Matching
Match the following terms with their definitions.
Premises:
The physician's documentation of a surgical procedure, usually dictated and transcribed
The process of systematically eliminating potential diagnoses. Also refers to the list of potential diagnoses
Analysis of body fluids
The physician's documentation of the examination of the patient, particularly at the initial visit
The diagnostic, therapeutic, or palliative measures that will be taken to investigate or treat the patient's condition or disease
The physician's directions regarding the patient's care. Also refers to the data collection device on which these elements are captured
Record of all drugs given to a patient during the hospitalization
Examination of a patient using x-rays
Acronym that describes the medical decision-making process. It also refers to the way physicians organize their progress notes
The nurse's evaluation of the patient
One or more surgical procedures performed at the same time
The physician's record of each visit with the patient
Responses:
Laboratory tests
Medication sheet
Progress notes
Rule out
Nursing assessment
Operative report
Plan of treatment
SOAP format
Operation
Physical examination
Radiology tests
Physician's orders
Correct Answer:
Premises:
Responses:
The physician's documentation of a surgical procedure, usually dictated and transcribed
The process of systematically eliminating potential diagnoses. Also refers to the list of potential diagnoses
Analysis of body fluids
The physician's documentation of the examination of the patient, particularly at the initial visit
The diagnostic, therapeutic, or palliative measures that will be taken to investigate or treat the patient's condition or disease
The physician's directions regarding the patient's care. Also refers to the data collection device on which these elements are captured
Record of all drugs given to a patient during the hospitalization
Examination of a patient using x-rays
Acronym that describes the medical decision-making process. It also refers to the way physicians organize their progress notes
The nurse's evaluation of the patient
One or more surgical procedures performed at the same time
The physician's record of each visit with the patient
Premises:
The physician's documentation of a surgical procedure, usually dictated and transcribed
The process of systematically eliminating potential diagnoses. Also refers to the list of potential diagnoses
Analysis of body fluids
The physician's documentation of the examination of the patient, particularly at the initial visit
The diagnostic, therapeutic, or palliative measures that will be taken to investigate or treat the patient's condition or disease
The physician's directions regarding the patient's care. Also refers to the data collection device on which these elements are captured
Record of all drugs given to a patient during the hospitalization
Examination of a patient using x-rays
Acronym that describes the medical decision-making process. It also refers to the way physicians organize their progress notes
The nurse's evaluation of the patient
One or more surgical procedures performed at the same time
The physician's record of each visit with the patient
Responses:
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