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OTA 120 - Documentation

This class was created by Brainscape user Jen Ludwig. Visit their profile to learn more about the creator.

By: Jen Ludwig
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Decks in this class (12)

Abbreviations and Symbols - 1 of 3
A inside circle,
A with line above,
Aa
132  cards
Abbreviations and Symbols - 2 of 3
Ha h a,
H ampersand p,
Hbv
121  cards
Abbreviations and Symbols - 3 of 3
Prn,
Pro,
Prom
119  cards
SOAP Notes: SUBJECTIVE
What is the s in soap,
How to be specific in a subjectiv...,
Examples of subjective notes
7  cards
Documentation and Observation Basics
The who of documentation,
The what of documentation,
The when of documentation
14  cards
Health Record, Terminology and Billing
Purpose of health record,
Things to remember while documenting,
Skilled vs nonskilled services
34  cards
Process and Credentials
Referral process,
How an ota decides what to do for...,
Ota roles in documentation paperwork
4  cards
SOAP Notes: OBJECTIVE
What is the o in the soap note,
What is the formulaic sentence th...,
What to include in the o section
8  cards
SOAP Notes: ASSESSMENT
What is in the assessment section...,
What are the 3 ps,
Problems in assessment note
9  cards
SOAP Notes: PLAN
What is included in the plan part...,
What is the purpose of the plan note,
Examples of plan note
3  cards
MIDTERM - Abbrevs from assignments so far
1 cva2 dx3 1 4 htn5 wfl6 dme7 prn...,
1 mcp2 fx3 dx4 htn5 ha or h a 6 s...,
1 wfl 2 loc 3 ama 4 bka 5 dme 6 pmh
7  cards
SOAP in Brief
S section,
O section,
A section
7  cards

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OTA 120 - Documentation

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