Custom observation types allow you to create and manage your own observation types for consultations.  Custom observation types are created in addition to the built-in observation types in Panacea, as illustrated below.
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To access the observation types screen, simply click Settings > Observation Types:

Panacea's built-in observation types will be displayed.  These cannot be modified or deleted:

To add a new observation type, click the green '+' in the top right hand corner of this screen and select whether the observation type will be a discreate value, or a list.

The 'New Type' screen will appear.
Enter the various details for the new custom observation type and click 'Save'.

The new observation type will now be listed in the Observation Types screen and can be used in consultations:

The list observation type allows you to select a value from a predefined list, as per the example below.

To preserve data integrity, some aspects of the custom observation types become read-only after the custom observation type is used for the first time.  You cannot change the values associated with a list observation type after it is used for the first time, for example.
You can change the labels associated with observation types, but this change will only be reflected in future consultations where that observation type is used.

Adding custom consultation types to the consult couldn't be easier - just click the '+' at the bottom of the Objective Observations section (of the edit consultation screen) and choose the require observation type from the drop-down list: