Instinct and ImproMed will work closely together to help simplify the check in/out process as well as help to easily capture missed charges.
Table of Contents
✅ Checking Patients In/Out
The check-in/out process for patients in Instinct is driven by ImproMed.
Check-In Through ImproMed
Once a patient has been checked in to ImproMed, they will automatically appear on the Instinct OP Board within 1-4 minutes. The grey arrows under the ‘In/Out’ column on the Status Board lets you know they were checked in via ImproMed as opposed to a manual check in via Instinct (manual check ins will not have the sync icon).

💡 Please note: A “reason for visit” will now transfer over to Instinct for these patients which previously did not occur with the ImproMed Integration.
To maintain a consistent workflow, it is ideal for the front desk team to complete as much information on the Instinct Status Board as they can after checking a patient into ImproMed. This helps the medical team know who is checked in, why they are here, which doctor they are assigned to, any specific alerts, and more!
Check-Out Through ImproMed
If a patient was checked in via ImproMed, the only way to remove them from Instinct is to check them out of ImproMed.
Force Check Out
This feature can help to “Force Check Out” a patient who is no longer checked in to ImproMed, but is still appearing on Instinct due to a lag in your internet connection. Please note that this should only be used if the patient has been checked out of ImproMed completely but is not being removed from Instinct. If you click ‘Force Check Out’ for a patient who is still checked in to ImproMed, they will reappear in Instinct after a few minutes because Instinct is still identifying them as being checked in.
To Force Check Out a patient, click the 3-dot menu next to the patient’s name on the Status Board and select “Force Check Out”.

If a patient is being force checked out and has a similar name as another patient, Instinct will suggest merging the patient records. Please ensure that the suggested patient is indeed a duplicate before merging, as merges cannot be undone!

💸 Invoice
The ImproMed and Instinct Invoice will sync information to make sure charges are being properly audited.
There are 3 different icons that can be found on the Instinct Invoice:
- Download Icon = Items entered directly on the ImproMed invoice that Instinct downloaded here to keep predicted billing accurate
- Sync Icon = Items completed in Instinct and already on the ImproMed invoice
- Orange Flag = Missed charges not yet included on the ImproMed invoice

Missed Charges – Instinct will automatically “flag” items with an orange triangle that are missing or not yet entered on the ImproMed Invoice. To hide any synced/downloaded charges and only show missed charges, toggle the “Only Show Missed Charges” button.

Missed Charges can be handled a few ways:
- Void it if it was incorrect (via 3-dot menu to the left of the invoice line item)

- Add this item to the ImproMed invoice which will cause it to “sync”

- Enter charges directly into the ImproMed invoice that may not be in Instinct (such as a TPLO plate). That item will be brought into the Instinct invoice with a download icon as shown below.

Voiding items on the Instinct Invoice
Synced items on the Instinct Invoice indicate a billable treatment was completed in Instinct and also added to the ImproMed invoice (so they are in-sync with each other). If a synced item on the Instinct invoice is voided, it will be removed from the Instinct Invoice but does not automatically remove it from the ImproMed invoice. Since this invoice item is still on the ImproMed invoice but not on the Instinct Invoice (because it has been voided), it will download to the Instinct Invoice and be displayed with the download icon. To remove this downloaded item from the Instinct Invoice, simply remove it from the ImproMed invoice.

👩⚕️Workflow at Discharge
Before checking out the patient, resolve any missed charges with your medical team. If no missed charges exist, you will see a Piggy Bank and you can proceed to check out the patient through ImproMed.

Suggested Workflow:
- Confirm there are no ‘Missed Charges’ and address if so (the piggy bank will indicate all charges have been sent)
- Apply the ‘Ready To Go’ icon (this can be used to show no further charges are to be sent/the invoice audit is complete)
- Process the ImproMed invoice with the client
- Check the patient out of ImproMed to close the Instinct visit
🔍 Troubleshooting and ProTips
- Make sure the Product in Instinct exists in ImproMed with the same PIMS ID, otherwise, syncing missed charges may fail.
- Make sure you enter the code and quantity exactly as they appear in Instinct on to the ImproMed invoice, otherwise, syncing missed charges may fail.
- If ImproMed is down:
- You can always manually check in a patient in Instinct to get a treatment sheet built. Once ImproMed is working again and the patient is checked into ImproMed, the check in/out and invoicing will sync up.
- If a new patient arrives when ImproMed is down you can create a new patient in Instinct with a temporary patient/account ID. When ImproMed is back online you would then check them in as you normally would. After doing this, you would have two of the same patients in Instinct: 1 with the temporary ID created in Instinct and 1 with the actual ID checked in via ImproMed. To resolve this, you’d merge these two patients together and reopen the treatment sheet from the temporary ID so you don’t have to create it again.
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