BIO-17 Lecture Notes - Lecture 27: Medical Record, Bloating, Libido
Document Summary
Give an opinion and recommendations but not write orders or. Give an opinion and write orders, provide care concerning area of patient"s. Consult and manage: orders for other consults, tests, etc. Date and time of orders must be included for each set of orders or note written. You should print your name and title first, then sign below. When you are a student or resident, you first print the attending or supervising residents name, then yours and sign below. All student orders must be co-signed by a senior resident or attending before they are. Patient orders: legal and will be carried out by nursing and other allied. ), and physicians impression of the prognosis at the time of admission. Not an h & p, more focused to patients current condition. The note is an important part of the medical record that documents the. 34 y/o hispanic male with right-sided weakness and slurred.
