---
id: visit-wizard-ehr-start-a-visit
title: Walk through a visit in the Visit Wizard
module: visit-wizard-ehr
audience: [clinician]
roles: [clinician, medical_director]
type: how-to
estimated_minutes: 8
last_reviewed: 2026-07-01
app_route: /facility/{facility_uuid}/visit-wizard-v2-page
related:
- visit-wizard-ehr-overview
- visit-wizard-ehr-wound-cockpit
- visit-wizard-ehr-wound-assessment
- visit-wizard-ehr-lcd-navigator
- visit-wizard-ehr-sign-off
prerequisites:
- visit-wizard-ehr-overview
tags: [visit-wizard, autosave, pull-from-history, DoseSpot, procedures-supplies, sign-and-lock]
---
# Walk through a visit in the Visit Wizard
Open the Visit Wizard from the Fleet Calendar or the Wound Cockpit, confirm the patient context, and work the **17 sections** end-to-end. This guide covers the full happy path plus the wizard's core behaviors: continuous autosave, the top-of-wizard data-pull toolbar, clinical history carry-forward, the LCD ambient badge, warn-and-proceed validation, DoseSpot e-prescribing, unified Procedures & Supplies, AI-assisted drafting, and **Sign & Lock**.
## Before you start
- Your appointment is on the **Fleet Calendar**, or you opened the wound from the **Wound Cockpit**.
- Your device has location services enabled (required for the GPS geofence on in-person visits).
- For follow-up visits, review the Wound Cockpit "Where this wound is at" panel so you know what carries forward — see [Wound Cockpit](./wound-cockpit.md).
---
## 1. Open the wizard
### From the Fleet Calendar
1. **Navigate to Fleet Calendar.** Click **Fleet Calendar** in the sidebar. The calendar opens in Day view by default, with swim lanes per provider.
*The patient header card on the Fleet Calendar appointment tile.*
2. **Tap the appointment tile.** A detail popover appears with the patient name, appointment type, date, and time.
3. **Click Start Visit.** Specialty routing sends wound-care patients to the **Wound Cockpit** and primary-care patients to the **Primary Care Cockpit**.
### From the Wound Cockpit
1. From the patient chart, open the **Wound Cockpit** for the wound you intend to treat.
2. Click **Start Visit** (or **Continue Visit** if a draft exists). The Visit Wizard opens to section 1 — or to the last section you worked if you are resuming a draft.
The **Visit Timer** starts automatically and appears in the top toolbar, alongside the **LCD ambient badge**.
*The Wound Cockpit panel — pre-visit snapshot of the active wound.*
---
## 2. Pull in prior data (top-of-wizard toolbar)
The toolbar at the top of the wizard lets you bring documented data forward before you start typing. For a transferred patient, a **migration context banner** also appears.
| Action | What it does |
|---|---|
| **Pull from History** | Brings forward documented sections from the patient's prior visit (Review of Systems, Comorbidities, Allergies, Previous Treatment, historic measurements, care plan). A preview shows what will be applied before you confirm. |
| **Smart Import** | Pulls structured clinical data the system has already extracted for this patient and maps it into the matching wizard fields. |
| **Pull Migration Data** | For patients migrated from a prior EMR, pulls the imported chart data (visit history, wounds) into the visit. |
Carry-forward is a starting point, not a substitute for re-assessment — always review pulled values against the patient in front of you before signing.
---
## 3. Section 1 — Consent & Attestation
1. **Present the HIPAA notice to the patient.** The full HIPAA privacy notice is displayed on screen.
2. **Toggle Telehealth Consent** if the visit is being conducted via telehealth.
3. **Collect patient e-signature.** Hand the device to the patient or use the signature pad. Click **Confirm Signature**.
4. Click **Next**.
---
## 4. Section 2 — Patient Context / Demographics
1. **Select the Visit Type.** Choose `Initial`, `Follow-up`, `Post-op`, or `Re-eval`.
2. **Enter the Reason for Visit.** Type a brief clinical summary (for example, "Evaluation and treatment of right heel diabetic foot ulcer").
3. **Review the Allergies card.** Allergies pre-populate from prior visits and sync with DoseSpot. Add or update if anything changed since the last visit.
4. **Review insurance.** Coverage is shown here for reference. The **secondary payer is read-only** — edit insurance on the **Insurance** tab, not in the wizard.
5. Click **Next**.
*Section navigator. The active section is highlighted; completed sections show a checkmark.*
---
## 5. Sections 3–6 — Clinical baseline
| Section | What to enter |
|---|---|
| **3. Review of Systems** | Body-system checklist. Pre-populated from the prior visit; review each system and update as needed. |
| **4. Objective Assessment** | Vitals: BP, HR, Temp, SpO₂, Respirations, Weight, Height, BMI. |
| **5. Comorbidities / Risk Factors** | DM, PAD, CVI, CHF, lymphedema, smoking status. These feed the billing engine and the stage-aware ICD-10 resolver. |
| **6. Functional Status & ADLs** | Ambulation, ADL independence, fall risk. |
Each section saves as you complete it. The LCD ambient badge refreshes on every save.
---
## 6. Section 7 — Wound Assessment
1. **Confirm wound etiology and staging.** Stage drives the ICD-10 selection downstream.
2. **Set the wound's Treating / Monitoring status.** A wound marked **Monitoring** carries a yellow pill and relaxes some required fields for that visit; flip it back to **Treating** at any time.
3. **Measure today.** Enter **Length (cm)**, **Width (cm)**, and **Depth (cm)**. Photo upload is required if your facility policy mandates it.
4. **Set tissue percentages by wound.** Granulation / Slough / Necrotic / Epithelial / Eschar must sum to 100%.
5. **Confirm the precise anatomical location.** The location field is editable — pick from the dropdown or type the specific area (for example, `Right lateral malleolus`).
6. Document exudate, pain, and infection signs.
7. Click **Next**.
See [Wound Assessment](./wound-assessment.md) for the full reference.
---
## 7. Section 8 — Previous Treatment
Document prior interventions so the plan and LCD checklist have the history they need.
1. Add or update prior treatments — offloading, compression, debridement history, prior grafts.
2. **ABI for compression.** If you intend to order compression, document the most recent **ankle-brachial index**. If compression is documented without an ABI on file, the wizard raises a **soft warning** and records a review flag — it no longer hard-blocks you from proceeding.
Compression therapy without a documented ABI is a top LCD denial reason. The wizard now warns instead of blocking, so it is your responsibility to enter the ABI (or order one) before the note is signed.
3. Click **Next**.
---
## 8. Section 9 — Treatment / Intervention
1. **Select debridement type** if performed: `sharp`, `mechanical`, `enzymatic`, or `autolytic`.
2. **Choose dressing(s)** from the catalog. Record ultrasonic therapy (MIST / Arobella) if used.
3. **AI-assisted draft.** Click **AI draft** to generate a narrative from the structured data you just entered. Edit the text — anything left in the draft becomes part of your signed note.
The first time you use AI drafting in a visit, you will be asked to acknowledge the **AI Disclaimer**. It documents that the AI output is a draft only and that the rendering provider is responsible for the final content.
4. Click **Next**.
---
## 9. Section 10 — Care Plan
1. Enter goals, visit frequency, and the **next-visit interval**.
2. Set plan-of-care dates — these satisfy LCD checklist item **Plan-of-care dates**.
3. Click **Next**.
---
## 10. Section 11 — Procedures & Supplies
This is the single source of truth for procedures and supplies.
1. **Add procedures** from the structured list.
2. **Scan UINs or enter graft SKUs and quantities.** Wastage is calculated automatically and shown on the line item.
3. Click **Generate Procedure Note** for a one-click procedure narrative; review and edit.
4. Confirm the per-intervention surface — every item here flows into the billing codes engine.
*The lower portion of the section navigator.*
5. Click **Next**.
On save, a **tissue log** entry is written and inventory is deducted automatically.
---
## 11. Section 12 — Orders & DME
1. Add clinical orders and DME. **DME is a vendor-fulfilled order** — there is no product picker here; you order the item and it is fulfilled downstream.
2. Click **Next**.
---
## 12. Section 13 — Medication Management
1. Manage the patient's medications and prescribe through **DoseSpot**. Pharmacy selection and the prescription itself are handled in the DoseSpot modal.
2. Click **Next**.
---
## 13. Section 14 — Billing
1. Review the **Medical Necessity Statement**. It is auto-generated from the clinical sections. Edit anything that doesn't match what you did.
2. Review the **CPT autocode** output. The deterministic engine runs first; if it returns zero rows, the **AI fallback** engages and the BillingLine provenance shows `AI` for the relevant lines. **Pull Codes** can auto-populate codes from your documentation.
3. Verify E/M level, modifiers (`25`, `59`, `KX`, `JW`, `JZ`), and **POS code**. Billing lines can be dragged to reorder.
4. **Read the BillingLine provenance panel.** Each line shows `Deterministic` or `AI`. Spot-check AI-sourced lines before continuing.
5. Click **Next**.
AI fallback fires when no deterministic rule matched. Billers see the same provenance in the Work Queue and may request corrections — verify any `AI` line is supported by your documentation before attestation.
---
## 14. Section 15 — Patient Education
1. Select patient education handouts.
2. Toggle **Teach-back documented** (`Y` / `N`).
3. Click **Next**.
---
## 15. Section 16 — LCD Audit & Review
1. The **LCD ambient badge** should be **green** at this point. If amber or red items remain, the Navigator shows links back to the section where the missing data must be entered. See [LCD Navigator](./lcd-navigator.md).
*Section 16 opens the LCD Navigator final review. Items requiring action are highlighted in amber.*
2. Resolve any remaining amber items by jumping to the linked section, fixing the data, and returning.
3. Click **Next** to move to Provider Attestation.
---
## 16. Section 17 — Provider Attestation
1. Read the attestation sentence covering the ESIGN Act, UETA, CMS, and HIPAA disclosure standards.
2. Sign on the signature pad.
3. Click **Sign & Lock**. If the service date does not match the appointment date, a soft-block prompt asks for a reason before locking.
Once locked, a **Go to Billing** prompt appears. The note is now locked and any later change requires an **Addendum** with a documented reason. PDF generation runs in the background — see [Sign Off](./sign-off.md) for what to do if PDF fails.
---
## Saving and resuming
- **Continuous autosave** — each field is saved as you complete it (per-field debounced save plus a safety-net heartbeat), so drafts survive network drops and device switches. The web wizard is online-only; there is no separate offline mode.
- **Resume** by tapping the same appointment tile on the Fleet Calendar (or opening the Wound Cockpit and clicking **Continue Visit**). You land back where you left off, on any device.
---
## Result
You completed all 17 sections, the LCD ambient badge is green, the Medical Necessity Statement and billing codes are reviewed, and the rendering provider has attested with **Sign & Lock**. The encounter is locked, the PDF is generated, the tissue log and inventory are updated, and a **Go to Billing** prompt hands the encounter off to the Billing Work Queue.
---
## Troubleshooting
| Symptom | Likely cause | What to do |
|---|---|---|
| **Start Visit** button is grayed out | Appointment is in `Canceled` or `No Show` status | Update the appointment status before starting. |
| Visit Timer shows "GPS unavailable" | Location services are disabled on the device | Enable location permissions for the browser or the Medipyxis app in device settings. |
| Wizard opens but shows the wrong patient | Tapped the wrong appointment tile | Close the wizard, then reopen from the correct tile. |
| Compression order shows a warning in section 8 | No ABI value on file | Enter the ABI in section 8 (Previous Treatment) or order one — the warning does not block you, but resolve it before Sign & Lock. |
| LCD ambient badge stays amber after a save | One or more checklist items still need data | Click the badge to open the Navigator; follow the jump-back link to the offending section. |
| BillingLine shows `AI` for unexpected lines | Deterministic engine returned zero rows for that scenario | Verify the line is supported by your documentation; correct in section 11 or 14. |
| PDF generation fails after Sign & Lock | Transient downstream error | The system retries automatically; if still failing, the Sentry event ID is shown — share it with support. See [Sign Off](./sign-off.md). |
## Related
Auto-rendered from `related:` in frontmatter.