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Document Modes

Less than 1 minute

  1. Read-Only Mode
    Displays in pages, used for medical record review, not editable;

  2. Form Mode
    Displays as a full page, used by outpatient doctors to fill in outpatient medical records, inpatient doctors to fill in inpatient medical records, and inpatient nurses to fill in nursing records;

  3. Design Mode
    Displays as a full page, used by HIT implementation personnel, medical institution IT staff, or department managers to maintain medical record templates;

Knowledge Base

  • The knowledge base contains commonly used medical record input items, helping doctors standardize and quickly complete natural language medical record writing. It is mainly used for inputs like 【Chief Complaint】, 【Signs】, 【Symptoms】, 【Medical History】, and 【Course of Disease】;
  • Double-click to automatically bring up the option list from the knowledge base, with the first line being the default option value;
  • Signs and symptoms do not have default identifiers and are usually passed into the document as a structured dataset for the entire paragraph;

Revision

  • Can be enabled in Form Mode
  • When modifying the content of input fields, changes are displayed with tracking

Annotations

  • Can be enabled in Form Mode
  • Right-click to select document content and add annotations
  • Directly input text in the annotation box to modify annotations

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