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Clinical Documentation

Instructions for Utilizing the Clinical Documentation Request Form

  1. Complete the Clinical Documentation Request form PDF Icon (117 KB) to request new OR modifications to existing:

    • CRIS documentation templates/flowsheets
    • Clinical Data Viewers (CDV)
    • Clinical Summary Views
    • NoteCetera tokens
  2. If requesting a new documentation template, it may be useful to review existing templates in CRIS in order to understand applicable functionality.  Additionally, if an existing template in CRIS has sections which you desire in your template, identify those on your request form as that may make the design process easier.

  3. PRIOR TO SUBMISSION, ensure the request is reviewed with appropriate members of the care team who will be utilizing the template to obtain feedback and consensus from the entire team. This will assist in the template build and testing phases in order to minimize changes in the future.

  4. Be sure to attach a draft hardcopy format of the template you would like designed in CRIS to your request form.

  5. Submit your request to CC-ClinDocReviewBoard@mail.nih.gov.

  6. Once submitted, the form will be reviewed by members of HIMD and DCRI (Clinical Documentation Control Board) and you will be contacted to schedule a meeting to discuss your request. Meetings are generally scheduled with 1-2 weeks of form submission. During that meeting, next steps in the process will be reviewed and a rough approximate of time needed to complete the request will be provided. Often times, the timeline changes depending on the complexity of the request.

  7. The Clinical Documentation Control Board will determine if any approvals are necessary from another group in the organization and work with you through that approval process as necessary.

If you have any questions, please send to: CC-ClinDocReviewBoard@mail.nih.gov.

Notes:

  • Templates are not built for individual protocol studies.
  • The use of copyrighted and public domain content such as scales, tools, tables or other language originating from persons or entities outside the NIH requires approval from the originating publishing source via a document stating permission is granted for use by the National Institutes of Health Clinical Center in their electronic medical record system. The NIH Office of General Counsel (301-496-6043) can provide advice on copyright and public domain research and must deem permission acceptable before the build of requests may be started.
This page last updated 03/09/2018
 

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