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Supported diagnosis and procedure coding systems
ICD-10-CM
Diagnosis coding system used in the United States.
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ICD-10-PCS
Procedure coding system used in United States inpatient hospital care.
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ICD-10
Diagnosis coding system used in international health reporting.
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ICD-10-UK
Diagnosis coding system used in the United Kingdom.
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CIM-10-FR
Diagnosis coding system used in France.
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ICD-10-GM
Diagnosis coding system used in Germany.
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OPCS-4
Procedure coding system used in the United Kingdom.
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OPS
Procedure coding system used in Germany.
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CCAM
Procedure coding system used in France.
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CPT
Procedure coding system used in the United States.
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Clinical note templates
SOAP Note Template
A structured SOAP note format for subjective history, objective findings, assessment, and plan.
SOAP Note Template
SBAR Handoff Template
A situation, background, assessment, and recommendation handoff format for clinical communication.
SBAR Handoff Template
Referral Letter Template
A formal specialist referral format with reason for referral, clinical context, and requested action.
Referral Letter Template
Discharge Summary Template
A discharge summary format for hospital course, diagnoses, medications, instructions, and follow-up.
Discharge Summary Template
Emergency Department Note Template
Fast emergency documentation for presentation, initial findings, interventions, and disposition.
Emergency Department Note Template
Progress Note Template
A progress note format for interval history, changes, assessment, and follow-up plan.
Progress Note Template