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, instead of relying only on 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 to a Clinical Reviewer position also makes them selectable as the ultrasound Physician automatically; removing them from the position removes that too. 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.

Pending approvals have a due time. The review process can remind the assignee as that time approaches and notify the initiator when the approval becomes overdue. The configured timeout determines the window; it is not a promise that a clinician will review by that time.

Overdue work is not automatically approved. Use Approvals to check the current assignment and state. If a reviewer is unavailable, 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.