Goal: Turn your treatment plan into orders the team can carry out, with every charge landing right the first time.
Why this matters
You have examined the patient, and you know the plan. The Treatment (Tx) Sheet is where that plan becomes real. It is what the team follows and what the patient actually gets. Enter it cleanly, and two things take care of themselves: nothing falls off the schedule, and every billable item posts to the invoice under the right doctor. Orders here are the difference between meant-to and done.
Need a refresher on starting your chart? Go back and review Start Your Chart Document.
Prefer to click through it first? Take the tour, then come back for the steps.
Step 1: Set who and where
Start with the header, because it drives the billing.
Open the Tx Sheet from the Status Board: Click the three-dot menu by the patient name and pick Tx Sheet, or just click the patient name.
Then set the header fields:
Doctor: the attending. Every fee posts under this doctor's initials, so set this first.
Exam Type, Ward, Hospitalization: set whatever applies to this patient.
Picking any of these adds its fee to the invoice automatically. That is why the header comes before ordering. It is the setup that makes the charges land right.
Heads up: Pick the doctor before Hospitalization. Hospitalization will not open until a provider is set.
Step 2: Order each item the way it calls for
Now build the plan. What you are ordering decides how you order it. Read the one that fits and skip the rest.
Ordering one thing (a treatment, a diagnostic, a single product)
Type it in the order bar at the top of the sheet and pick it from the drop-down.
Set the quantity, route, frequency, and start and end time.
Optional: toggle Mandatory Treatment Notes, or add an Order Note for administration notes, call parameters, or a staff-safety reminder.
Click Order.
Tip: A treatment with a note shows an orange comment icon on the sheet. Hover to read it.
Ordering a group of items together
Use this workflow when you need to order a predefined group of items at the same time, such as an anesthesia bundle or a CBC panel.
Type the group name and pick it.
In the Group Confirmation window, Click each dot to toggle items on (blue) or off (gray).
Adjusting Items
Adjust one item: Click its name, update it, and click Order in that item.
Adjust several at once: Bulk Edit at the top to set frequency, start and end times, or doctor across all selected items.
Click Order to add the whole set.
Recording a one-time treatment
Use this workflow for treatments or tasks that are completed once and do not need an ongoing schedule, such as adding a new fluid bag, replacing an IV catheter, or giving a one-time medication dose.
Click + One-off in the top right of the sheet.
Enter the details and click Complete.
One-offs land in the Discontinued and Completed section, since there is nothing scheduled in the future. Dose safety warnings still fire for one-off medications.
Heads up: Do not use One-off for items with an automatic charge, like oxygen monitoring or IV fluid rates. It creates a duplicate charge.
Step 3: Use the dose calculator
When you order a medication configured with a dose calculator, the smart calculator opens automatically, alongside Plumb's Monograph and the Medication Guide.
Type the medication name and select it.
Enter either the Dose or the Total Dose. The Calculated Quantity fills in automatically.
Click Use Calculated Quantity to drop it into the Quantity field.
Out of range? Instinct EMR shows a warning. Recalculate, or click Ignore + Order if you mean it.
Set the remaining fields and click Order.
Heads up: The calculator needs a patient weight. If you do not see it, add the weight first.
The warning is the point. Instinct EMR checks your math against a safe range every time you order — the second set of eyes paper never gave you.
👉 Now you try
Setup: Open your practice patient's Tx Sheet in Instinct.
Do: Set the header with yourself as the doctor. Order a medication using the dose calculator — enter a dose, accept the calculated quantity, and place the order.
Check: The order appears on the sheet. The charge shows on the invoice under your name. If a safety warning fired, you just saw the dose range check in action.
Done right: The medication is ordered and billed correctly. If a safety warning appeared, you also saw the dose range check in action.