> For the complete documentation index, see [llms.txt](https://docs.pravatherapy.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.pravatherapy.com/charting.md).
# Charting
Completing a chart note is a critical step in the workflow at Prava. A chart note must be completed for every session with a client otherwise we won’t be able to bill for it and it won’t get added to your payout.
## Web Platform
Check out [Charting in the Prava Web Platform](https://www.loom.com/share/f0d08e6b12a8440f9cdc7ab0e00e4774) for a video demo of the charting experience!
There are multiple ways in which to create a chart note for an appointment:
1. You can navigate to or , click on appointment card and hit “Create Note”:
2. You can go to the client’s profile, click on the “Charting” tab and click “New Note”
## Mobile Platform
See [Charting in the Prava Provider App](https://www.loom.com/share/2a4d91723f9f4e2ab171e262b983ee02) for a video demonstration of the note writing experience!
You can create a new directly from the appointment card either on the home screen on the day of the appointment or via the schedule tab:
Or you can navigate to the Client Profile > Notes section and create a new note from there:
There are a couple different types of chart notes available:
* Care Plan Transition - use when transferring an existing care plan from a different clinic, where it’s not appropriate to do another evaluation.
* Treatment - note for treatment sessions
* Evaluation - used for initial or re-evaluations
* Progress Note - used to submit a progress note for the patient
* Recert - used to submit a certification to extend a care plan
* Discharge - used to discharge a patient
## Note Types
### Treatment Notes
Fields
* Client Case – confirming the case, body part, or condition the note applies to.
* Date/time - confirming the date and time of the session
* Location - confirming whether the session happened virtually, in the clients home or at a clinic
* Patient Status - optional field to remark on additional context to the patient’s status
* Assessment/Patient Response - patient’s response to skilled interventions and provider’s assessment of the session
* Coding Fields (up to 4 distinct codes can be attached)
* CPT Code: the code being billed
* CPT Code Minutes: the number of minutes spent on this activity
* CPT Code Interventions & Justification: the list of skilled interventions (with dosage) performed as well as description of skilled & medical necessity
See also [AI Treatment Notes](#ai-treatment-notes).
### Progress Notes
Progress notes can be submitted as a standalone non-billable note or as a combined Progress/Treatment Note that includes the billable treatment portion. Progress notes themselves aren’t billable and have no CPT Codes attached, but the treatment session is and is billed/documented as a regular treatment session.
See also [AI Progress/Recert/Discharge Notes](#ai-progress-recert-discharge-notes).
### Recertification Notes
Recertifications are submitted as additional, non billable, notes when a care plan needs to be recertified by the referring physician.
We will send these to the referring physician automatically after submission to get signed.
See also [AI Progress/Recert/Discharge Notes](#ai-progress-recert-discharge-notes).
### Discharge Notes
There are two ways to document a patient discharge, depending on the clinical situation:
1. **Discharge Note:** Used when a patient is no longer receiving care and no treatment was provided on the discharge date. This is submitted as an additional, non-billable note to close out the episode of care.
2. **Discharge / Treatment Note:** Used when the last visit includes active treatment. In this case, the discharge information is documented within the final treatment note itself — no separate discharge note is needed. This note is billed as a standard treatment visit.
Once a discharge note is submitted, the client will be automatically archived within 2 weeks. Providers do not need to contact Provider Support to initiate this process.
See also [AI Progress/Recert/Discharge Notes](#ai-progress-recert-discharge-notes).
## Completing Notes
In order for us to process a session for billing and include in your payout you need to “Sign & Lock” the note to mark it as finalized. You can always [Unlock a Note](#unlocking-notes) after locking it if you need to make any modifications. Instructions are below:
Note: You may only have the option to “Sign” if you’re approved to be a rendering provider. This can happen if you’re an assistant (see [Assistant Co-signatures](#co-signatures) for more information) or if you’re not credentialed with a specific insurance company and need someone to co-sign your notes.
### Web
As you’re editing the note, go to “Chart Note Options” and click on “Sign and lock” (or just “Sign” if that is what is shown)
### Mobile
As you’re editing the note, click the “Sign & Lock” button at the top (note that assistants only need to “Sign”):
## Carry Over / Prefill
Information from previous notes within the same [Client Case](/client-cases.md) will carry over to the next note automatically when you create it.
### Copy from previous note
If you need to copy over from a specific previous note (e.g. an Eval from a different case) then you can choose a specific note to copy from from the chart note edit view:
Under the 3 dotes menu on the chart note edit page select “Copy from chart note”:
Then you can select the specific note you want to copy from:
Then when you click copy all fields that have the same field name from the selected note will be copied over and override what is currently entered.
## Tracking Outcome Measures
You can optionally choose to track outcome measures in a more structured format within the charting notes. In the SOAP note template you can select to record any number of outcome measures:
You can also choose to attach any relevant files (e.g. filled out metric surveys) here. The Prava EHR doesn’t yet support natively recording and calculating outcome measures, so we recommend using a tool like . Alternatively you can choose to upload these reports directly under [Client Documents](#client-documents). Files attached to Chart Notes will only be accessible via the Chart Note, not under the Client Documents tab.
These measures will show up in a graph format on the “Metrics” tab of the Client profile:
We don’t currently support entering in the actual outcome survey results, so we recommend using a tool like to calculate the score and then export the result as a PDF and attach it to the client’s profile.
## Documenting Self Pay Services
To document cash pay services and have Prava collect appropriately you would add the Cash pay services under the “Billing Codes” section just as you would any codes that you’re billing to insurance There’s 2 ways this typically works:
1. Charging the entire visit as a cash pay visit
If the Client has been [set up as a cash pay client](/client-intake-process.md#self-pay-cost-estimates), then you would submit a “Treatment” note just as you normally would for an insurance session. You’re still required to fill in the Billing Codes section to document the total time spent with the client (and in case the client wants a [super bill](/compliance-insurance-billing.md#what-is-a-superbill)), but the specific codes you select do not affect how much the client is charged.
2. Adding an additional cash pay charge to an insurance visit
If we are billing insurance for the session but you would like to add an additional cash service (e.g. Dry Needling) then you would bill your normal billable cpt codes (e.g. 97110, 97112, …) and add the cash pay services as additional billing items:
## Client Documents
If you’d like to access or upload any files related a client you can do so in the Client Profile under Charting > View Documents
On the mobile app, this is also available under the “Documents” section in the client profile:
## Smart Phrases
You can manage your Smart Phrase library from your profile:
**Web Platform:** click your name at the bottom of the left navigation bar, select "Profile", then open the Smart Phrases tab
**Mobile App:** Menu > Smart phrases
Here you can add, edit and delete your Smart Phrases.
Then when you’re writing your chart note you can quickly insert these phrases by clicking on the lightbulb icon in the text edit field and then selecting from the list of available smart phrases:
## Unlocking Notes
After signing & locking a chart note, sometimes you need to go and make an update due to billing or clinical errors. You are free to unlock the note in this situation and provide a reason for what kind of modification is required. This is added to the audit log of the note to maintain clinical note integrity.
### Mobile Instructions
* Navigate to the locked note and tap on it to open it:
* Then you can click on the Unlock button to enable editing, this will allow remove the signature
### Web Instructions
To do this on you can click on the “Unlock” button on the chart note view:
## Co-signatures
All notes written by assistants or non credentialed providers must be co-signed by a lead provider before we can process for billing.
Assistants/non credentialed providers don’t have the ability to lock their chart notes - instead they “Sign” the note to mark it as complete and then the lead provider on the case (the one who submitted the Eval) will get a [task reminder](/tasks.md) to review and lock the associated note. The provider is free to unlock and edit the note or ask the other provider to fix it before signing and locking it themselves which would trigger us to bill it.
Task reminder:
Clicking on this task will open up the associated note where you will be able to review and “Sign & Lock” it like you would any other note.
### Can I switch the lead provider who will review the notes?
Yes you can! Just email and we can update the lead provider for a care plan. This will update the provider who is responsible for progress notes and recerts as well.
If you’re looking to just update the provider for a single session, the system will allow any of the other (non-assistant) providers to “Sign & Lock” a note, so they would just need to navigate to the chart note via the Client’s Profile and review it there.
### How can I make edits to the note?
If you’d like to edit any of the note contents to correct billing or add additional justification you can do this easily white reviewing. To make edits you first need to remove the current signature on the note to open it up for editing. To do this, click on the red trash icon in the signature section:
Then you can click on the Edit button in the top right corner to open up the note in edit mode and make any changes you need:
### How do I see a full list of co-signatures I’m responsible for?
We recommend using the Dashboard/home page which will show you all your open tasks and let you filter by task type.
Go to
Select the "Co-signatures" category:
This will show you only your open co-signature requests:
Then you can click on each row which will open up the note on the right where you can review and sign off on:
## AI Treatment Notes
This feature allows you to record your treatment sessions and have AI auto-generate a highly compliant note within minutes. This minimizes the effort needed to write treatment notes and eases the burden of worrying about properly justifying skilled and medical necessity.
You can also watch a video demonstration of this feature here: [Treatment Notes (App) + AI Scribe](https://www.loom.com/share/ecea623d6c30432abb93eba2907b08a8).
There are 2 “modes” you can use this feature in:
* Whole session recording: you can record the entire session and the AI will automatically filter out the relevant bits from the natural dialog with the patient. For example, it will note which exercises the patient is being instructed in, but will completely ignore any non clinical discussions around personal life or small talk.
* Note dictation: you can use it at the end of the session to narrate the details you would like included in the note. This is a quicker way to enter in the details instead of typing and it will automatically include the correct verbiage around medical necessity and skilled involvement to connect the exercise to the care plan/goals for the patient.
### Web App
**1.** Create a treatment note as you usually would through the Prava Provider Mobile App (*note: the PT - Treatment - SOAP template is not supported*).
**2.** Start recording - At the top of the screen, you'll now have the ability to start recording your session. Click on “Record”
**3.** Note the instructions on the confirmation page and hit “Start recording”:
**4.** To finish the recording, click on the red stop button on the recording widget at the bottom of the page:
**5.** Once the recording is complete, you can click on "Generate Note," to start generating the note:
**5.** Any billing codes will be detected automatically and displayed for you to confirm. Please review and make any edits
6\. After hitting “Continue” the note will take about a minute to process and generate:
### Mobile App
To leverage this, follow these steps:
**1.** Create a treatment note as you usually would through the Prava Provider Mobile App (*note: the PT - Treatment - SOAP template is not supported*).
**2.** Start recording - At the bottom of the screen, you'll now have the ability to start recording your session. Move the slider from left to right to start recording.
**3.** Note the instructions on the confirmation page and hit “Start recording”:
**4.** To finish the recording, tap on the recording widget and select "Complete Session."
**5.** Once the recording is complete, you can click on "Generate Note," which will have you confirm the billing codes and minutes and then generate the rest of the fields for you.
**6.** After the generation is done, you can review the output as you normally would and make any edits you would like before submitting the note as usual.
## AI Progress/Recert/Discharge Notes
For progress notes we are able to pre-fill the following fields for you before you even start the session!
* Summary of Skilled Interventions
* Patient Progress & Response to Treatment
* Reason for Continued Skilled Services
We do this by reading all of the daily treatment notes that you have submitted since the last Eval/Recert/Progress Note and automatically summarizing the information from those. You are of course able to edit the information that is pre-filled and are highly encouraged to review for accuracy. We do find about 90-90% of all progress notes are submitted with zero or minimal modifications, but it is still your responsibility as a practitioner to review for errors.
How to use?
You can create a progress note as you normally do via the mobile app (it won't work via the web) and it will automatically pre-fill the supported fields immediately. You can then review/edit and submit the note as you normally would.
You can also view a video demonstration of this here: [AI Treatment Notes (App)](https://www.loom.com/share/178930d172784ae9bea04319f5894b05)
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