Goal: Build your plan into an estimate the owner understands, get their signature, and document anything they turn down.
Why this matters
This is the money conversation, and it is a medical one too. The estimate turns your plan into a number the owner can weigh, and their signature is consent to proceed. What they decline belongs in the record as much as what they approve. Do this well, and everyone is clear: what is happening, what it costs, and what the owner chose not to do.
Need a refresher on prescriptions? Go back and review Review Prior Prescriptions and Dispense a New One
Prefer to click through it first? Take the tour, then come back for the steps.
Step 1: Build the estimate
Click Estimates at the top of any patient visit, then build the plan.
Start from a template: type the name in the search field and pick it under Templates. Templates are practice-specific, set in Admin, then Estimates.
Add individual items: search products by name. Use the Exam, Ward, and Hospitalization drop-downs to include those charges.
Hospitalized patient? Set the Duration to the expected length of stay. Instinct EMR calculates a range from frequency, quantity, and duration.
Adjust a price range: edit the AMT LOW and AMT HIGH fields directly.
Tip: Drag and drop line items into the order you want to walk the owner through. The estimate is a script for the conversation, not just a total.
Heads up: You can build an estimate for a patient who is not checked in, as long as they have a previous visit in Instinct EMR.
Step 2: Mark what the client declines
When an owner turns something down, that is part of the medical record. Check the box to the left of the item and click Decline, or drag the item into the Declined Items section at the bottom of the estimate.
A declined item stays on the printed estimate without its price and will not carry over to the Tx Sheet or the invoice. Delete the line instead, and that history is gone.
Step 3: Get client sign-off
A signature is the owner's consent to proceed. Review the estimate with them before completing it. Once signed, the estimate locks.
Remote (email link)
Click Complete and select Sign and complete.
Confirm or enter the client's email and click Send Signing Link.
The client gets a mobile-friendly email with the full estimate, types their name, checks the legal acknowledgment box, and selects Sign.
In person
Turn the workstation or tablet toward the client.
They type their name in the signature field under the terms and conditions, check the legal acknowledgment box, and select Sign.
Either way, Instinct EMR records a time-stamped signature on the estimate, visible to your team right away.
Tip: Once the estimate is approved, use Generate Tx Sheet to turn it straight into orders. Approved items carry over and declined items do not.
Tip: To print instead of signing digitally, click Print and choose Print w/all details, Print w/all prices, or Print w/total only.
Heads up: Once signed digitally, the estimate is legally binding and cannot be edited. If something needs to change, create a new estimate.
Step 4: Send the paperwork after sign-off
Discharge materials and follow-up go out through the Comm Log, which keeps the whole conversation on the record.
Open the Comm Log from the top right of any patient visit, or press Ctrl+L.
Pick the method: Phone – Outbound to log a discharge call, or Email to send documents.
Attach files from the patient Chart, including any Plumb’s handouts, then enter the client email and click Send.
Everything sent, attachments and phone notes alike, logs automatically to the patient record.
Heads up: If the client replies, it lands in your practice inbox, not back in Instinct EMR. Paste replies into the Comm Log to keep the conversation in one place.
👉 Now you try
Setup: Open a patient in Instinct and navigate to Estimates.
Do: Add two or three items—or start from an estimate template. Decline one item, then complete and sign the estimate in person.
Check: Confirm the estimate is signed and the declined item appears under Declined Items.
Done right: The declined item remains visible on the estimate without a price and does not carry over to the Treatment Sheet or invoice.