Writing Patient/client Notes: Ensuring Accuracy in Documentation

  • ISBN 9780803618787

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This is an ideal resource for any health care professional needing to learn or improve their skills - with simple, straightforward explanations of the hows and whys of documentation. It also keeps pace with the changes in Physical Therapy practice today, emphasizing the Patient/Client Management model. Section by section, exercise by exercise, the 4th Edition will help you to write clear, concise, and correct patient care notes using a variety of tools, including SOAP notes. The book features exercises and worksheets at the end of each section and chapter, with answers provided in Appendix A. It also provides samples of both correct and incorrect note writing; teaches readers how to write a defensible note; and, offers a quick review of medical terminology and abbreviations.
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