The attending physician is responsible for which of the following types of acute care documentation.
which of the following is not usually a component of acute care patient records.
the number of ligatrues, sutures, packs, drains, and sponges used specimens removed would be found in
which of the following is an example of clinical data.
emergency care record
which type of specialized record includes care provided prior to arrival at healthcare setting and times and means of arrival.
which of the following represents documentation of the patients current and past health status.
which of the following contains the physicians findings based on an examination of the patient.
documents opionions about the patients condition from the perspective of a physician not previously involved in the patients care.
in a medical history, which of the following is a detailed chronological description of the development of the patients illness.
to document the physicians instructions to other parties involved in providing care to a patient.
which of the following is an example of a advance directive.
patient history questionnaires are most often used in:
which report in medical record includes name of doctors.
which of the following is not included in a an accute care record.
which of the following is not considered clinical data.
care driven directly related to patient
patients complete history
which of the following is not document in ER report
acute care record with chronilogical report to the persons stay in the hospital
which part of the medical history documents the patients description in their own words
contains physician findings based on an examination of the patient.
community mental healthcare
not long term care setting
in which setting may treatment chart travel with patient between treatment facilities.
nurse responsible for which of the following type of acute care.
which of the following would not be found in a medical history.
an attending physician requests the advice of a second physicaian who then reviews the health record and examines the patient. the second physician records impressions in what type of report.
which specialized type of progress note provides healthcare professionals impressions of patient problems with detailed treatment action steps.