section below the Physical Exam grid. 2 Select the check box to add the findings to the grid. Create Assessment/Plan (NextGen KBM 8.3 Dermatology) The Assessment/Plan panel enables provider to add an assessment to diagnose the patient issue(s) and then formulate a treatment plan. The Assessments, My Plan, A/P Details, Labs, Diagnostics, Referrals, Office Procedures, and Cosign Orders active links information can be added by clicking the Add/Update button. To document assessment and plan details: 1 Click the Add/Update button below the Assessment/Plan summary grid. The Add or Update Assessment pop-up template opens. Today s reasons for visit display at the top. The following are the three grids below the Today's concerns/reasons for visit field: Diagnosis History: a list of active diagnoses for this particular patient. Clinical Problems: a list of all active chronic problems that have been entered into the Chronic Problem list for this patient. My Favorites: the provider s personal list of diagnoses that were saved for ease of use and are not specific to this particular patient. 1 If the required assessment is not on one of these lists, click the Add Common Assessment active text link in the lower-right corner to access the Common Assessment pop-up template. 2 Select an assessment and click Save & Close. OR Click the Diagnosis Code Lookup active text link to open the diagnosis search window, where you can search for and select a diagnosis. 3 Click the Add/Update button. 4 Click the My Plan tab to open the My Plan template. a) Highlight the assessment in the Today's Assessment field. This displays an order set for that diagnosis category. Page 84 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide b) Select the desired check boxes for the Labs orders, Diagnostics, Office medications, Office procedures, Office labs, and Additional orders. c) Add the My Instructions information. d) Click the options in the Follow-up visit/referral section and enter the information in the Order Timeframe pop-up template. e) Click the Place Order button. Perform: today is the default time for these orders. f) For follow-up visits, change the Perform date to the time desired from the Appt Timeframe picklist. Note: It is preferable to complete today s orders first, click the Place Order button, and change the Perform date to do the follow-up visit so that the provider does not inadvertently order labs that are to be complete within one year. When the order is placed, the provider can click the next tab A/P Details to display the Assessment Plan Details pop-up template. On this template, the provider can select an assessment and then enter the comments, differential diagnosis, plan details, provider details, or today's orders or use My Phrases or Common Phrases (practice-wide phrases) and Follow-Up. Entering information in A/P Details tab is optional. 5 Click the A/P Details tab to access Assessment Plan Details template. 6 Click the Follow-up button to access the Follow-up/Disposition pop-up template. a) Highlight the diagnosis in the grid and select the follow up check box. b) Enter the details and time of the follow-up visit. c) In the Disposition field, select an option from the picklist. If the required option is not available in the list, click the top blank row to type a value in the Disposition field. d) In the Reason field, select an option from the picklist. e) Click the Place Order button. The fields clear so that another follow-up appointment can be entered. f) Click OK to return to the Assessment Plan Details template. If the Place Order button is not clicked, then the order will not be saved, part of the note will be visible on the Checkout tab. 7 Click Save & Close to return to the SOAP template. In the Assessment/Plan grid, the follow-up appointments are displayed. To remove an assessment details, highlight an item in the Assessment/Plan grid and click the Remove button. The Consent active text link opens the Consent - Procedures pop-up template to document the details such as Provider name, Consent by, Type of procedure, Procedure date, and Comments. The Consent button generates a consent note with the details documented in the Consent - Procedures pop-up template. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 85 of 116

Chapter 5 Provider Workflow SOAP Link Icons The icons for various links displayed in the SOAP template: Icons Description The Provider Communication icon opens the Provider Communication template to document the communication with a family member or another physician can be documented. The Meds icon opens the Medication module. The provider can prescribe new medicines for the patient. The Procedures icon opens the Ngkbm Udp Procedure Picklist db picklist with a list of procedure templates. This list can be customized by specialty or provider. The All option can be added to the list to open all procedure choices or the left navigation bar can be used to open the Procedures template. The Patient Plan icon generates the patient plan document which can be printed and given to the patient at each visit. Save Quick Note The Generate Note icon displays a list of possible notes or documents available for generation. The Chart Note is a customizable document (by practice or by provider). The Master Document is the complete and legal record of the visit and should be generated at each visit. If the Chart Note is not customized, it is preferable to use only the Master Document. The EM Coding icon opens the Finalize template. This can also be accessed by clicking on the Finalize tab on the navigational tabs. The Dictation icon opens the Dictation template. The details like reason for visit, medication etc. can be entered here and sent for transcription. The EM coding level must be selected manually on the EM History template when using the template. You can save the current SOAP template as a Quick Note. To save the current SOAP template settings as a Quick Note: 1 Click the Save Quick Note button at the bottom of the SOAP template. The Save Template Defaults pop-up template displays. Page 86 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide The Default Set Category entry of Full Exam indicates that the Quick Note provides defaults for the entire SOAP template. 2 Type a name in the Default Set Name field. 3 If you want the default template settings to be available for all specialties, click the All Specialties option. If you want this template set to be available only for the current specialty, click the Current Specialty Only option, where the current specialty is indicated. 4 If you want to include all templates that you accessed during the current encounter, click the Save All Templates option. If you want to save only the currently open template, click the Save Current Only option. The current template is identified by its template name in the data field to the right. If you want to save selected templates: a) Click the Select Templates to Save option. The data field to the right is enabled. b) Click the data field. The NGKBM Td Dbp Set Names pop-up template displays. c) The pop-up template lists all of the templates that can be added to the current Quick Note. d) Click the name of a template to be included in the Quick Note. e) Click OK. You are returned to the Quick Save Template pop-up template with the name of the selected template in the data field. f) Repeat these steps to add templates to the Quick Note. Note: If you add the same template to the list twice, you must click the Clear button to erase the current contents of the field and reselect the templates to include in the Quick Note. 5 Click Save & Close. Generate Note To create a note to be associated with the encounter: 1 Click the icon to access the Ngkbm Get Dbpicklist Items picklist. 2 Select the required note from the list. 3 Click OK. Finalize Template The Finalize template is where the provider calculates all of the elements that are documented in the Intake, Histories, and SOAP tabs, selects the Evaluation and Management (E&M) code level for the visit, and submits the E&M coding to the Superbill module. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 87 of 116

Chapter 5 Provider Workflow Finalize Tab Sub-Navigational Links (Derm) The Finalize template includes the following sub-navigational links: Order Management Document Library Procedures Tobacco Cessation Tobacco Cessation Sub-Navigational Link The Tobacco Cessation sub-navigational link displays the Tobacco Cessation template. In the Tobacco Cessation template, you can document tobacco history details, complete the medication screening questions, select the methods used for tobacco cessation, add assessments, and select and schedule the recommended treatments. Page 88 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide General Panel The General panel in the Finalize template indicates whether the office visit code is calculated for a new patient or an established patient. You can also indicate whether the physical exam was multi system or single system. If the PE type is single system, click the Single system option and select a type of exam from the Pe Em Exam Type picklist. If the PE exam type is multi system, click the Multi system option. Note: The option to select single system or multi system is available only when you enable the 97 Coding Guidelines for Evaluation and Management coding automation in the Ngkbm Config practice template. Today's Assessment Panel (NextGen 8.3 KBM Dermatology) The Today's Assessment panel displays a list of assessments provided to the patient, which is used for E & M coding. Provider Sign Off Panel The Provider Sign Off panel enables you to send a request to the supervising physician for review and to sign off to indicate that the plan of care is appropriate. If the user selects the Physician Sign Off Request check box, a request will be submitted to the supervising physician for review. If the user selects the I have reviewed and agree with the diagnosis and treatment plan check box, the Master document generates or is submitted for offline generation. Evaluation and Management Coding Panel The Evaluation and Management Coding panel enables you to identify the level of complexity associated with the encounter. In this panel, you can document counseling given to the patient and its duration. You can also calculate the Evaluation and Management (E&M) code and submit the generated code to the Superbill. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 89 of 116

Chapter 5 Provider Workflow To document information in the Evaluation and Management Coding panel: 1 In the Medical Decision Making section, click the appropriate level of complexity associated with the encounter. NOTE: The View MDM Guidelines active text link opens the Medical Decision Making Guidelines pop-up template, which provides information to assist you in determining the level of complexity involved in the medical decision making. The View Risk Table active text link opens the Table of Risk pop-up template, which provides information to assist you in determining the level of risk associated with the encounter. 2 In the Counseling section: a) Select the Counseled greater than 50% of time and document content check box if the duration of the counseling is known. The Total Time Visit Time numeric keypad opens. b) Type the total visit time and click OK. The total visit time displays in the Total visit time (minutes) field. c) Click the Counseling Details active text link to document the total counseling time. The Counseling Details pop-up template opens. The following table provides the instruction for the Counseling/Educational Details section: Field Type of counseling Method of counseling Action In the field, select a value from the Select type of counseling picklist. You can indicate up to five types of counseling. In the field, select a value from the Select method of counseling picklist. Page 90 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Field Evaluation of counseling Time Comments Interpreter used Action In the field, select a response from the Select your evaluation counseling picklist. Type the total time spent on the counseling. Type the additional information about counseling. Select the check box if the interpreter is used by the provider to convey information. In the Language field, select a language used to interpret from the picklist. Type the name of the interpreter in the Interpreter's name field. In the Relationship field, select a relationship description of the interpreter with patient from the picklist. The following table describes the Counseling/Educational Factors section: Field Detailed document Reviewed Readiness to learn Barriers to learning Learning preferences Cultural/spiritual needs d) Click Save & Close. Action Select the option if you need to generate a detailed document. Select the option if the documented information is reviewed. Select the check boxes to indicate the patient's readiness for counseling. Select the check boxes to indicate barriers to learning. Select the check boxes to indicate the patient's preferences to take the counseling. Select the Yes or No option and enter comments in the corresponding field. The total time spent for counseling is displayed in the Total counsel time (minutes) field. 3 In the Evaluation and Management Code section: a) Click the Calculate Code button. The calculated code displays in the Visit code and Calculated EM code fields. b) To submit the generated code to the Superbill, click the Submit Code button. If you have the Set to Offline generation check box selected in the Ngkbm Config practice template, the Master_Im document generates. When this check box is not selected, the the specialty master document generates instead. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 91 of 116

Chapter 5 Provider Workflow Note: A code can be manually selected by selecting one of the options on the right of the Evaluation and Management Code section. The View Other Codes active text link opens an often used list of E&M code. The Additional E & M Code active text link is used to add an EM code for any additional EM services performed during the encounter. The SNOMED Visit Type (optional) active text link opens the SNOMED Visit Type pop-up template. The Medicare Preventive Codes active text link opens the Medicare Preventive Codes pop-up template where you can select a code for the encounter. The Quality button opens the CQM - SNOMED Visit Type information pop-up template. The CQM Check button appears on the Finalize template for all specialties. The CQM check runs when you open the Finalize template. When you click the CQM Check button in the Evaluation and Management Coding panel, the CQM Results template opens. E & M Level Summary Panel The E & M Level Summary panel displays the calculated history level and exam level, listing the number of elements that were documented. History Details The History Details panel displays the detailed information for calculating the totals for each component of the history level and exam level. Page 92 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Evaluation and Management Guidelines You can use either the '95 or '97 guidelines. Only one set of guidelines can be used at a time. Open the Ngkbm Config practice template to configure the set of guidelines under the EM Coding section. The set that is not selected will still display on the template but will not be available for use. With the '97 Coding Guidelines, you can select whether to use multi-system or single-system by selecting the appropriate option on the Finalize template. 95 Physical Exam Details Panel The 95 Physical Exam Details panel displays the calculated EM totals for each component. 97 Multi System Physical Exam Details Panel The 97 Multi System Physical Exam Details panel displays detailed information for calculating totals for multi-system physical exam calculation type used in calculating a total EM service code. 97 Single System Physical Exam Details Panel The 97 Single System Physical Exam Details panel displays detailed information for calculating the totals for single-system physical exam calculation type used in calculating a total EM service code. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 93 of 116

Chapter 5 Provider Workflow Dermatology Procedure Billing Panel In the Dermatology Procedure Billing panel, you can add the procedure billing details, verify the charges, and submit to Superbill. To document procedure billing: 1 Double-click the data grid. The Procedure Billing pop-up template opens. 2 Enter the required information. 3 Click Save. Note: To remove the existing data and add another set of procedure billing details, click the Clear For Add button. 4 Click Close. The data is displayed in the data grid in the Dermatology Procedure Billing panel. 5 To verify the charges, click the Verify Charges button. The selected Charges verified check box appears at the top of the data grid. 6 To prevent the charges for the encounter from billing, select the Surgery Hold check box. 7 To process the charges, click the Submit To Superbill button. Page 94 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Note: The charges should be submitted to Superbill only after the patient encounter is completely documented to ensure the most accurate codes and units are uploaded. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 95 of 116

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NextGen KBM 8.3 Dermatology User Guide C HAPTER 6 Checkout Staff Workflow After completing the intake staff and provider workflow, the front office staff initiates the checkout process of the patient in the Checkout template. The checkout process involves: Reviewing and/or placing all orders. Scheduling future appointment as ordered. Generating Patient Plan and Checkout documents if needed. Checkout Template (NextGen KBM 8.3 Dermatology) The Checkout template has two panels: The Today's Orders panel processes the lab orders that the Provider had placed in the My Plan template. The Given to Patient/Verified panel verifies the items given to the patient. Lastly, the Patient Plan is generated from the Patient Plan button and given to the patient. The Checkout template for Dermatology also includes the following sub-navigational links below the navigational tabs: Demographics Order Management Document Library Tobacco Cessation 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 97 of 116

Chapter 6 Checkout Staff Workflow Today's Orders Panel The Today's Orders panel is used to process any lab or radiology orders that the provider documented in the My Plan template. The numbers next to the items in the blue pane indicates the amount of items in queue. To process the lab orders: 1 Click the Lab/Radiology Order Processing active text link above the Today's Orders grid. The Process and Submit Lab/Radiology Orders pop-up template opens. 2 Select Labs or Radiology option. 3 Click the Vendor field and double-click the required option from the picklist. Page 98 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide 4 Highlight the row for the order in the Today's Orders grid. 5 Click the Include selected order arrow to move the order to the Orders for Selected Vendor section. 6 Click Process/Submit to include this order in the Orders module. 7 Click Save & Close to return to the Checkout template. The Requisition button generates the Requisition document with the lab requisition details. NOTE: Different buttons appear below the Today's Orders grid, depending on which item you select in the blue pane. For example, if you select Procedures, you can click the PreOp button to open the Preop Visit template or you can click the Scheduling button to open the Procedure Scheduling pop-up template, if necessary. If you select Medications, you can click the Medication List button to generate the Medications document, if needed. Send Tasks To send tasks to a provider: 1 In the Today's Orders panel, click the Tasks active text link. The To Do pop-up template opens. 2 Enter and/or select the options for the following fields: Date Due Priority Subject Category Message 3 Click Save & Close. The Attach picklist displays. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 99 of 116

Chapter 6 Checkout Staff Workflow 4 Select an option and click OK to access the Select Task Recipients pop-up template. 5 From the Available Users/Workgroups section, select one or more users under a practice(s). 6 Click the Add User(s) button. The selected user(s) displays in the Task Recipients section. 7 From the Priority list, select a value. 8 Click OK. Given to Patient/Verified Panel The Given to Patient/Verified panel allows you to verify the items given to the patient. To verify the items and check out the patient: 1 Select the Yes check boxes for the required fields to confirm that they were ordered. 2 Click the Checkout button. The checkout document generates with today's orders. The Patient Portal Upload button links you to the NextGen Patient Portal application to send documents through the Electronic Document Posting pop-up template. Reference: For more information, refer to the NextGen Patient Portal User Guide Version 5.8. Page 100 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Patient Tracking - Check Out After the patient's checkout process is complete, you can update the status in the Todays Patient Tracking pop-up template. To update the status of the patient: 1 From the left Navigation bar, click the Patient Tracking icon. The Todays Patient Tracking pop-up template opens with the status and location of the patient during the course of the encounter. 2 In the Status field, select Checked out from the picklist. 3 Click Save & Close. Generate Note To create a summary for the patient: 1 Click the Patient Plan button in the Given to Patient/Verified panel. The Patient Plan document generates. 2 After printing the document and giving it to the patient, click Close. 3 Click the Checkout button. The checkout document generates with today's orders. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 101 of 116

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NextGen KBM 8.3 Dermatology User Guide C HAPTER 7 Procedure Template and Skin Cancer History Grid In NextGen KBM 8.3, the Skin Cancer History grid can be accessed on the Dermatology Biopsy Destruction Shave Removal procedure template. The Procedures icon on the SOAP template opens the Ngkbm Udp Procedure Picklist db picklist with a list of procedure templates. If it is commonly used, the procedure template can also be placed in the navigation bar. Using the Procedure Template and Skin Cancer History Grid To use skin cancer history grid: 1 Go to Histories tab. 2 Click Add in the Skin Cancer History Log panel to open the Skin Cancer History Log - Derm template. 3 Select an option for the Treated?. 4 Enter a year in the Year of DX field. 5 Enter data in the Accession field. 6 Click the Diagnosis field to select a diagnosis. 7 Click the Location field to select the location of the problem. 8 Click the Recommended treatment field to select a recommended treatment. 9 Click Save & Close. To use the Excision template: 1 Go to the SOAP tab. 2 Click Procedures and select Excision/Repair. 3 Answer yes to the question Are you performing an excision on a biopsy proven malignancy? 4 The Skin Cancer History grid section will expand. 5 Select the previously entered grid row and note that site details will populate appropriate fields below. 6 Document excision as usual. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 103 of 116

Chapter 7 Procedure Template and Skin Cancer History Grid 7 Select Submit to Procedure Billing. 8 The selected row will be updated with: a) Treated date b) Treated value "Y" c) Performed treatment "Excision" To use the Destruction template: 1 From bottom bar, click on Procedures and select Biopsy/Destruction/Shave Removal. 2 For the Are you performing an excision on a biopsy proven malignancy?, select Yes. 3 Select the appropriate grid row. 4 Document the details of the excision. 5 Select Submit to Procedure Billing. 6 Click Save & Close. 7 Click the Generate Note icon. 8 Select Procedures and then Ok to create the Procedure Note. Page 104 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide C HAPTER 8 Derm Quick HPI The Derm Quick HPI template allows providers to rapidly enter information and add up to six complaints on the HPI grid. Using the Derm Quick HPI To access the Derm Quick HPI: 1 Go to the Intake Template. 2 Select Derm Quick HPI in the Reason for Visit section to launch the Derm Quick HPI template. NOTE: This should only be done by the provider. 3 Complete the General section. 4 Complete the Dermatology Specific section. 5 Document current and previous treatments in the Treatment section. 6 Complete the Additional Information, if applicable. 7 Use the Concern section to update or add a concern to the grid. The Review of Test section displays information about pathology/diagnostic studies, lab orders/results, referrals, and other reports. You can select a test in the grid and click Add to populate information about the test to the Action Details/Notes section. The Derm Quick HPI also includes a Skin Cancer History section. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 105 of 116

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NextGen KBM 8.3 Dermatology User Guide C HAPTER 9 New Codes for Dermatology Assessment The following diagnosis codes have been added to the Dermatology Common Assessment: Suture removal V58.32 Disturbance in Sensation 782.0 The Dermatology Common Assessment can be accessed from the My Plan template. New Codes on Dermatology Common Assessment To access the new codes on the Dermatology Common Assessment: 1 Go to the *Intake template. 2 Select Excision from the left side navigation to launch the Proc Derm Excision pop-up template. 3 Click the Add Common Assessment active text link to open the Common Assessment pop-up template. 4 Click Suture removal active text link select an option from the list, and click Ok. 5 Click Disturbance in sensation active text link, select an option from the list, and click Ok. 6 Both descriptions and codes populate the Today's Assessments grid in the order they are selected. 7 Click Save & Close. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 107 of 116

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NextGen KBM 8.3 Dermatology User Guide C HAPTER 10 Excision Template The Epidermal Sutures picklist on the Excision templates has been updated with the following: 3-0 nylon 4-0 nylon 6-0 nylon Using the Excision Template The Excision template displays a list of valid epidermal excision and suture types. 1 Click Procedures icon on the SOAP tab. 2 Select Excision/Repair and then OK to open the Proc Derm Excision templates: a) The Lesion 1 tab opens the Proc Derm Excision 1 template. b) The Lesion 2 tab opens the Proc Derm Excision 2 template. c) The Lesion 3 tab opens the Proc Derm Excision 3 template. d) The Lesion 4 tab opens the Proc Derm Excision 4 template. 3 Enter data. 4 Select a repair type. 5 Select from the following list of epidermal suture types: 5-0 fast absorbing 6-0 fast absorbing 5-0 poliglecaprone 25 5-0 nylon 3-0 polypropylene 4-0 polypropylene 5-0 polypropylene 6-0 polypropylene skin staples 6 Select Submit to Procedure billing. 7 Click Save & Close. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 109 of 116

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NextGen KBM 8.3 Dermatology User Guide C HAPTER 11 Biopsy Log A new practice template was created that pulls all pathology orders for the provider. This template allows providers to set filters on the grid, result the order, and document patient notification. Using the Biopsy Log To open Biopsy Log: 1 Go to the File menu. 2 Select System\Practice Template. 3 Select the Practice tab. 4 Select Show "All". 5 Select Ngkbm Biopsy Log. In the Pathology Orders Filter section: 1 Select filter from available fields 2 Click the Filter button. In the Pathology Orders section: 1 Select the desired grid row. Data from that row will populate the fields below the grid in Pathology Results section. 2 Complete the following fields: Assession # DX Code PX Code Modifier Additional diagnosis details Recommended treatment Clinical comments 3 If a diagnosis of 172 is selected, the Clark's level and Depth fields will display. 4 Select an option for Lesion has been treated. If Yes is selected, document the treatment date and actual treatment. 5 Select Update Order to update the Skin Cancer History grid if the DX code is a 172 or 173. 6 Select Submit to Superbill to submit the charge for pathology reading. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 111 of 116

Chapter 11 Biopsy Log To document communication, expand the Patient Communication section. To view the patient's skin cancer history, expand the Skin Cancer History section. Save and close the biopsy log. Page 112 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide C HAPTER 12 Mohs Templates The following changes were made in NextGen KBM 8.3 for the Mohs templates: The existing static left navigation bar was replaced with the sliding left navigation bar. The Preview Proc Note button was added, allowing the user to generate a procedure document. The tumor navigation was moved above the Pre-Procedure section. Each section has expand/collapse functionality. The panels will be expanded when the template is opened. Using the Mohs Templates Mohs surgery is only performed on pathology proven lesions. Each patient should have pathology proven skin cancer items in the Skin Cancer History Log. This information is added during the office visit when a biopsy is ordered and during the subsequent chart history encounter when the pathology results are documented and added to the Skin Cancer History Log. To access the Mohs templates: 1 Select a visit type of Mohs Surgery Visit. 2 Go to the Intake tab. 3 Select Mohs Surgery in the Reason for Visit panel to open the Derm Surgical - HPI. 4 Document the patient's information in the HPI. NOTE: This is done by the provider only. 5 Click Save & Close. 6 Click the Procedure tab at the top to open the Derm Proc Mohs 1 template with Tumor 1 selected. 7 Complete the Pre Procedure section. To complete the Site Details panel: 1 To populate the grid with a skin cancer diagnosis, select the Untreated option for Skin cancer history above the Site Details grid or click Add to open the Skin Cancer History Log - Derm popup template. 2 Select the diagnosis in the Site Details grid to populate the fields below the grid. 3 Select the Patient verified site check box. 4 Complete the Mohs # and Path lab fields. 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 113 of 116

Chapter 12 Mohs Templates 5 Post op size fields will be calculated automatically when the Mohs stage information is used. To complete the Mohs panel: 1 Document the following: Site cleansed with Indication Hemostasis Anesthesia 2 To document stages, click on the check box to select the appropriate sage, select findings from the picklist, and then enter the number of bocks or sections using the numeric keypad. To complete the Repair panel: 1 Document the repair details. 2 Click the Generate Text button to generate the repair text. You can also edit and review the repair text if necessary. To complete the Post Procedure panel: 1 Document the post-procedure details. 2 Click the Submit to Procedure Billing button. 3 You can generate the procedure document by clicking the Preview Proc Note button. To finalize the Mohs visit: 1 Click the Finalize tab at the top to open the Finalize - Mohs Procedure template. 2 Enter information in the Medications panel, if necessary. 3 Enter information in the Allergies panel, if necessary. 4 Click Verify Charges in the Procedures Summary panel. 5 To add a modifier to a procedure, double-click on the row for the procedure to launch the Procedure Billing Ext extended pop-up template. 6 Click in the appropriate field to make the modification, then click Save and then click Close. 7 Right-click the procedure row in the grid to highlight it, then click the Submit Code button. Page 114 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013

NextGen KBM 8.3 Dermatology User Guide Index 9 95 Physical Exam Details Panel 103 97 Multi System Physical Exam Details Panel 103 97 Single System Physical Exam Details Panel 103 A Active Text Links (NextGen KBM 8.3 Dermatology) 17 Alerts 22 Allergies 51 Allergies Panel on the Home Page Template 86 B Biopsy Log 121 C Call/Communication Sub-Navigational Link 33 Care Guidelines 26 Checkout Staff Workflow 107 Checkout Template (NextGen KBM 8.3 Dermatology) 107 Communication Panel on the Home Page Template 87 Compose Introduction 88 Configuration and Setup Procedures 11 Create Assessment/Plan (NextGen KBM 8.3 Dermatology) 93 D Demographics Sub-Navigational Link 33 Derm Quick HPI 115 Dermatology Procedure Billing Panel 104 Diagnostic Studies 77 Document Library Sub-Navigational Link 38 Document Revision History 4 Document SOAP (NextGen KBM 8.3 Dermatology) 87 E E & M Level Summary Panel 102 Evaluation and Management Coding Panel 99 Evaluation and Management Guidelines 102 Excision Template 119 F Family History 75 Finalize Tab Sub-Navigational Links (Derm) 97 Finalize Template 97 G General Office Visit Workflow 15 General Panel 47, 98 Generate Note 97, 111 Given to Patient/Verified Panel 110 Global Days 27 H Health Promotion Plan Template 53 Histories Sub-navigational Links (NextGen KBM 8.3 Dermatology) 61 Histories Template 61 History Details 102 History of Present Illness Panel 48 History Review 79 History Summary Panel 70 History Summary Panel on the Home Page Template 86 Home Page - Dermatology Template 31 Home Page - Provider Review 83 Home Page Sub-Navigational Links 32 I Intake Note Generation 79 Intake Note Generation (Intake template) 61 Intake Staff Workflow 31 Intake Sub-navigational Links (NextGen KBM 8.3 Dermatology) 39 Intake Template 39 11/08/2013 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. Page 115 of 116

Index Introduction 9 M Medication Reconciliation for a Patient 49 Medications 49 Medications Panel on the Home Page Template 86 Mohs Templates 123 N New Codes for Dermatology Assessment 117 New Codes on Dermatology Common Assessment 117 O Orders Management Sub-Navigational Link 36 Orders Panel 57 Orders Panel on the Home Page Template 87 P Panel Controls 23 Panels on the Dermatology Home Page Template 83 Patient Information Bar 15 Patient Tracking 80, 83 Patient Tracking - Check Out 111 Physical Exam Panel (NextGen KBM 8.3 Dermatology) 92 Point of Care Tests 59 Problem List Panel 66, 69 Procedure Template and Skin Cancer History Grid 113 Provider Sign Off Panel 99 Provider Test Action Sub-Navigational Link 35 Provider Workflow 83 Q Quality Buttons and CQM Information Pop-up Templates 24 Quick Note 88 R Reason for Visit Configuration 12 Reason for Visit on the SOAP Template (NextGen KBM 8.3 Dermatology) 88 Requirements 9 Review of Systems (NextGen KBM 8.3 Dermatology) 60 Review of Systems on the SOAP Template (NextGen KBM 8.3 Dermatology) 90 Risk Indicators (NextGen KBM 8.3 Dermatology) 38 S Save Quick Note 95 Screening Tools and Document Library 28 Send Tasks 109 Skin Cancer History Log 64 SOAP Link Icons 94 Social History Tobacco Template 71 Sub-Navigational Links 13 T The Joint Commission Standards Configuration 11 Tobacco Cessation Sub-Navigational Link 98 Today's Assessment Panel (NextGen 8.3 KBM Dermatology) 99 Today's Orders Panel 108 U Using the Biopsy Log 121 Using the Derm Quick HPI 115 Using the Excision Template 119 Using the Mohs Templates 123 Using the Procedure Template and Skin Cancer History Grid 113 V Vital Signs on the SOAP Template 92 Vital Signs Panel 52 Vital Signs Panel on the Home Page Template 87 Page 116 of 116 Confidential Proprietary Information For Use By Authorized NextGen Healthcare Clients Only. Do Not Distribute. 11/08/2013