Use Doc Alert to send an ultrasound for physician review. Reviewers work in Approvals. A custom chart can have its own named approval chain.

These are related actions with different purposes:

A general visit provider review used for AAAHC is separate from the ultrasound's Doc Alert. Completing a visit, locking its notes, or sending a different chart for review does not sign the ultrasound.

The physician is the reviewer. The notification staff member is the person to notify after the doctor signs. Both selections are required for an ultrasound send.

If something required is missing, for example no physician chosen, no notify-on-sign-off staff member selected, or the ultrasound not yet marked as performed, Send to Physician stays visible but disabled, and shows the exact reason right there so you know what to fix before trying again.

Doc Alert notifies the physician by email only; it has no text message option. Read the send result. If the reviewer has no email on file, the alert still sends, but staff see a warning and need to contact that physician directly. Do not assume that a queued review means the physician has received an email.

Open Approvals:

On the visit, Ultrasound → Info → Doc Alert shows the sent and reviewed indicators and dates. Review status provides the available review detail.

An empty reviewer list does not mean a sender's submission disappeared. Check Submitted by me and confirm which physician was selected.

Open the assigned item from Approvals or its notification link. Review the findings and available attachments, then use the offered approval, denial, or return-for-corrections action.

A reviewer can also turn on Review Assigned to You under Your notifications to get a text message or an in-app alert as soon as a chart, Doc Alert, or other approval is assigned to them. This adds an alert; it does not replace or turn off the reviewer email. See Choosing What You're Notified About.

A returned item needs correction and resubmission. A signed item is protected from normal edits. Follow the correction controls on that record; a chart document's Addendums panel is different from a Visit Record note lock or an administrator's Reset Doc Alert action.

An administrator should confirm that the intended reviewers have active user accounts, the required review access, and usable email addresses.

For an ultrasound, staff select the Physician on the visit. Other chart review paths can use a configured reviewer position or a position marked Clinical Reviewer. Do not change position routing simply to compensate for an incorrect physician selection.

To set up a position for physician or clinical review: open or create the position, turn on Clinical Reviewer, and add the active staff who should review as Qualified Team Members, confirming each has a working email address. Doc Alert routes by the Clinical Reviewer flag, not the position's name. Adding someone who is not an administrator to a Clinical Reviewer position also marks them as a physician, which makes them selectable as the ultrasound Physician and turns their login into a review-only account (see below). Removing them from the position does not undo this; contact support if someone was added by mistake. See Positions for the full setup steps. Configure custom chart chains on the relevant custom chart template. Their template names remain their names in Approvals.

The reviewer preview on a chart template's Approval Chain setup also flags common setup gaps under Setup health, such as a Clinical Reviewer position with nobody assigned, or someone assigned to that position who is not yet linked to a CoolFocus login. Resolve what it flags before assuming the routing is correct.

If a send says no reviewer is configured, resolve that setup problem before sending again. If several clinicians could review, confirm the intended assignment instead of assuming the first name or first available email will be chosen.

A physician who signs ultrasounds and does nothing else in CoolFocus needs a physician account, not a staff user group.

A physician gets Approvals automatically. From there they can open only the visits and scans that were sent to them for review, read-only, and sign or return them. They do not need Care, Visits, Scheduler, or any other permission.

Exceptions: a physician who is also an Administrator keeps full access, since administrators manage the organization. Do not use a Clinical Reviewer position for staff who also do other work in CoolFocus, such as a nurse manager. It would turn their login into a review-only account. Route their reviews through a regular reviewer position instead.

The CoolFocus 5 setup checklist may flag a physician-only group as having no access. That is expected for this group.

Pending approvals have a due time. The configured timeout determines the window; it is not a promise that a clinician will review by that time. Overdue work is never approved automatically.

Your own notification settings can't stop Sign-off required or its reminder. Those emails depend on who the review is assigned to and the email address on their user record. To stop them reaching someone, assign reviews to a different person or position.

Reminders and overdue emails stop once the review is signed or withdrawn, including when it is signed in CoolFocus 3. If a reviewer is unavailable, use Approvals to check the current assignment and state, and ask an administrator to review the recovery options for that pending item.

A custom chart's approval chain is configured separately from the ultrasound Doc Alert. Follow the action on that chart and its named chain.

Pregnancy Test review is also its own chain, separate from the ultrasound's Doc Alert. Sending a pregnancy test for review does not send or affect the ultrasound, and sending or resetting the ultrasound Doc Alert does not touch a pregnancy test review, even on the same visit.

Setting it up: on a visit's Pregnancy Test section, an administrator opens Reviewer settings and chooses the position that reviews pregnancy tests, for example a nursing position. This choice applies across your whole organization, not just the one visit. If a chart template already uses a Premium custom approval chain for Pregnancy Test, that chain is used instead and Reviewer settings does not appear. Until a reviewer is configured, Send for review stays unavailable, and the section explains that an administrator needs to choose a reviewer.

Sending and tracking: after recording the pregnancy test result, staff use Send for review in the Pregnancy Test section. If a review was returned for corrections, the same button reads Resubmit for review. A pending pregnancy test review shows in Approvals like any other review, and the assigned reviewer signs off there.

Reopening after signing: an administrator can use Reopen Pregnancy Test on a signed pregnancy test to reopen it for another review. This is separate from Reset Doc Alert; resetting one never clears or changes the other's sent, signed, or signature state.