The doctor

All manuals

For KlinikFlow 3.0.0. Each manual is checked against the app itself.

Who this is for

This manual is for doctors who see patients in a clinic or nursing home that uses KlinikFlow and who sign in with the ready-made Doctor role. It covers the day at the desk — the queue, the consultation, prescriptions, certificates and results — and, where the clinic has wards, everything a doctor does for a patient in a bed: asking for a bed, the stay, the chart, the medicine chart, consents and the discharge summary. Each section says which screen to open and which button to press, using the words on the screen. Where something is the nurse's or the desk's job, the manual says so. If your clinic has given you a role of its own instead of the ready-made one, you may see more or less than is described here.

Contents

1. What the Doctor role can reach
2. Your desk and your queue
3. The consultation
4. Printing the prescription
5. Certificates and the letter to a referring doctor
6. Results — lab and radiology
7. Sending a patient on
8. Casualty
9. Moving a patient to the ward
10. The ward map
11. The stay page
12. Fit to go, and the five ways to leave
13. Medico-legal cases (MLC)
14. The patient's chart — vitals and NEWS2
15. The medicine chart — ordering medicines
16. The round
17. Consents
18. The discharge summary
19. The stay's bill — doctor's visits and other charges
20. Your reports and your own figures
21. Who does what — doctor, nurse, desk
22. When a patient dies — the cause of death
23. The theatre
24. The labour room

1. What the Doctor role can reach

Your sidebar shows:

• My queue — your desk (section 2).
• Ward — only if the clinic has at least one ward set up.
• Casualty
• Patients — the patient directory and each patient's record.
• Lab results
• Prescriptions — today's patients, to print a prescription again.
• Reports — your own patients' registers.

The search box at the top of every screen finds a patient by name, phone, patient number or today's token. Press / to jump to it.

The ready-made Doctor role can:

• see patients, consult, prescribe and order work;
• issue certificates, and cancel your own;
• record vitals;
• work in casualty;
• work on the ward: admit, move bed, change doctor, discharge, add charges and consents;
• order a stay's medicines, set how often vitals are taken, and write and sign the discharge summary — only doctors can do these;
• see your own figures and, if you are a visiting consultant, your own payout statement.

It cannot take payments, give discounts or refunds (you can only suggest a discount), dispense medicines, or work the lab and radiology queues.

2. Your desk and your queue

My queue opens on your desk. It shows only your own patients, never the whole clinic's, and it updates by itself when the desk issues a token or the lab finishes a test.

What is on the desk:

• Seen today, Waiting and Results in — counts at the top.
• My patients in beds — appears when the clinic has wards and you are the doctor in charge of someone in a bed. Each line shows the bed, the ward and the day of the stay, with MLC and going home chips where they apply. Click a line to open the stay.
• My queue — today's patients with token, name, reason, status and how long they have waited.
• Results just in and Sent for tests.
• With the nurse — patients waiting for vitals (see below).
• Health checks — health-check reviews waiting for their results. A review joins the queue once every result is back.

How to see the next patient

1. Open My queue.
2. Find the patient in the My queue table. Casualty patients are always listed first; everyone else is in the order they arrived.
3. Click Call in. The clinic's token display is told, and the consultation opens.

How to read the queue's chips

• Awaiting payment · ₹… — the patient still owes money at the desk. You get View instead of Call in. Only the desk can clear this.
• vitals not recorded — the patient came straight through, usually from casualty, before any vitals were taken.
• registered, waiting, with doctor, in service — the status of the visit.

How to take vitals yourself when no nurse is free

A patient normally reaches your queue only after the nurse records their vitals. Until then they are listed under With the nurse.

1. In With the nurse, click Record vitals beside the patient.
2. The form opens filled in with the clinic's normal values. Change what you measured: Systolic, Diastolic, Pulse, Temp °F, SpO₂ %.
3. Click Record and call in. The vitals are saved under your name and the patient moves onto your queue.

Good to know: Casualty patients, and anyone you have already started seeing, are never held back for vitals.

3. The consultation

The consultation screen has three columns:

• left — who the patient is;
• middle — what you write now;
• right — what you order.

Nothing on it makes you leave the page.

What you see about the patient (left column)

• Name, age, sex and blood group, with an Allergy chip and their chronic conditions.
• Last visit and the number of Visits.
• Vitals (nurse entered) — BP, pulse, temperature and SpO₂, or "Not recorded yet".
• Recent results — each with Report, or Film for an X-ray or scan not yet reported. These open the report viewer.
• History (top right) opens the patient's full record.

How to write the notes

1. Under Consultation notes, fill in: - Complaint - Examination - Diagnosis, with its ICD code in the box beside it (for example E03.9) - Advice
2. To set the review date, either pick a date in Review on, or tap one of 1 week, 2 weeks, 1 month, 6 weeks or 3 months. None clears it. The date prints on the prescription, and reception sees the follow-up fall due.
3. The Previously card lists past diagnoses and past medicines. Tap a medicine to add it to today's prescription at the dose last given. You can edit it after.

How to write the prescription

1. In the Prescription card, click ＋ Add drug for each medicine.
2. Fill in each line: - Drug - Dose - Frequency — in the 1-0-1 pattern - Days - When — pick After food, Before food, Empty stomach, At bedtime, With milk or If needed (SOS) from the list, or type your own.
3. Click ✕ to remove a line.
4. To use a saved set of medicines, tests and advice, click Templates ▾ and then Apply. - Applying a template adds to what you have written. It never replaces it. - You still have to save the consultation. - In the same dialog you can Star, Share, Delete or Copy to mine.
5. To keep today's medicines, tests and advice as a template, click Save as template and give it a Name.

Good to know: The patient's-language line is printed for the parts that are fixed phrases: the 1-0-1 timing, the When choice and the number of days. Anything you type freely prints only as you wrote it. It is never machine-translated. The languages are Tamil, Telugu, Kannada, Hindi and Malayalam.

How to order tests and procedures done here

1. In Add services & lab, search, or switch between the Lab tests and Procedures chips.
2. Click ＋ beside an item. It appears under Ordering now with its price. Change the quantity if needed.
3. Patient pays shows the total, so you can tell the patient the cost.
4. To suggest a discount, type the amount in Suggest a discount ₹ and say why. The desk sees it filled in and decides. You do not handle money.
5. Click Save & send to billing at the top.

Good to know: For an outpatient, the lab and the nurse do not see the order until the desk has been paid. For a casualty patient or a patient in a bed, work starts at once and the bill is settled later.

How to advise tests done elsewhere

1. In Advise elsewhere, type what you advise, such as an MRI or a biopsy, and click Add. Or tap one of the clinic's listed outside tests.
2. Each line is marked Not billed. It prints on the prescription under Advised outside. Nothing is charged or queued.

How to finish

• Save keeps your notes and the patient stays on your queue.
• Print & close saves, takes the patient off your queue and opens the prescription ready to print. Closing a consultation is not a discharge: ordered work and anything owed are untouched.

4. Printing the prescription

1. Click Print & close on the consultation, or Preview & print in the Prescription card. To print one again later, open Prescriptions and click Print beside the patient.
2. Under Page, choose: - the Letterhead — the one chosen for prescriptions under Settings → Letterhead is already selected (the owner's manual lists which document prints on which); - the Patient's language — the language on the patient's record is selected, or choose English only; - whether to tick Include diagnosis, Include vitals, Include ordered tests and Include outside advice.
3. Check the Preview. Your name, qualifications and council registration come from your own profile.
4. Click Print. KlinikFlow's print dialog opens with the printer already chosen, or you can download the PDF.
5. To keep a copy on the patient's record, click Save as PDF to patient record. Each save is numbered as a new copy.

Good to know: The saved PDF copy is in English only. The line in the patient's language prints from this screen.

5. Certificates and the letter to a referring doctor

How to issue a certificate

1. On the consultation, in the Certificates card, click New certificate.
2. Choose the kind: - Medical leave — fill in Diagnosis, Rest from and Until. - Fitness to resume — fill in Diagnosis and Fit to resume from. - Fitness for an activity — fill in Activity. - Letter to the referring doctor — see below.
3. Add Remarks if needed.
4. Read As it will read, which uses the clinic's own wording. If anything is missing, it says so there.
5. Click Issue & print. The certificate gets its number and opens ready to Print.

How to write back to a referring doctor

Choose Letter to the referring doctor. It is addressed to the doctor recorded as the referrer when the patient was registered, and it gives your findings from the Diagnosis box.

How to correct a certificate

An issued certificate cannot be edited.

1. Open it, from the Certificates card on the visit.
2. Click Cancel certificate, type a Reason, and confirm.
3. Issue a new one.

The cancelled number stays in the register, marked cancelled, and still prints that way. You can cancel only your own certificates, unless your role allows cancelling anyone's.

6. Results — lab and radiology

• Results just in on your desk shows the newest results.
• Lab results in the sidebar lists every result for your patients, newest first. Tap Out of range to see only the abnormal ones.
• Click Report to open the report viewer. For an X-ray or scan, the button is Film until it is reported, then Report.
• The viewer can Print, send by WhatsApp and Download.
• For images it can also zoom (−, Fit, +), change Brightness, Invert, go ⤢ Full screen or open in ⧉ Own window.
• A CBC read from a haematology analyser shows the machine's WBC, RBC and PLT histograms under its values, as on the printed report — unless the lab keeps them off.
• Under the report, Images — as the machine made them shows the machine's own DICOM: an X-ray with Brightness and Contrast made from the original's full grey levels, an ultrasound or echo loop with ▶ Play and a frame slider. They are for reference — the diagnosis is made on the machine or a DICOM viewer. Download the originals gives the files exactly as the machine made them, for a second opinion or a referral.
• A result or image marked MOCK came from a mock device or a sample, for trying KlinikFlow. It is not a patient's and is never sent to them.
• Click Patient to open the patient's record.
• The patient's record also shows reports in its Timeline, and a Trend card for repeated tests.

Good to know: A lab value past a panic limit is not released until the lab records that it told the doctor, and who was told. Expect a phone call.

7. Sending a patient on

• To a colleague in this clinic. On the consultation, choose the colleague in Send on to a colleague here and save. These hand-offs are counted for the owner's report on where patients come from.
• To a test or specialist outside. Use Advise elsewhere (section 3).
• A letter back to the doctor who referred the patient to you. Use the Letter to the referring doctor certificate (section 5).
• Out of the nursing home to another hospital. This is a way of leaving a stay — Referred (section 12) — with a Referred discharge summary (section 18).

Good to know: KlinikFlow does not work out referral commissions on any screen.

8. Casualty

Casualty is shared by the doctor and the nurse working the case.

How to work a case

1. Open Casualty. Patients the desk has registered are under Just arrived. Click Start case sheet.
2. Choose the Case type and fill in Brought by.
3. On the Case sheet, fill in On arrival and Treatment given. Click Save sheet as you go.
4. Add charges as you go, in Add a charge and the Running bill. Treatment is never held up for payment; the bill is settled when the case closes.

Medico-legal cases

Road traffic accident, Poisoning, Assault and Burns are medico-legal.

1. Fill in Police station intimated and Intimation no.
2. Click Record intimation now.

The case cannot be closed until this is done. The sheet locks when the case is closed.

How to finish a case

• Close case & send bill — the patient goes home and the bill goes to reception.
• Admitted — ask for a bed — the patient goes on the ward's waiting list. You can first choose a ward in the box beside the button, or leave Any ward.
• The MLC details move onto the stay.
• By default, the casualty bill moves onto the stay's bill too. A clinic can choose instead to settle casualty separately.
• Print case sheet prints the sheet, open or closed.

9. Moving a patient to the ward

A doctor decides to admit. The desk, or the ward staff, then gives the bed. These steps appear only where the clinic has wards.

How to ask for a bed from the consultation

1. On the consultation, find the Admit card in the right column. It appears only for an outpatient visit.
2. Click Admit this patient….
3. In Ward, choose a ward (each shows its free beds), or Wherever there is a bed.
4. In Why, give the reason. Your diagnosis is filled in already.
5. Click Ask for a bed. The card then says the patient is waiting for a bed and that the stay will open under you.

What happens next

1. The patient appears under Waiting for a bed on the Ward screen and on the Admit screen, labelled "from the doctor's room" with your name.
2. The desk or the ward clicks Give a bed. They choose the bed, confirm you as the doctor in charge (Under), and fill in Who to call with a relation and phone number. They also fill in who pays, any package, and the estimate given to the family.
3. On Admit, the stay gets its own admission number (IP-year-number). - The admission form and a wristband can be printed. - The patient appears in My patients in beds on your desk. - From now on, work ordered for them starts at once and goes on the stay's running bill. Nothing waits for payment.
4. A request can be taken off the list with Not now on the Admit screen.

Your role also holds the ward permission, so you can give the bed yourself: Ward → Give a bed. To admit someone directly, open their record and click Admit. The Admit screen can also hold a bed for a planned admission (Planned · on a date, then Hold the bed).

How to admit from casualty

1. On the open case, click Admitted — ask for a bed. Before that, record the police intimation if it is a medico-legal case.
2. The patient waits on the ward's list "from casualty", and the bed is given as above.
3. The MLC details come across onto the stay as casualty recorded them, and cannot be removed there.

Good to know: When a bed is chosen in a ward meant for the other sex, the Admit screen warns, and the admission needs Admit anyway.

10. The ward map

Open Ward. If you have patients in beds, it opens on Mine. The chips across the top switch to All wards or to one ward.

Each bed tile shows the bed label and its state:

Chips on a bed in use:

• NEWS2 with the latest score;
• MLC;
• going home — after you say fit to go;
• new today.

The right-hand side shows:

• Doses due across the ward
• Waiting for a bed
• Today — came in, going home, held for later, free now
• Last night's count — patients in beds at midnight

Alerts escalated to you

When a high alert on one of your patients — an early-warning score of 7 or more, a reading in the red — is not taken by a nurse in five minutes, it comes to you (and to the ward's nurse in charge): the header shows it, and the list says the bed, what, and who else was told. I'm on it takes it. It is a second line beside the monitor's own alarm (plate 80b).

11. The stay page

Click a bed to open the stay. A line in My patients in beds on your desk opens the patient's Rounds tab, ready for your round. The title shows the patient's name and admission number. Under it are age and sex, bed, day of stay, consultant, and when and from where they were admitted.

The tabs

The Who to call card shows the attendant and their phone, who pays, and the patient's allergies.

Good to know: Nothing on The stay is edited or deleted. Every action — moving bed, changing doctor, a second opinion, fit to go, an order for vitals, a medicine started or stopped, a consent made, the summary signed, leaving — adds a new line with the time and who did it.

How to move a patient to another bed

1. Click Move bed at the top.
2. Choose the new bed under To. Only free beds are offered.
3. Leave At blank for now, or give the time it happened. The time cannot be before the admission or in the future.
4. Give a reason under Why, and click Move.

From then on, the day's charge follows the new bed. The old bed goes to be cleaned.

How to change the doctor in charge

1. Click Change doctor.
2. Choose the Doctor, say Why, and click Save.

The new doctor is in charge from now. The doctor before stays recorded in the stay.

How to record a second opinion

1. On The stay tab, click Also seen by….
2. Choose the Doctor, write Their opinion, and click Save.

It becomes a line in the stay.

Other buttons

• Admission form opens the printed form, with Wristband and Print.
• Print interim bill prints the account so far.

12. Fit to go, and the five ways to leave

How to say a patient is fit to go home

1. On The stay tab, in the Going home card, type a note under Fit to go home — a note if you wish (for example "Review in 2 weeks").
2. Click Fit to go.

The bed shows going home on the ward map, and the patient is listed under Going home for the day.

Only a doctor can say fit to go. This is also the moment to start the discharge summary (section 18).

How a patient leaves

Anyone who works the ward can discharge, including you. In the Going home card:

1. Under How the patient leaves, choose one of: - Home - Against advice — fill in Why, in their words. Click Print the form to sign so the patient or attendant signs the against-advice form before they go. - Referred — fill in Referred to (required). - Left without telling — the patient absconded. - Died — fill in Cause of death (required). Give the time in Leaving at.
2. Leave Leaving at blank for now, or give the time it happened.
3. Check Before the patient leaves: - Doctor says fit to go — needed only for Home. - Police told of the discharge — needed for a medico-legal stay, whatever the way of leaving (section 13). - Discharge summary signed, or not signed yet. - Bill settled, Bill not settled yet, or ₹… left due.
4. Click Discharge. While something required is missing, the button reads Discharge — n things left and cannot be pressed.

The bed goes to be cleaned, and the Left card records how and when.

Good to know:

• Against advice, referred, left without telling and died do not wait for "fit to go".
• The bill and the discharge summary are shown on the checklist as facts. Neither ever stops a patient leaving: nobody is kept in a bed for paperwork or money.
• Cancel admission is only for an admission made by mistake. It needs a reason, and it is refused once any work has been ordered or money taken; such a stay is discharged instead. The number stays in the register, marked cancelled.

13. Medico-legal cases (MLC)

• A stay admitted from a medico-legal casualty case carries the MLC chip on the stay, the ward map and your desk. It also carries the police station, MLC number and time of intimation from casualty.
• Before the patient leaves in any way, the checklist asks for Police told of the discharge. Someone who works the ward clicks Told them once the police have been informed. The time is recorded in the stay.
• The casualty case sheet stays locked after closing, and prints from Casualty → Print case sheet.

14. The patient's chart — vitals and NEWS2

Open the stay and click Chart. Nurses write the chart through the day; you read it on your round.

What it shows:

• Vitals since admission: a graph of pulse, BP, temperature, SpO₂ and breathing rate, and a table of every set. The columns are BP, Pulse, Temp, SpO₂, RR, AVPU, O₂ and Score, with who took each set.
• 24 hours, 3 days or Whole stay chooses how much of the stay the graph and the table show. A stay of three days or less opens on the whole stay; a longer one on the last three days.
• Before admission: what casualty or the OPD took on the visit the patient was admitted from, and on any other visit of theirs in the 48 hours before, is shown hatched to the left of the Admitted line and marked Casualty · before admission or OPD · before admission in the table. It counts for nothing on the ward: not when the next vitals are due, not the bed's score on the ward map.
• Print vitals chart prints what is on screen — the range chosen — on the clinic's letterhead, through the print dialog: the graph, every set with its score and who took it, the NEWS2 key, and who printed it and when. For the file, a referral or the insurer. Each print is in the record-access log.
• Nursing notes by shift, each signed by whoever wrote it. The nurse manual covers how they are written.
• Intake and output for the chart day, 8 AM to 8 AM, by shift, with the day's Balance.

What the score means

Each set of vitals gets an early-warning score, NEWS2. It is worked out from seven readings: breathing rate, SpO₂, oxygen, systolic BP, pulse, consciousness (AVPU) and temperature.

• The score is in the Score column, and as NEWS2 n on the bed tile.
• A score with + (for example 3+) means a reading the score needs was not taken, so the real score may be higher.
• At 5 or more, or when any one reading is in the red (scores 3 on its own), the chart shows the red banner "Early-warning score n … — tell the doctor." The bed turns red on the ward map, and the score is marked · doctor.

Good to know: The score prompts a look. It does not diagnose, and the nurse and the doctor decide. KlinikFlow uses NEWS2's SpO₂ scale 1 only; scale 2, for patients with a lower target saturation, is not offered.

How to set how often vitals are taken

Only doctors can do this.

1. On the Chart, below the vitals table, find Vitals with a drop-down.
2. Choose every 1, 2, 4, 6, 8, 12 or 24 hours, or as the score says.

The order is written in the stay. The next set is due by your order or by the score, whichever is sooner. The chart shows Next due … with "as the doctor set" or "as the score asks", and turns red with — overdue when it passes.

You can also click Take vitals on the chart yourself.

15. The medicine chart — ordering medicines

Open the stay and click Medicines. The doctor orders, changes and stops medicines; the nurse marks each dose. The patient's allergies are shown in a warning at the top, and again when you order.

How to order a medicine

1. Click Order a medicine.
2. Medicine · from the shelf or typed — pick from the pharmacy's names or type one. Then fill in Dose, and How it is given: - Oral, IV, IM, SC, Sublingual, Inhaled - On the skin, Rectal, Nasal, Eye drops, Ear drops, Other
3. Choose the kind: - At set times — tap one of the usual rounds, or remove times with ✕ and add your own with Add time:
   • Once a day — 8 AM
   • Twice a day — 6 AM, 6 PM
   • Three times a day — 6 AM, 2 PM, 10 PM
   • Four times a day — 6 AM, 12 PM, 6 PM, 12 AM
   • When needed — fill in Given when (for example "temp > 100.4 °F") and At most a day (0 to 24). Leave 0 for no daily limit.
   • Once — a single dose.
4. Fill in the rest: - For how many days — 1 to 90, or 0 until stopped. Not used for Once. - Rate, for an infusion — for example "80 ml/hour". - Starts — blank is now. Otherwise a time during the stay, not more than a week ahead. - Instructions
5. Click Order.

How to change a medicine

1. Click Change under the medicine. This is available on today's chart only.
2. Edit the order and click Change it.

The change is a new order, and it stops the old one from when the new one starts. The old order stays on the chart, struck through.

How to stop a medicine

1. Click Stop.
2. Give a reason under Why if you wish, then click Stop.

It stops now and stays on the chart, struck through, with who stopped it and why.

What the nurse sees

• Each scheduled dose is a cell under its time:
• ○ — not due yet;
• Give — due, from an hour before its time;
• Late · give — from half an hour after its time;
• not given — the day ended with nothing marked.
• A marked dose shows ✓, held or refused, with the nurse's name and their reason.
• When-needed and once medicines are in the When needed · once column. A when-needed medicine shows "n of max today".
• Doses due across the ward lists every dose due or late in every bed, most overdue first.

Good to know:

• A stopped medicine cannot be given, a dose cannot be marked twice or before it is due, and a when-needed medicine stops at its daily limit — the nurse is told to ask the doctor.
• Marked doses stay on the chart whatever happens to the order afterwards.
• The medicine chart records giving only. Stock moves when the pharmacy issues medicines to the stay.
• Use ‹ and › to look at earlier days. Medicines stopped or finished before the day you are looking at are listed under Stopped or finished before ….

16. The round

The round is your note at the bedside — how the patient is, and the plan — and the orders that follow from it, made in one go. Open the stay and click Rounds, or click the patient in My patients in beds on your desk. Only doctors write rounds; the ward and the doctors read them.

How to write today's round

1. Check Vitals at the top: the last 24 hours as a small graph, the latest set with its early-warning score, and the day's highest score with the readings that raised it. The whole chart → opens the Chart.
2. Choose My round, or Second opinion if you are seeing the patient for the consultant in charge.
3. Write How the patient is and the Plan. One of the two is needed.
4. Add the orders that follow from it, under Orders from this round: - Stop: click a medicine on the chart to stop it (it turns red with ✕). Click again to keep it. - Start: click + A medicine and fill the same form as the medicine chart's Order a medicine; click Add to the round. Click a medicine you added to take it off. - Tests: type a lab test, a scan or a procedure from the rate card (for example "CBC") and press Enter. Click one to take it off. - Vitals: choose how often vitals are taken from now, or leave as they are. - Charge this round as a visit: tick it for a visiting consultant whose rounds are charged; the visit goes on the stay's bill at your inpatient fee, as + Doctor's visit does on the bill.
5. Click Save round. The button says how many orders it will make.

Each order is made where it belongs, as if made there: a stopped or started medicine on the Medicines tab (a stopped one says "on the round"), a test on the stay's Orders for the lab or the nurse — it starts at once, as everything for a patient in a bed does — and the vitals interval on the Chart. The round lists what it ordered.

Good to know: a round is all or nothing. If one order would be refused — a medicine with no times, a test that is not on the rate card, a visit charge when the clinic has not set one up under Settings → Wards — nothing is made and nothing is saved; fix it and save again.

Rounds so far

Every round is kept as written, newest first, with who wrote it, when, and what it ordered. Nothing is edited: a change of plan is the next round. The latest round is the first thing the nurse sees on the Chart.

This is also the way to order a test for a patient already in a bed: write it on the round.

17. Consents

Open the stay and click Consents. The desk, the ward and doctors can all make consents. You are the one who explains the procedure and its risks to the patient.

• Consents for this stay lists each consent as Signed, Owed or Void.
• The general consent to admission is first. It is printed on the admission form.
• Leaving against advice is kept here too, once its form is printed.

How to make a consent

1. Under New consent, choose the Kind: - Consent to a procedure or surgery - Consent to anaesthesia - Consent to blood transfusion - High-risk consent - Refusal of treatment
2. Language: English, or English and the patient's language when their record has one. The other language prints only if the clinic has written its own wording for that kind; otherwise it prints in English alone.
3. What, and its risks — write what is to be done and its risks, in plain words. It is filled into the clinic's wording.
4. Doctor explaining — choose yourself, or the doctor who will explain.
5. Signed by — The patient, or A relative, for the patient. For a relative, fill in their name and Relation, and why the patient is not signing.
6. Click Make it and print to sign. The print dialog opens.

Once the patient or relative has signed in front of a witness, the signed page is photographed or scanned back with Add the signed page. The nurse manual describes this. A consent made by mistake is set aside with Void and a reason; it stays on the list.

18. The discharge summary

Open the stay and click Summary, or open the Summary tab from any page of the stay. Only doctors can write and sign it. Everyone who sees the ward can read and print it.

When to write it

1. Start it when the patient is close to going home — the day you say Fit to go is the natural time. Open Summary, check what is filled in, and click Save draft.
2. Sign it before the patient leaves, so they take it home.
3. It never blocks the discharge. The going-home checklist reminds everyone with Discharge summary not signed yet, but the ward can still discharge.
4. For a patient who leaves another way, the summary is still written: - choose Against medical advice, Referred or Death summary as its Kind; - if you first open the summary after the patient has left, the kind is already chosen from how they left, with the referral or cause of death filled in.
5. A correction after signing makes a new version (see below).

How it is filled from the stay

The first time you open it, the summary is filled from the stay for you to keep or trim:

• Diagnosis on admission — the reason given at admission.
• Diagnosis, ICD-10, Complaints and findings and Advice — from the stay's consultation notes, if any were written.
• Investigations — every lab result released during the stay, with its values and any high or low flags, and every reported scan's impression.
• Treatment given — each medicine actually given on the medicine chart, how often and how many doses. If the chart was not kept, it uses what the pharmacy issued to the stay.
• Procedures — procedures completed during the stay.

Good to know: The filling happens once, when the summary is first opened. After you save a draft, results or doses that come later are not added by themselves. Add them by hand before you sign.

How to write and sign it

1. Check or fill in each field: - Kind: Discharge, Against medical advice, Referred or Death summary - Condition at discharge - Diagnosis on admission - Diagnosis and ICD-10 - Referred to (for a referral), or Cause of death and Date and time of death - Complaints and findings - Course in hospital - Investigations, Treatment given, Procedures
2. Under Medicines to take at home, add lines with ＋ Add drug exactly as on a prescription: Drug, Dose, Frequency (1-0-1), Days, When. They print in English and in the patient's language, the same way a prescription does.
3. Fill in Advice, and Come back on for the return date.
4. Click Save draft whenever you stop. As it prints shows the page on the letterhead chosen for discharge summaries, marked DRAFT — not yet signed.
5. Click Sign, then Sign again in the dialog.

What happens when you sign:

• the summary prints with your name and registration;
• Come back on becomes the patient's follow-up, on the follow-ups list the desk works from;
• a line "… signed" is written in the stay;
• the Summary tab shows · signed, and the checklist shows Discharge summary signed.

A summary cannot be signed without:

• a Diagnosis;
• a Condition at discharge — except a death summary;
• for a referral, Referred to;
• for a death summary, Cause of death.

How to correct a signed summary

1. Click Correct it · a new version. A new draft opens from the signed one.
2. Make the change, and Sign it.

The earlier version is kept, marked replaced, and still prints with REPLACED BY A LATER VERSION. Every version is listed under Versions, and each signed or replaced one has its own Print.

How to print it

Click Print at the top of the Summary page. The print dialog prints it on the letterhead as a real PDF. A draft prints marked as a draft.

19. The stay's bill — doctor's visits and other charges

Open the stay and click Bill. Running bill by day shows everything charged, day by day:

• bed and nursing, posted each midnight;
• each queue's work;
• medicines issued by the pharmacy, and anything returned;
• anything casualty did before the bed.

You can add charges. Only the desk takes money.

How to add a doctor's visit

1. Click + Doctor's visit.
2. Choose who it was Seen by, and click Add the visit.

It is charged at that doctor's own fee for a visit to a patient in a bed, and paid to that doctor.

How to add another charge

1. Click + Other charge.
2. Search the rate card, pick the item and give How many.
3. Click Add.

Bed-days post by themselves, and medicines come from the pharmacy. For a patient in a bed, work that goes to the lab or the nurse starts at once. To order a test with your reasons for it, write it on the round instead (section 16).

The estimate

Estimate at admission shows what the family was told. Use Give one or Revise when the plan changes, and tell the family. Each change is written on the stay. The bill is flagged when charges pass the estimate, and again when they are well past it.

20. Your reports and your own figures

Reports

Reports in the sidebar, on the The day tab, lists the reports you can read. For a doctor these are the OP Register and Follow-ups, for Your patients only and without money.

1. Choose a period: Today, Yesterday, This week, This month, Last month, Last quarter, or From – to.
2. Click View to open a report on screen. You can search, sort, and open the patient a row is about.
3. Or download it as PDF, Excel or CSV, or Print it.

The day's file gives every report you may read as one file. Every report opened or downloaded is written in the clinic's access log.

Your own figures

On your desk, under the counts, a line shows your last 30 days:

• sessions held of those planned;
• patients, and how many were new;
• how full your sessions were;
• the median wait;
• how many booked patients did not come.

If you are a visiting consultant paid by statement, a Your share tile shows what you have earned in the current statement, and whether it is paid.

21. Who does what — doctor, nurse, desk

Good to know: Your role technically lets you mark doses and write nursing entries, because it holds the ward permission. In most clinics those are the nurse's, and the chart shows who wrote each entry.

22. When a patient dies — the cause of death

When a stay is left as Died, its Left card offers Cause of death · Forms 2 and 4. A death in casualty is in Reports → Death register.

1. Write the chain as the certificate asks: I (a) the immediate cause, (b) what led to it, (c) the underlying cause — each with how long before death — and II other significant conditions.
2. Choose the manner of death. Give the underlying cause's ICD-10 code; KlinikFlow suggests one from your words — check it before taking it.
3. For a woman, say whether she was pregnant or delivered within six weeks. For a medico-legal death, tick Sent for post-mortem if she or he was.
4. Save draft to come back to it, or Sign the certificate. Once signed it is not changed.

The desk prints Forms 2 and 4 and gives them to the registrar.

23. The theatre

Where the nursing home has a theatre, Theatre in your sidebar is each theatre's list. Book a case from the patient's stay — the procedure, you as surgeon, the anaesthesia and anaesthetist, the time — and see where each patient has got to. As anaesthetist, tick the pre-anaesthetic check with the ASA grade. A patient goes in once the consents and the check are done; in an emergency, write your reason and take them in.

The case's page

Once the patient is in theatre, open The case's page.

• Anaesthesia (the anaesthetist): the ASA grade, airway, technique, the knife time; Readings every five minutes; Drugs and fluids, each with its time. A narcotic chosen from the shelf goes in the narcotics register — any waste needs a second person's PIN. At the end, the Aldrete score and the time handed to the ward.
• Notes (the surgeon): the procedure as done, findings, steps, implants with their lot numbers, specimens, blood loss, drains and post-op instructions; Save notes. Once the nurse has confirmed the counts, Sign the notes. Signed notes are not changed; add an addendum.
• Post-op orders take you to the stay's medicine chart. Print is the operation record for the file.

24. The labour room

Where the nursing home has a labour ward, Labour room in your sidebar lists each woman in labour. Her page has the partograph plotted as the nurses enter readings, against the alert and action lines; her pregnancy at admission; and what needs you — a line crossed, the fetal heart out of range, meconium, a high BP — which also reaches you through the ward's alerts. Print the partograph for the file.