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Guide to clinical documentation

Author: Debra D Sullivan
Publisher: Philadelphia : F.A. Davis Company, [2019]
Edition/Format:   Print book : English : Third editionView all editions and formats
Summary:
"Here's your guide to developing the skills you need to master the increasingly complex challenges of documenting patient care. Step by step, a straightforward approach teaches you how to write SOAP notes, document patient care in office and hospital settings, and write prescriptions. You'll find a wealth of examples, exercises, and instructions that make every point clear and easy to understand"--
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Additional Physical Format: Online version:
Sullivan, Debra D.
Guide to clinical documentation.
Philadelphia : F.A. Davis Company, [2019]
(DLC) 2018019898
Document Type: Book
All Authors / Contributors: Debra D Sullivan
ISBN: 9780803666627 0803666624
OCLC Number: 1032289053
Description: xxi, 393 pages : illustrations ; 28 cm
Contents: Medicolegal principles of documentation --
The comprehensive history and physical examination --
SOAP notes --
Prenatal care visits and newborn physical examination --
Pediatric preventive care visits --
Adult preventive care visits --
Older adult visits --
Outpatient charting and communication --
Prescription writing and electronic prescribing --
Admitting a patient to the hospital --
Documenting inpatient care --
Discharging patients from the hospital.
Responsibility: Debra D. Sullivan, PhD, RN, PA-C, Lead Advanced Practice Provider, Academic Urology and Urogynecology of Arizona, Litchfield Park, AZ, Owner, Sullivan Consulting Services, Medicolegal Consulting, Glendale, AZ.

Abstract:

Your guide to developing the skills you need to master the increasing complex challenges of documenting patient care. Step by step, a straightforward "how-to" approach teaches you how to write SOAP  Read more...

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