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How To: Create, Edit, Delete, View, Share, Export, Fax and more with your notes

Learn how to create a new note, edit, delete, view, share (and more) existing notes.

Ruhi avatar
Written by Ruhi
Updated over 5 months ago

The Charting feature allows you to electronically take notes on clients in an organized way, using customized templates that also allow for automation like pre-fill and incorporation of intake form answers into charting templates. You are able to easily view an archive of client charts, e-fax them to other healthcare professionals, and it allows us to quickly export information into Super-bills and for easy billing.

Charting notes are private unless shared with a client.


Overview

Our platform enables therapists to:

  • Take notes on clients during or after a session

  • Build customizable templates

  • Share chart notes with other providers via HIPAA-compliant E-fax

  • Optionally share parts or all of a chart note with clients

  • Create group charting notes

  • Ensure that notes auto-save while charting is in progress

  • Notes are tied to a clients user id. If a client creates a new accounts old notes will not automatically transfer over


Create a Chart Note for a Client

To get started with a new client chart note, you can navigate to your client's profile within Ruh Care.

Step 1: Open a New Charting Note

Click the "Charting" tab from the client profile > Click "Create Charting Note"

Step 2: Select Your Charting Template

From the drop-down, select the charting template that you'd like to use for this note. You'll see all of the charting templates that are automatically included in your Ruh provider account, along with any additional custom charting templates that you've created in the Form Builder.

Have your own charting form that you'd like our team to create for you? Email us at [email protected] or message Client Care team with a Word doc or PDF version of your charting template. Our team can build your template for you within your account, this process typically takes 2 weeks.

Step 3: Write Your Note

Beyond the actual content of your chart note, you'll also be able to adjust the:

  • Chart note name (click the pencil icon next to the name)

  • Date of service (click the date to select a new date)

  • Time of service (select a different time from the dropdown)

Within text boxes in your chart, there are additional formatting options available to you, including:

  • Bold, italic, underlined text

  • Adjust text color or background color

  • Hyperlink to an external URL link

  • Add an image or a video (.png or .jpeg for images)

  • Created a bulleted or numbered list

  • Insert a table

There is a green button on the top that will indicate your chart note has been autosaved. Hover over the "autosave" button to see the last time it was shared. You can also click the "Save" button at any time.

Tip: Smart Phrases allow you to create and save standard charting phrases that you can leverage for future charting notes. This allows you to make quick work of charting.


Access Client Information While Charting

During your session with a client, we make it easy for you to have important client information available to you directly in the charting area of the platform. This prevents you from having to leave your chart notes to view this information or opening multiple web browsers.

You can access general information about a client, while charting by clicking on "Quick Profile". This will open up a right-hand-side panel with key information on your client that may be helpful for you to review. You'll find basic client information, created goals, journal entries, and even completed forms in the Quick Profile.

Toggle the Quick Profile on/off while charting.

Additionally, you can reference past-created chart notes while writing your new note.


Save or Lock a Chart Note

When you're done with the chart note, you can take the following actions:

  • Save and Close the note

  • Sign Note

  • Lock Note which will save and lock your note to prevent further edits)

  • Sign and Lock


Post-Charting Workflows to Leverage

You are also able to export Chart Notes directly into a Super-bill for efficient completion of these billing notes, as well as to generate as a PDF version of the note or send it as an e-Fax.

Client Care team is responsible for generating payment and insurance documents like super-bills.

Additionally, therapists can share charting notes with clients, as post-session summaries. You can select specific fields of the charting note to share, and a copy will be added to your client's private documents.

You can also use this sharing option if you'd like to create a PDF or e-fax that only includes specific fields from your charting note.

Quick Tips

  • Keep client details readily available with the Quick Profile feature during charting.

  • Utilize tabs to reference past notes without interrupting your current session.


Edit or Delete a Chart Note

To edit a chart note, navigate to your client's profile > Charting > View Chart Notes. Select the chart note from the left side panel and then click the Edit button.

To delete a note, navigate to your client's profile > Charting > View Chart Notes. Select the chart note from the left side panel and then click More on the top-right (next to Edit) and choose "Delete Charting Note" from the options. Once this action has been performed, your deleted chart note cannot be recovered.


View Past Chart Notes

You can view an archive of your previous chart notes by navigating to the charting section of your client profile and clicking "View Chart Notes." You'll also see a "Provider" tab if you'd like to filter by Provider when viewing a specific note.

This view will allow you to see all past chart notes written for your particular client. You can filter charting notes to locate a specific note, based on the filter options:

Charting Note Type

  • All Types

  • Charting Notes

  • Intake Forms

  • Program Forms

Chart Note Status

  • All Statuses

  • Signed

  • Unsigned

  • Locked

  • Unlocked


View Multiple Chart Notes at Once

You also have the ability to have multiple charting tabs open simultaneously within the same charting session. This will allow you to toggle between different notes or intake forms (ie. a new chart note and past notes) for more efficient charting and workflows. You can open a new charting tab whether you are currently writing a new note or previewing a note.


Export a Chart Note

Once you are done writing a chart note, there are several next steps you may want to take as part of your workflow. You can access these features in two ways:

  1. Directly within the active charting area (click the More option on the top right)

  2. Review your note by going to the "Charting" section of your client profile > View Charting Notes > More

Export as a PDF

You may want to save a copy of your charting note (or several charting notes) to provide to your client at their request, or to communicate with other care team members.


E-Fax a Chart Note

Once you are done writing a chart note, there are several next steps you may want to take as part of your workflow, including connecting and sharing your chart note via E-Fax. You can find the "E-Fax" option in two ways:

  1. Directly within the active charting area (click the "More" option on the top right")

  2. Review your note by going to the "Charting" section of your client profile > View Charting Notes > "More"

On the page where you can view all past charting notes, pressing the "Send Fax" button will enable you to select multiple notes to include in a single fax:


Download a Summary of Your Client Chart

There may be several reasons that you are looking to export or transfer client information from the platform.

If you'd like to download (and share) a complete record of your client's chart notes and intake forms, you have the option to do so within charting.


Share a Chart Note with a Client

You are also able to share a charting note’s content with your client, include the whole note, or specific sections of a note, and have that content added as a PDF in the client’s Documents within your Ruh Care account.

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