Preparing Your Patient Data in Clinical

Clinical Diagnosis Coder

In MD3 there are two ways to enter past medical history items:

  • Pick from list (Coded) or
  • Free Text (Uncoded)

    Both of these options are available to use in Past History. However if you have entered a diagnosis into the Past History tab that was not selected from the 'Pick from list' it will not be internally coded, and as such will not be found when doing searches. This is particularly important for Chronic Disease Management or when using some supplied decision support options.

    For example, if you typed 'Diabetes type 2' into the uncoded section of the Past History tab, rather than using 'Diabetes Type II' from the drop down list, it will not be found when you do a search for Diabetic Type II patients.