Sending notes and letters, and what to do when a delivery stops

Cliniko and Nookal connections require a paid plan.

Small Mercy writes nothing on its own. Reading your diary is something you ask for; writing into a patient’s record is something you confirm.

• A note reaches your practice software only after you confirm it and then acknowledge the exact patient a second time on the delivery card.
• It is written as a draft in your practice software. It is a document to check and sign there, not a finished record.
• Once you have confirmed a letter, you can file it as a PDF copy on the patient’s record. Filing it is not sending it: the recipient still receives the letter the way they always have.
• Later edits in Small Mercy are never described as the version that was delivered. If you change the note after sending, Small Mercy says so rather than implying the two match.

Filing a draft note

On a confirmed note from a consult that started on a linked appointment, the delivery card names the exact record the draft will go to. Tick the acknowledgement — I confirm this is [patient]’s Nookal record, case [n], or I confirm this is the Cliniko appointment for [patient] — then choose File draft in Nookal or Send draft to Cliniko.

Small Mercy then tries two steps, in order:

1. Writes the draft into the template you configured for the patient and appointment you confirmed.
2. Reads the draft back by its returned identifier and checks its draft state, destination and reviewed text against what was sent. Nookal’s check includes the case; Cliniko’s includes the booking and attendee. If no identifier comes back, Small Mercy stops and follows the recovery path below instead of claiming delivery.

Only when the readback agrees does the card say Draft filed (Nookal) or Draft sent (Cliniko).

Practice systems tidy what they store — Nookal, for instance, decodes HTML characters on the way in and renders a date in its own display format on the way out. Small Mercy compares what a clinician will read, not the bytes on the wire, and it never compares a field the vendor does not promise to echo exactly.

When a delivery stops

Small Mercy would rather stop than guess. A stopped delivery is not a lost note: the confirmed note is still in Small Mercy, still exports as clean text and PDF/A, and can still be copied across by hand — see getting a note into your practice software.

The card says, in plain words, what happened and what you can do. These are the states you may see:

• Being prepared — Filing is being prepared. Refresh before taking another action. The write is in progress; wait for it.
• Rejected before anything was created — Nookal authoritatively rejected the previous request before creating a note. You may explicitly retry. (Cliniko: A bounded reconciliation found no exact draft. You may explicitly retry.) Nothing was written, so Retry draft to Nookal / Retry draft to Cliniko is safe.
• Outcome unknown — Nookal may already have created this note. Small Mercy will not send another copy because the API has no safe duplicate-reconciliation contract. If Small Mercy received a Nookal note ID, Check outcome in Nookal appears and reads that exact note again. If no ID came back, there is no check button: inspect the patient’s treatment notes in Nookal and resolve the uncertain write with Small Mercy support before another filing action. For Cliniko, Check outcome in Cliniko can also work without a returned ID: it searches a bounded set of candidate drafts and stops for manual review if the result is not decisive. Neither system is sent another note automatically.
• Did not match — The returned Nookal note did not exactly match the reviewed destination. Nookal disagreed on [the fields]. Small Mercy read a record back, but it was not the note it sent on one or more named fields. Small Mercy will not send another copy. When Check outcome in Nookal is offered, use it to read that exact note again — a later read may resolve the mismatch. Otherwise inspect the patient’s notes in Nookal and resolve the record manually.

Check outcome in Nookal and Check outcome in Cliniko are read-only and safe to repeat when offered. Nookal’s check needs an exact note ID; when Small Mercy never received one, the button is absent and the record needs manual inspection. Cliniko checks a known ID directly, or makes a bounded candidate search when the ID is missing. The card updates only when the result is supported by that readback.

The target changed

If the clinician mapping, the template or the patient link moved after your consult started, the card says so — This Nookal clinician, patient or template mapping changed after the consult started. Small Mercy will not use the old destination; transfer the confirmed note manually. — and offers nothing to send. Small Mercy froze the destination when the consult began; rather than deliver into a destination that has shifted, it asks you to start a new linked consult or copy the note across yourself.

Filing a letter

Australian, New Zealand and United Kingdom organisations can file a confirmed letter as a PDF copy on the patient’s record in Cliniko or Nookal, from the letter itself. Small Mercy uploads the confirmed PDF and checks the returned attachment. In Nookal, Small Mercy downloads the stored file and compares its bytes with the PDF it sent. In Cliniko, Small Mercy checks the attachment ID, filename, patient and file size when Cliniko returns one; it does not download or hash the stored PDF. If the available checks cannot confirm filing, the card shows the unresolved outcome and Small Mercy does not file a second copy on its own.

A filed copy is a record, not delivery: send the letter to its recipient the way you always have. To attach or send it yourself instead, export it as a PDF — see getting a note into your practice software.

Disconnecting with a delivery outstanding

If any delivery is still in an uncertain state, Disconnect asks you to resolve it first. Disconnecting would throw away the only record of what may have been written, and that record is what makes the state resolvable.

Disconnecting — or deleting data in Small Mercy — does not remove notes or letters already filed into Cliniko or Nookal. Those live in your practice’s own software and are managed there.