Bring Back the Manual

Every procedure begins from the same skeleton. Build new ones into this shape and they’ll read like the rest of the manual.

The standing shorthand every team member writes and reads the same way:

• Appt appointment · Canx cancelled · CC credit card · CR case review · Doc document(s) · Dx diagnosis · Enc encounter · EP established patient · F/U follow-up · IC initial consult · L/M left message · NP new patient · PA prior authorization · PG patient guide · PPQ patient portal queue · Pt patient · Rx prescription · SOAP appointment notes · Supp supplement · T/T talked to · Tx treatment · WP working procedure · V / MC / D / AE card types.

1. Create a group named for the practice.
2. Add a new snippet.
3. Abbreviation — the shorthand you type to trigger the expansion.
4. Content — the full text inserted when you type the abbreviation.
5. Label — a plain-language title so the snippet is easy to find in your list.

The starter library every practice should build

• Date / initial stamp — expands to [date] (xx). The single most-used snippet in the building.
• Order & case-review confirmations — the standard “your order is on its way / here’s how to prepare” messages.
• Estimate approvals — patient confirmation, the matching SOAP note, and the task note, all kept verbatim.
• Billing language — credit-card declination, e-consult fee explanation, expired-card-on-file.
• Scheduling — established-patient self-scheduling, telemedicine confirmation, cancellation labels.
• File-name stems — “Lab Results,” “Order [date],” collection-date prefixes — so filing stays uniform.

Written once, perfected once, deployed identically by everyone. That is leverage.

1. Get the vendor’s product page from the clinician; keep it open for reference.
2. In Cerbo: Admin → Manage → Alternate Plan Items.
3. Search several ways first to confirm it isn’t already in the database.
4. Add a new item. Alternate Plan Name: use the supplement name (not the brand). If something similar exists, distinguish it in parentheses — brand, strength, quantity, or form. e.g. Optimal PC (capsules) vs. Optimal PC (liquid); 5-MTHF (Thorne 1mg) vs. 5-MTHF (Thorne 5mg).
5. Action Type: supplement.
6. Code / ID#: abbreviate the vendor, then their product code if they use one (e.g. an Emerson code). If the vendor has no product IDs, use the vendor abbreviation alone.
7. Plan Class: self-order for self-order items; is_supplement for everything else.
8. Nicknames: usually blank, unless a common abbreviation would be used to search.
9. Description: paste a brief manufacturer description if available. Use no special characters (no ™, ©, bullets).
10. Build the default profile: Brand, Strength, Method (Oral / Topical / Nasal, etc.), Frequency, Total doses (e.g. “120 vcaps,” “1 oz”), and Expires — N if it never needs clinician approval to refill, Y if it does, a space if unknown.
11. Instructions to Patient: the clinician’s dosing; if none, the website’s; if still none, “Please follow directions on the bottle.” For self-order items, add the order link.
12. Create the default profile.

From the original working procedure

1. In Cerbo: Admin → Manage → CPT Database.
2. Search several ways first to confirm it isn’t already there.
3. Proper Name — follow the naming rule for the source:
   • LabCorp / Quest marker: [test name] [LabCorp/Quest]. Add [F] if fasting; put a send-out lab in the brackets, e.g. T4, Total [Quest — Esoterix].
   • Anything else: [lab facility] [brief test name], e.g. Genova Organix; HDRI Methylation Pathway.
4. Alternate title: other names the test might be called (useful when the proper name is a test number).
5. CPT Code: from the lab — always five digits, with any modifier (-59) or quantifier (x3). Enter every code.
6. Headings & Nicknames: blank. Do not check “performed by a specific lab.”
7. Description: the lab FAQ (HTML allowed for headings/links).
8. Notes to Laboratory (prints on the requisition): LabCorp/Quest test number; for send-outs add SEND TO [lab] [test #]. Leave blank for non-LabCorp/Quest.
9. Procedure Type: Radiology/Scans for imaging; Pathology and Laboratory for everything else.
10. Display Class: radiology, is_kit, labcorp_marker, quest_marker, or self-order as appropriate.
11. Save.

From the original working procedure

General rules for tasks

• Charging or refunding cards → the billing [Admin].
• Tasks tied to a given provider’s patients → that provider’s [Admin].
• A question about something in a note/task → back to whoever originated it.
• Patient questions/concerns → the clinician, unless someone else can answer.
• Always re-use the original task to communicate anything about the original encounter. If it’s already crossed off, edit it and un-check “mark this task as complete.”

Add a new task

1. Open the chart to confirm the clinician.
2. Hover “tasks” → add new task.
3. Subject: [patient] [brief description] [date if needed] (clinician initials). e.g. John Doe Supplement Refill 4-30 (P3). Dates required for supplement/Rx refills and follow-up appointments; clinician initials required for anything tied to an encounter note.
4. Details: date/initial stamp, then your message.
5. Assign to the right person and save.

Send an existing task

1. Open the task to edit it; do not change the subject.
2. Add your date/initial stamp, your message, what to do next or who to send to, then draw your line.
3. Assign to the right person and save.

1. Open the chart.
2. In the SOAP/Encounter Notes box, click “+” to add a note.
3. Title & categorization by note type:
   • Established visit → Follow-Up [m-dd-yy] (Provider) · Phone/Office/Video.
   • First appointment after intake → Case Review (Provider) or First Follow-Up (Provider) · Office.
   • First appointment → Initial Consult (Provider) or New Patient Visit (Provider).
   • Patient question to clinician → [brief summary] (initials) · Admin note.
   • Rx refill → Rx Refill (m-dd-yy) (initials) · Prescription Refill.
   • Supplement refill → Supplement Refill (m-dd-yy) (initials) · Supplement Refill.
   • Clinician response / order confirmation / post-appointment notes → titled as such · Admin note.
4. Details: if not an appointment, delete the auto-populated text, then enter your message.
5. Copy the note title, then save and close.
6. If this is the main encounter note (not a sub-note), start the matching task: Subject = [patient] [paste title]; details = date/initial stamp + message; assign to the right person.

1. Open the chart.
2. Click the message bubble at the top-right of the patient’s photo.
3. Title: brief description of the subject.
4. Message:
   Hi [patient], [your message] [your signature]
5. Send.

From the original working procedure

1 · Empty the non-appointment encounter (or the one with fewer items)

1. If the note is signed: append a comment titled “Moving to other encounter,” date/initial stamp + “Another encounter is open with charges. Moving this request to that encounter (name).”
2. If unsigned: put the same line + stamp + message in the main note.
3. Right-click each item in the Charge box → edit charge details → set price to $0 (it greys out). Save and close.

2 · Build up the appointment encounter (or the one with more items)

1. If signed: append a comment “Added Charges,” date/initial stamp + “Added [supplements/test] from [other encounter] to avoid duplicate shipping and processing charges.”
2. If unsigned: put the same line + stamp + message in the main note.
3. In the Charge box, “+” each item from the other encounter. Save and close.

1. Unreviewed faxes appear in the “Received Faxes (Unfiled)” box (visible from the portal queue and from the schedule).
2. Click a document to preview it.
3. Read it to decide: file to a chart, separate, file to the fax queue, or discard.
4. If rotated → rotate. If it has blank/cover pages with no useful content → delete those pages. If it holds results for more than one patient → split it.
5. To file to a chart (lab results, Rx refill or prior-auth requests): assign the patient; name the document [test/lab] Results [mm-dd-yy] or Rx Refill Request [date] (medication) or PA Request [date]; check “needs to be reviewed by doctor” and select the right [Admin]. This files it to the chart and adds it to that person’s queue.

From the original working procedure

1. Find the document in the orange tabbed section of the dashboard.
2. Right-click → “fax this document.”
3. Attach any additional documents from the drop-down.
4. Double-click the cover sheet to edit it, then apply.
5. Choose “other — type in number,” enter as (xxx)-xxx-xxxx.
6. Send, then close the form.

1. Open the chart; note the clinician and the patient’s last appointment type.
2. From the portal queue, “save and review” the lab.
3. Flag for review? Follow the per-provider rule: generally, before a case review upload but don’t flag; after a case review upload and flag; not-current-labs upload but don’t flag; for some providers, established patients always flag. CIRS panels flag to that provider’s [Admin].
4. Title: [collection date yyyy.mm.dd] [patient] [test/lab] Results. e.g. 2025.04.17 John Doe LabCorp Results.
5. Document Type: Labs (ordered by the practice or within the last year); NCL (ordered elsewhere); Legacy (older than a year); Radiology (imaging).
6. Notification: default (not needed). Add lab + collection date to Notes/Key Results where the provider rule calls for it.
7. Show in patient’s portal. Match to open orders. Save, unreviewed.
8. For tests where the practice supplied the requisition, go to Forms and un-check “show in portal” on the old requisition so the patient only sees the current one.
9. Archive the portal queue message.

From the original working procedure

1. Open the chart.
2. From the portal queue, “save document and review.”
3. Title: leave default. Document Type: forms. Notification: default. Show in portal.
4. If it’s a Metabolic Assessment, check the meds/supplements section:
   • If blank, message the patient to confirm they take none.
   • If they confirm none → sticky note: date/initial stamp + “Pt has no current supps or meds.”
   • If they do take some → if a CR encounter exists, add a sub-note “Current Supps/Meds” (Patient Portal category) with their message; if no encounter yet, sticky-note the list.
5. Save, unreviewed.
6. In the chart, click the tags in the Patient Information box and un-check the form name to show it was received.
7. When all case-review forms are in, open the last one and mark “needs to be reviewed by” the case-review [Admin]; save unreviewed.
8. Archive the portal queue message.

From the original working procedure

1. Open the chart from the portal queue message.
2. “Save document and review”; scroll to confirm the patient signed/completed it.
3. Title: default. Document Type: consent.
4. By type:
   • Arbitration / Client Agreement: show in portal; for arbitration, mark for the provider’s [Admin]; then un-tag it in the Patient Information box to show it’s received.
   • Medicare Opt-Out: show in portal, file, un-tag.
   • Registration Forms: check the DOB wasn’t entered with the current year and, for CA residents, that the county is present (note corrections in Notes/Key Results). Then open the Patient Information box and clean every tab — capitalization, phone format (xxx) xxx-xxxx, remove duplicate numbers, star the preferred number, record any nickname in a blue notice, set billing-address flag correctly, and move free-text intake notes into the “Need to Know” box.
   • Release from / to the practice: un-tag the matching release in the Patient Information box; title the document ROI [direction] [party] exp [date]; show in portal; mark for review by whoever sent the release.
5. Archive the portal queue message.

From the original working procedure

Documents

1. Open the chart; note clinician and last appointment type.
2. “Save and review.” If the preview says it can’t display in frames, it isn’t a PDF — skip to the non-PDF steps below.
3. Flag for review per the same before/after-case-review rule used for labs.
4. Title: [date if a test, yyyy.mm.dd] [patient] [brief description] [doc date].
5. Type: Labs, Radiology, Misc (incl. current supplement lists), or Legacy (records over a year old, health summaries).
6. Show in portal; match to open orders; save. Archive the message.

Special cases

• Not a PDF: delete it (reason: not a PDF) and message the patient to resend as PDF.
• Insurance: open details editor → accept change → edit patient. Archive.
• Pictures: save and crop (focus on the patient). Can’t rotate — if it previews rotated, ask the patient to resend correctly.
• Supplements/drugs: add to chart; paste the patient’s note; do not set it as the system default profile.
• Vitals: accept the reading, confirm the value populated (height often won’t auto-fill), save.

From the original working procedure

1. Open the chart; find the encounter where the clinician noted a handout should go to the portal.
2. Hover “my documents” → browse → Handouts tab → find the referenced handout.
3. Right-click → “copy to current pt’s chart” → OK.
4. Title: default. Type: handouts. Show in portal; file.
5. Let the patient know where to find it:
   Hi [patient], You can now find the [handout name] in the Labs and Documents section of your Patient Portal. Please let us know if you need anything else. [your signature]
6. Archive the portal queue message.

Established patients

1. Reply in the portal:
   Hi [patient], Now that you are an established patient, you can schedule follow-up appointments yourself in your Patient Portal under “Appointments.” The calendar is currently open through [date]. [your signature]
2. If a patient struggles to find a slot, assign a task to the [Admin] to add them to the cancellation list.

New patients

1. Assign as a task to the correct provider’s [Admin].
2. Subject: “Appt.” Message: date/initial stamp + “please contact pt to schedule” or “please see patient’s response.”
3. Assign.

1. Open the chart.
2. Review the Open Orders box — these are outstanding. Results sometimes arrive unmatched, so also check the “unreviewed” and “labs” tabs.
3. Highlight the open orders and copy the list.
4. Reply in the portal:
   Hi [patient], We are still waiting on results from the following tests: [paste list, removing “no results”] In Labs & Documents you can view Open Orders and Test Details for each. Once results arrive, the test name disappears from the list, your clinician reviews them, and we make them viewable in your Portal. [your signature]
5. If the patient says a test was done weeks ago, use the lab FAQ to judge whether results should be in. Contact the lab if overdue; sticky-note the chart with when the sample was sent.

From the original working procedure

1. Check the schedule for next week’s initial consults.
2. Open each chart; confirm required paperwork is complete (message the patient if not).
3. Start a new encounter note. Title: Initial Consult (clinician initials).
4. Set the encounter date to the appointment date.
5. Categorize by appointment type (Phone, Video, etc.).
6. Add the matching charge — e.g. “IC (Phone)” or “IC (Video)” — with the correct clinician’s initials.
7. Save and close (do not “save & sign”). Close the chart; repeat.

1. Check the schedule for next week’s case reviews; open each chart.
2. Confirm the case-review questionnaires are done. If not, remind the patient (at least two days out). If done, download all five and combine into one PDF in the set order (Metabolic Assessment, Food Survey, Dietary Habits, Mold Survey, Case Review Questionnaire).
3. Title the combined file mm-dd-yy [patient] CR Documents using the CR date; upload to the chart, leave unreviewed, show in portal; delete the individual files.
4. Confirm all lab results are received and made visible. Create the blood-chemistry report. If any are missing, log in to the lab to check; download and upload if available, or leave a sticky note that no sample is at the lab.
5. Start a new encounter note titled Case Review (clinician initials); set the date to the appointment; categorize Office Visit; add the “Case Review” charge.
6. Save and close (not “save & sign”). Close the chart; repeat.

1. From the schedule, read the first appointment’s type (NP, office, phone, video).
2. Open the chart. Check there isn’t already an open encounter for it (one is often created when the patient sent pre-visit notes through the portal — in that case nothing else is prepped).
3. If none exists, start a new note. Title by where the patient is: New Patient Visit, First F/U, or EP [mm-dd-yy] — always with clinician initials. Categorize by appointment type. Save and close.
4. If this is the first follow-up after transferring in, confirm prior records are in the NCL (results) and Legacy (notes) tabs.
5. In Open Orders, resolve any outstanding orders: check lab updates; if a result is available, download and upload it; if not, call the lab and request a fax; if the lab has nothing, document each outstanding lab and its status in the encounter’s Admin section with a date/initial stamp.
6. Hover “tasks” → “show patient portal history” and address anything the patient sent about today’s visit.
7. Close the chart; repeat for the day.

From the original working procedure

More than two weeks out

1. Check the clinician; open the practice’s Case Review Opportunities sheet and find at least five available slots (CRs are booked 7–8 weeks out to allow lab time). Copy day/date/time.
2. Reply in the portal. If the reason is missing labs, lead with the standard guidance that rescheduling for a few missing results usually isn’t advised, then offer the slots and ask for the patient’s top three:
   Hi [patient], We received your request to reschedule. [If labs: We don’t usually advise rescheduling for a few missing results — any not available at your Case Review are reviewed on receipt and addressed at follow-ups.] If you’d still like to reschedule, please send your top three choices from the list below; these are offered to several patients on a first-come basis. [paste 5 options] [your signature]
3. On the patient’s reply, place their top available choice on the sheet.
4. In the chart, open the Initial Consult Admin Notes; line + date/initial stamp + “CR Rescheduled to [date & time] with [Provider] (Office).” (Append a comment if already signed.)
5. Copy the preferred phone number. Open the original CR appointment, change its type to “cancelled,” and prefix the phone field with (CANX [today]); save (it turns black).
6. Schedule the new event: Title/Type “Case Review — [Provider]”; event details “Phone: [number]”; set the duration to the provider’s standard; assign to the correct clinician only; set the reminder lead time; add the event.
7. Mark the sheet as scheduled. Confirm to the patient:
   Hi [patient], We’ve rescheduled your Case Review for [new date and time] with [Provider] at their office. [your signature]

Less than two weeks out

1. Same flow, with one addition required by the signed Patient Guide: the patient owes the full Case Review fee for the cancelled appointment, and the rescheduled review is billed at the provider’s hourly rate. State this plainly in the reply and get explicit confirmation before rebooking.
2. On confirmation, create an Admin-note encounter “Cancelled Case Review (initials),” date/initial stamp the reason, add the Case Review charge, and task the billing [Admin] “Ready to charge per charge box.” Then cancel/rebook exactly as above and confirm to the patient that the cancelled-appointment fee will be charged and the new appointment is set.

From the original working procedure

Set-up (always)

1. Open the chart; confirm the clinician and that there isn’t already an open encounter with uncharged items (if there is, consolidate — see Two Open Encounters).
2. Check the card on file isn’t expired. Check the patient’s age — if 65+, confirm a Medicare Opt-Out is on file. Either gap routes you to the “information needed” branch.
3. Start a Supplement Refill [m-d-yy] (initials) note (Supplement Refill category); delete the auto-text above the patient’s message.
4. In the Plan box, add each requested supplement. As you add each, read its Expires flag — N no approval needed, Y approval needed, blank = unknown.

Branch A — none require approval

1. Add each supplement to the Charge box (name must match the Plan box exactly), set quantities.
2. SOAP: date/initial stamp + “Ready to order per charge box. Does not require clinician approval.” Save.
3. Task the billing [Admin] “Ready to order per encounter.” Send the patient the standard “submitted” message (below).
4. When the task returns “charged,” paste the ordered list into an order-confirmation reply, save & sign, send to portal. Mark task complete.

Branch B — some require approval (or approval is unknown)

1. SOAP: date/initial stamp + “OK to order per plan box?” (for unknowns, add “Please advise if [supplement] needs approval in future”). Save.
2. Task the clinician “Please see encounter, notate, sign, and task back to [you].” Send the patient the standard “submitted” message.
3. On return: add to the Charge box, append “Ready to order per charge box,” task the billing [Admin]. For unknowns, also set that supplement’s Expires flag per the clinician and save it as the default profile.
4. When charged, send the order-confirmation reply, sign to portal, mark complete.

Branch C — information needed from the patient

1. Build the order, then SOAP “Holding for [updated CC / Medicare Opt-Out].” Task yourself with a one-week due date.
2. Message the patient for exactly what’s needed (expired-card or opt-out language); send the opt-out form if required. Hold the order until they respond.
3. On receipt, update the chart (see Update Credit Card), then rejoin Branch A or B at the charge step.

Standard messages

From the original working procedure

1. Open the chart; confirm the clinician and that a pharmacy is listed with phone and fax in (xxx) xxx-xxxx format (fix via Admin → Manage → Pharmacy Listings if not).
2. If the request is for LDN and the strength/daily count is missing, start the Rx Refill note “Holding for dosage info,” task the clinician, and ask the patient to confirm strength and pills per day. When they reply, paste it into the note and proceed as a normal refill.
3. From the portal queue, “start a note.” Title Rx Refill (initials), category Prescription Refill; delete text above the patient’s message; date/initial stamp + “refill request.” Save.
4. Task the clinician “Refill request per encounter.” Reply to the patient: “Your request has been submitted; we’ll be in touch once the order is sent.”
5. When the clinician returns the task, create a sub-note “Rx Confirmation” (Admin) explaining any charge:
   Hi [patient], [Provider] sent the requested prescription to your pharmacy. Please note a $[e-consult fee] e-consultation fee applies, as this was a new problem addressed outside a scheduled appointment. [your signature]
6. Save & sign to the portal. On the task: if no charge, mark complete; if a charge, date/initial stamp “Ready to order per encounter,” draw a line, and send to the billing [Admin].

From the original working procedure

The mechanics differ by vendor, but the pattern is identical every time:

1. Build the requisition from the Open Orders box (choose “taxable form”) or the vendor’s own portal/PDF.
2. Set the ordering provider to the clinician of record.
3. Clean every field — the To, Insurance & Payment, and Notes boxes are emptied unless the vendor specifically requires content there. Add the practice’s results email/client ID only where that vendor needs it.
4. Honor shipping rules — no PO boxes; respect state restrictions (several kits can’t ship to/from NY); use expedited air where required.
5. Flag fasting — add the standard “FASTING lab” note for any marker marked (F).
6. Send by the vendor’s channel — fax, email “Please see attached order,” or submit on the vendor portal — then save the requisition to the chart under Forms, titled [patient] [lab] Order [encounter date].
7. Portal visibility — show patient-facing requisitions (LabCorp/Quest) in the portal and un-check older ones so only the current is visible; vendor-faxed orders generally don’t need to be shown.
8. Kits shipped by the practice (e.g. certain specialty panels) — flag the requisition to the fulfillment [Admin] and task that a kit is ready to ship; they file the requisition once it ships.
9. Self-pay notes — record clinician-account billing or self-pay receipts in the practice’s bookkeeping folder where required.

Practice-shipped kit, never received or missing an item

1. In Forms, find the USPS shipping label and track it.
2. If it shows delivered but the patient doesn’t have it, confirm the address by portal message, offering to reship or use an alternate address.
3. On reply, re-open the original encounter’s task: date/initial stamp + “Pt did not receive [kit]. Please reship to address on file,” line, assign to the [Admin].
4. When it ships, copy the new tracking number and message the patient that a new kit is on the way.

Patient needs a fresh kit due to their own error

1. Message the patient about the shipping charge and get approval (with the card on file).
2. On approval, add a sub-note “Replacement [kit]” (Admin) documenting the approval, re-open the original task to the [Admin], and tell the patient a new kit will arrive in ~3 business days.

From the original working procedure

1. On a “create pharmacy record” request, open the patient’s chart and edit the Facilities/Specialists box.
2. Start typing the pharmacy — if it already exists, assign it and close the request without re-adding (re-adding creates a duplicate).
3. If new, choose the correct Pharmacy Type (use Google on the address if unsure), tidy the address formatting, and ensure both a phone and a fax exist in (xxx) xxx-xxxx format — call the pharmacy for the fax if missing.
4. Reference Name: the city (prefix with the pharmacy name if the type is “other”). Add the pharmacy.
5. Check the chart for sticky notes about prescriptions waiting on a pharmacy, and recent appointments with prescriptions, to be sure they were sent.
6. Archive the message.

From the original working procedure

When an encounter with charges is open

1. Open the chart. In the Admin Notes box, edit and replace the old card in this exact format: [today]: [V/MC/D/AE] [card] (MM/YY) (CVV). Save.
2. Update shipping/billing address or billing name in the Patient Information box if needed.
3. In the encounter’s Admin Notes, date/initial stamp, note the estimate/charges, then add the new-card line and “same billing address.” Mirror that into the matching task and assign to the billing [Admin].
4. Reply to the patient confirming the card was updated.

When no charged encounter is open

1. Update the card in the Admin Notes box (same format) and any address.
2. Create a task [patient] CC Update [date] with the new card details, assign to the billing [Admin].
3. Reply: “We have updated your credit card on file.”

From the original working procedure

1. Open the chart; check the Admin Notes for whether a declination fee has already been waived.
2. Message the patient (title “Credit Card Declination”). If a fee was never waived before, offer the one-time waiver in exchange for a valid card; otherwise state the fee applies and request a valid card. Either way: order on hold until they reply.
   Hi [patient], Unfortunately the card ending in [XXXX] was declined on your recent order. A $[decline fee] declination fee was assessed[, which we’ll waive if you provide a valid card]. Please send the full 16-digit number, expiration, CVV, name on card, and billing address. Your order is on hold until we hear back. [your signature]
3. On the task, date/initial stamp that you messaged the patient; set a one-week due date; keep it assigned to yourself.
4. On the patient’s reply, update the card in the Admin Notes box (standard format) and any address.
5. In the encounter’s Admin Notes, line + date/initial stamp + notes + new-card line, noting if the one-time waiver applies. Copy that message into the matching task and assign to the billing [Admin].

From the original working procedure

1. Open the chart; update the address in the Patient Information box.
2. If a charged encounter is open: in its Admin Notes, date/initial stamp + “New [billing/shipping] address: [full address].” Mirror into the matching task → billing [Admin]. Reply to the patient confirming the change.
3. If none is open: create a task [patient] Address Update with the new address, assign to the [Admin], and archive the portal message.

From the original working procedure

1. Open the chart; find the encounter where the item was ordered.
2. Create a sub-note — “Return of Product” (supplements) or “Refund of [test]” (tests) — categorized Admin. Date/initial stamp the request and reason. Copy the title; save.
3. Re-open the matching task (un-check “complete”): date/initial stamp + “Please see [sub-note] for refund request,” line, assign to the billing [Admin].
4. For tests, also remove the test from Open Orders (“Remove — pt will not fill”).
5. Reply to the patient that the request went to billing.
6. As the task moves back and forth with the [Admin], record each exchange in the sub-note and task with date/initial stamps and lines (the task is the running thread).
7. When refunded, send the patient the confirmation and sign it to the portal:
   Hi [patient], We’ve refunded $[amount] to your card ending in [XXXX] for the return of [item]. [your signature]
   Mark the task complete.

From the original working procedure

1. Open the chart; open the encounter the patient is asking about.
2. Hover Reports → generate the insurance invoice. At the top choose “only insurance reimbursable charges” (rarely “show all”).
3. Select the clinician who performed the service so Provider/title/NPI are correct — not an Admin name (the default is whoever started the encounter).
4. Verify formatting: items aligned to prices, commas between CPT codes, quantifiers placed after each code (the system defaults them to the end — fix it).
5. Print to PDF; keep the default file name and append DOS m-dd-yy.
6. Upload to the chart under Invoices; don’t require doctor review; allow portal viewing; don’t add to PMH.
7. Notify the patient where to find it (portal message or document notification), pointing them to Labs & Documents → Invoices.
8. If the request came from an encounter’s Admin Notes, mark “(done)” next to it.

From the original working procedure

Records & labs

1. Confirm a signed release is on file (check the request or the Consent tab). If not, tag and send the “Release from the practice” form, message the patient that it’s needed, sticky-note the chart, and wait.
2. Review exactly what was requested (some want only certain dates of service or diagnoses).
3. Reports → “printable patient chart.” Remove SOAP lists, misc/social notes, insurance info, problem-list summary, and vaccination records. Then scrub per the request: strip Admin/Post-Appointment notes from each visit, remove clinician questions (but keep the “response” notes), remove supplement orders, Rx refills, order confirmations, and returns.
4. Save under Legacy, titled with the patient’s name (and date range if applicable); don’t attach; don’t show in portal.
5. Fax the request (or the first document/ROI), attaching the documents to send. Never send anything labeled NCL, requisitions, or handouts; you’ll rarely send Rx, forms, “sent” items, or invoices — typically only Labs, Radiology, and Legacy.
6. Edit the cover sheet, enter the destination fax, send. On the record request, date/initial stamp “faxed.”

Billing statements

1. Same ROI rule. Expand the Billing box → print statement → set dates/options → review → print to PDF.
2. Upload under Invoices, titled [patient] Billing Statement [date range]; file so it doesn’t linger as unreviewed.

From the original working procedure

1. Confirm the patient has signed the video-conferencing consent before scheduling.
2. Schedule the visit on the provider’s video platform and confirm the appointment to the patient in the portal, including any account-setup steps they must complete before the visit.
3. Categorize the encounter as a video consult so it bills and documents correctly.

Patient leaves voluntarily

1. Open the chart; review anything outstanding.
2. Reply with an understanding message and what happens next — typically 5–7 days to download anything before the portal deactivates:
   Hi [patient], Thank you for letting us know. If you’d like copies of any lab results or notes, please download them soon, as your Patient Portal will be deactivated on [date]. We wish you the best on your journey back to optimal health. [your signature]
3. If a charged encounter is open, document the resolution in its Admin Note (e.g. “appointment fee only”).
4. Sticky-note “patient is leaving the practice”; cancel upcoming appointments.
5. Create a task [patient] Inactivation — “Holding for inactivation,” due in 5–7 days, no reminder, assigned to yourself.
6. After 5–7 days: remove the sticky note; in Open Orders, “Remove (pt will not fill)” each test; edit Patient Information → set status to INACTIVE; set portal to “No access”; date/initial stamp the Access Notes with what happened.

Bad-debt status

1. Message the patient that, absent a valid card / response, orders were removed, only the appointment fee stands, the account is flagged for bad debt, and the portal deactivates in a week unless resolved.
2. Create the same “Inactivation” holding task, one week out.
3. After one week: sign the open encounter’s Admin Notes; remove open orders; cancel appointments; set a red “BAD DEBT” notice; portal to “No access”; date/initial stamp the Access Notes “bad debt status.”

From the original working procedure