Lab cases and referrals

Lab work and referrals sit on the Documents tab of the clinical record, with prescriptions, letters and the patient's filed documents. Both name the labs and clinicians kept under Settings → Professional contacts. Every lab case of the practice is also on the Lab page, and in the UK and the US you can send orders to connected labs that take them online.

The Documents tab

The buttons across the top choose what the list shows, each with how many it holds: All, Lab work, Referrals, Prescriptions, Letters and Files. All lists everything newest first — a lab case by its dispatch or due date, a referral by its submission. You only see the parts your role can read.

Each row shows:

• what it is, as a coloured label (Lab case, Referral, Prescription, Letter, or the kind of a filed document);
• its status, as a coloured label too (for example Sent, Submitted or Issued);
• who it is with — the lab, the clinician, the prescriber or the delivery;
• its date;
• the next thing to do as a button, with anything else under More.

New at the top right opens a new lab case, referral, prescription or letter, or uploads a file. If a list can't be loaded, the tab says so with Retry instead of showing it as empty.

Files lists every document filed on the patient, and Prescriptions has its own page.

Lab cases

Choose New → New lab case and fill in:

• the lab and the site sending the case (left as The patient's site, it is the patient's own site);
• the treatment it is for, its plan and the visit the work is fitted at — each picked from the patient's own;
• the due date, the shade and the lab's reference;
• the lab fee, in the practice's currency;
• the enclosures — type each one, such as an impression or a bite, and click Add; × takes one off;
• a note.

Then click Open case. The row's button moves the case along:

Each button asks for the date it happened, set to today at the case's site; change it when you record something after the day. A date in the future is refused, and so is one before the step it follows: work can't be received before it was sent, or fitted or returned before it was received.

A lab case is never deleted; cancel it instead.

Re-sending work

Re-send on a returned case opens a new case with everything the lab needs copied from the returned one — the lab, the site, the treatment, the plan, the visit, the shade, the lab's reference, the fee and the enclosures — for you to check and change. Set a new due date: Open case waits for it. The note is not copied.

Changing a case

While a case is open — not yet fitted, returned or cancelled — Edit on its row opens the same form with the case filled in and the patient's name and date of birth at the top. Make your changes and click Save changes — for example, when the lab tells you the work will be late. The lab and the site cannot change; for another lab, open a new case.

Once a case is sent, what the lab was sent is fixed: the treatment, the plan, the shade and the enclosures can no longer change. The due date, the visit, the lab's reference, the fee and the note still can.

A case saves only over the version you opened: if a colleague changed it in the meantime, your Save changes is refused and the list reads again so you can see their change first.

When the patient has episodes, the form also has an optional Episode: the course of care the case belongs to. Choosing another one moves the case there; None takes it out. The same Episode is on the referral form while the referral is a draft.

Orders to a connected lab

When the lab you choose in New lab case is a connected lab — one that takes orders online — the form's button reads Continue. It opens the lab's own order form in a panel on the right, under a Smileline header with the patient's name and date of birth, the lab and the plan item, filled in with the treatment, plan, visit, due date and note you chose. Once you send the order there, it is listed here as a lab case, Sent.

To send the patient's intraoral scans with a new order, click Add scans in the panel, tick the files and click Send to the lab: the lab's order form offers them among the patient's files once each one reads With the lab. See Send scans to a lab.

A connected order's row shows:

• the lab's stage, as a coloured pill;
• Lab needs you when the lab is waiting for you: an approval, a report, files, a reply or an invoice to pay;
• an invoice chip when the lab's invoice has money to pay;
• Open order, which opens the lab's order page in the panel: its messages, approvals, files, holds, remakes, and the invoice with paying it.

Cancel and Re-send are not offered on a connected order: cancelling and remakes happen in the lab's order page and reach the record by themselves, a remake as a new case linked to the first. Mark received, Mark fitted and Returned to lab stay your own steps — the carrier marking the parcel delivered does not mark the work received. Edit changes only the visit and the note: the due date, the lab's reference (its order number) and the fee come from the lab.

The Lab page

Lab in the clinical sidebar (/pms/lab) lists every lab case of the practice, sent by hand or to a connected lab, newest first. Everyone who can see lab cases opens it. A patient whose record is being erased is not listed.

Narrow the list with:

• Status — the cases in one state, such as Sent or Received;
• Lab — one lab's cases;
• Due — Late, or Due in the next 7 days;
• Sent with — Any, A connected lab or By hand — and Lab needs you, the connected orders whose lab is waiting for you (UK and US practices).

Load more carries on until the list is done. In the UK and the US, Lab invoices opens a connected lab's invoices in the panel.

Referrals

Choose New → New referral. Choose the direction (outbound to another clinician, or inbound from one), the kind (private in-group, in-house or external; a UK practice also refers on the NHS), who it goes to or came from (a practitioner here or an external contact), the urgency (a UK practice also has the NHS two-week wait) and the reason. You can also choose:

• the Referring clinician of an outbound referral — you, if you have a practitioner profile, unless you choose someone else;
• the site writing it (left as The patient's site, it is the patient's own site);
• the Treatment it is about, from the patient's chart;
• the Letter, from the documents filed on the patient — a document marked entered in error is not offered;
• the NHS reference (URN), at a UK practice.

From the chart

• On the Chart tab, open a finding's actions in History and choose Refer. A new referral opens with the finding as its reason and the finding linked to it.
• Refer out on a planned treatment marks it as referred elsewhere. Tick Create a referral now in its confirmation (it starts unticked) and, once the treatment is referred out, a referral opens pre-filled with that treatment.

Either way, you review the referral and save or submit it yourself: the chart never creates or sends one on its own.

From a perio exam

On a saved soft-tissue exam on the Perio tab, each finding has Create referral. It opens a new referral with the finding as its reason. The referral keeps a copy of the finding as that version of the exam recorded it, so a later amendment to the exam never changes what the referral came from. The button appears once the exam is completed, and not while you have changes to the exam that are not saved yet.

Ticking Refer on a finding stays a recommendation: it never creates or cancels a referral.

Drafts and submission

Until it is submitted, Edit on a draft's row opens the same form filled in, with the patient's name and date of birth at the top. You can change who it goes to or came from, the referring clinician, the urgency, the treatment, the letter and the reason, then click Save draft; the direction and the kind stay as they were. Once submitted, the referral is what was sent and has no Edit: who it is for and from, the treatment, what it came from, the reason, the urgency and the letter never change; the NHS reference still can. What comes back is recorded with the buttons below.

The row's button moves the referral along:

1. Submit once the letter has gone. From then on the letter cannot be changed.
2. Mark accepted when they accept the patient.
3. Mark booked when the patient is booked with them.
4. Record reply when their reply comes back: type the outcome they sent and the referral is completed with it.

Mark rejected and Cancel are under More. Outbound referrals still waiting for their outcome appear on the Referral replies worklist in To do, each naming who referred the patient; Mine keeps the ones you referred.

A draft referral saves only over the version you opened: if a colleague changed it in the meantime, your Save draft or Submit is refused so you can see their change first. Pressing a status button again — or a retry after a dropped connection — never moves a referral or lab case twice. It keeps the date of the first press and adds nothing to its history.