Clinical workspace

The caseload lists patients who have been admitted to Rehab - those with a Rehab patient profile. It is not a list of every patient your organisation holds.

That distinction is deliberate. A dual-product organisation may hold tens of thousands of patient records that exist only for billing; presenting those here would describe an unlinked billing record as a rehabilitation patient. To bring a patient into Rehab, search for them in the add-patient dialog and admit them.

To open a chart from any Rehab screen, use the patient search in the header (or press Ctrl+K, or /). Type at least two characters of a first name, last name or MRN; "Jane Smith" and "Smith Jane" both work. It searches the same caseload as the Patients page, so it never shows a billing-only patient, and each result shows name, date of birth, MRN and whether the patient has an active episode. Opening a result opens the chart, which makes that patient the active patient - or, if a different patient is already active, asks before switching.

An episode is one course of rehabilitation care, with its own discipline, setting and status. A patient may have more than one over time.

Status moves Active → On hold → Active, and either can go to Discharged or Cancelled. Those two are terminal: an episode cannot be reopened. If care resumes, start a new episode - which is both what actually happened and the only thing the record can express honestly. A discharge that could be quietly undone is a closure that means nothing.

Cancelled means the care did not happen, so an episode can be cancelled only while no care has been delivered on it (no completed visit, signed note or billed service). After that it has to be discharged. Discharging, cancelling and decisions about goals need clinical signing authority - see episodes of care.

The patient record carries three lists that belong to the patient rather than to an episode: allergies, medications and problems and medical history (with an optional ICD-10 code).

The allergy list has three states that are shown differently: allergies recorded, "No known allergies (NKA)" recorded, and "Allergies not recorded". An empty list means nobody asked; it is never shown as reassurance. A banner at the top of the patient record and the episode page shows the allergy state, and a line at the top of every note shows allergies and precautions.

Anyone using Rehab can add an entry the patient reported, or record NKA as patient reported. Adding an entry from any other source, and resolving, stopping or marking an entry as entered in error, needs a clinician with signing authority, or a Supervisor or Admin. Entries are closed with who, when and why, never deleted.

Each episode carries the structured context a therapist records: diagnosis code and diagnosis in words, body region, functional limitations, mobility status, assist level, cognitive status, a fall-risk flag, the patient's own goals, payer context, and time available per session.

Everything in this section is recorded by a clinician. ArkCloud does not assess or derive any of it, and it does not conclude a fall risk. The diagnosis code field looks codes up in the loaded ICD-10-CM release as you type, but a match only means the code exists - not that it is right for the patient - and ArkCloud never sets a code itself. A value is present because a person entered it.

Facts already confirmed elsewhere on the episode are offered beside the fields they belong in, each behind a button: functional limitations confirmed on the body map, and current mobility and assistance by activity from confirmed observations. Copying appends to what is there and never replaces it, and a copy that would not fit a field's length is refused rather than cut short.

Fields are deliberately optional. An unknown value has to stay distinguishable from a recorded negative, because those mean different things clinically.

Pick a site on the body map, or search for it, and choose the side. The site opens with guided questions for that region and lists of conditions, symptoms, examination findings and functional limitations commonly recorded there. Answering “Yes” ticks the matching items; “No” and “Unsure” record nothing. Opening a site ticks nothing by itself.

Red-flag screening questions (for example new bladder or bowel change, saddle numbness, calf swelling with warmth) show a prompt to consider medical review when answered yes. The prompt never names a condition and never blocks you; the answer is recorded as a screening item you can confirm.

Selected is not confirmed. “Save selections without confirming” keeps your work; “Confirm” records it under your name. Only confirmed findings can go into a note or be offered anywhere else. The lists are awaiting clinical review and say so on screen.

Regions also offer special tests (for example Lachman, McMurray or Slump), each recorded as positive, negative or inconclusive.

Saving findings and mobility observations depends on a deployment setting. It is switched on for the hosted service; on a deployment where it is off, the screens show but nothing can be saved. More in body map and guided assessment.

Record what the patient did and how much help it took, one activity at a time: bed mobility, transfers, walking, stairs, wheelchair use, standing balance and self-care. Each observation has a level - Independent, Modified independent, Supervision, Contact guard, Minimal, Moderate or Maximal assistance, or Dependent - with its definition shown, plus helpers, device, the date, and whether you observed it or it was reported. “Not attempted” needs a reason.

There is no default level, and ArkCloud never sets one. The last confirmed level for the same activity is shown for comparison but never copied into the form. A new observation never overwrites an old one, so the change from, say, Moderate to Minimal assistance stays visible. These are the conventional clinical levels; they are not CMS Section GG codes and are never converted to them.

Once an activity is confirmed as needing a helper, the matching functional limitation (for example “Difficulty with stairs”) is offered on the body map with the observation as its reason. You tick it or you do not.

When your organisation switches this on, a site can list conditions that are consistent with the findings a clinician has confirmed there - never with the site alone, and never with unconfirmed selections. Each entry shows exactly which confirmed findings it rests on and which listed findings are not recorded. The list is in catalogue order; there is no score, no likelihood and no “most likely”, and none of it is a diagnosis.

For a condition you confirmed, ICD-10-CM candidates can be listed from the loaded release, matched to the side you documented, each with the release's own description. Choosing one fills the diagnosis field, which saves like any other edit; a primary diagnosis that is already set is never replaced. This is a lookup, not an AI aid. The rules behind both lists have not yet been clinically reviewed, which is why the feature ships switched off.

If a colleague saved changes to an episode while your form was open, your submission is refused rather than merged, and you are asked to reload. Nothing you typed is silently written over work you could not see.

Free-text clinical fields - the diagnosis in words, mobility, assist level, cognition, payer context, functional limitations, patient goals, and the patient note - are encrypted at the field level before they reach the database.

The diagnosis code is not field-encrypted. It remains protected by tenant isolation, by row-level security and by exclusion from logs; it is kept readable because a coded value has to support exact-match filtering, which encryption would make impossible. It is still treated as protected health information.

Field-level encryption is the only encryption a stored clinical value has today: the database disk and its backups are not encrypted at the storage layer in the current deployment.

If a protected value cannot be decrypted, ArkCloud reports an error. It does not show you a blank field - an unreadable note and an empty note are different facts, and only one of them means the clinician wrote nothing.

You can record the score from an instrument you administered outside ArkCloud, once a clinical lead has approved that instrument for your clinic. Each score is range-checked and dated, the first and latest are shown side by side, and a score line can be added to a draft note. ArkCloud does not administer the instrument, compute the score or interpret it. See outcome measures.

Administering a measure inside ArkCloud needs a published measure, and none is published yet. The governance guide explains what has to be established first.

The episode page also carries the clinical documentation for the episode: templated notes (Initial Evaluation, Visit note, Progress Report, Re-evaluation, Plan of Care, Discharge Summary), the structured plan of care, goals and the home exercise programme. How those records relate is described in how documentation works, each type in note types compared, and signing in review, signing and amendments.