What does it mean to document accurately and appropriately? : 3 important facts to note
September 16th, 2018
document accurately -What does it means to document accurately and appropriately?
Please answer the following questions and include your rationale and evidence-based research to support your written work.
- What does it means to document accurately and appropriately?
- What are the documenting guidelines? When is it appropriate to use abbreviations?
- What is the difference between subjective and objective data?
- What does it mean to demonstrate clinical reasoning skills?
- How can you use clinical reasoning to plan the organization of a comprehensive exam?
- How will you document variations of normal and abnormal assessment findings?
- What factors influence appropriate tools and tests necessary for a comprehensive assessment?
- Reflect on personal strengths, limitations, beliefs, prejudices, and values.
- How will these impact your ability to collect a comprehensive health history?
- How can you develop strong communication skills.
- What interviewing techniques will you use to interview the patient to elicit subjective health information about their health history?
- What relevant follow-up questions will you use to evaluate patient condition?
- How will you demonstrate empathy for patient perspectives, feelings, and sociocultural background?
- What opportunities will you take to educate the patient? document accurately