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A medical record includes a variety of types of "notes" entered over time by healthcare professionals, recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, X-rays, reports, etc. The maintenance of complete and accurate medical records is a requirement of health ...
Dental charting is a process in which your dental healthcare professional lists and describes the health of your teeth and gums. Periodontal charting, which is a part of your dental chart, refers ...
SOAP note. The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by healthcare providers to write out notes in a patient 's chart, along with other common formats, such as the admission note. [1] [2] Documenting patient encounters in the medical record is an integral part of practice ...
Medication Administration Record. A Medication Administration Record [1] ( MAR, or eMAR for electronic versions), commonly referred to as a drug chart, is the report that serves as a legal record of the drugs administered to a patient at a facility by a health care professional. The MAR is a part of a patient's permanent record on their medical ...
diabetes. HIV. anemia. cancer. coronary heart disease. Even if a person does not have heart disease, a blood test can show whether they may be at risk of developing the condition. Other blood ...
The audiogram is a fairly simple graph: The Y-axis (vertical) measures the intensity, or loudness, of the sound. It’s measured in decibels (Db) and ranges from -10 to 110 on the audiogram. Low ...
To help compensate for this problem, many doctors rely on pain scales to get a more concrete sense of a person's pain. You might have seen a pain scale in your doctor's office before. One common ...
Right Dose. Right Time. Right Route. Right Documentation. Right Response. Tips for Medication Administration. 4 min read. One of the most serious responsibilities that health care providers have ...
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