Writing Patient/Client Notes

Writing Patient/Client Notes
Author: Ginge Kettenbach
Publisher: F.A. Davis
Total Pages: 295
Release: 2016-05-11
Genre: Medical
ISBN: 080365846X

Develop all of the skills you need to write clear, concise, and defensible patient/client care notes using a variety of tools, including SOAP notes. This is the ideal resource for any health care professional needing to learn or improve their skills—with simple, straight forward 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 and WHO’s ICF model.

Writing S.O.A.P. Notes

Writing S.O.A.P. Notes
Author: Ginge Kettenbach
Publisher: F. A. Davis Company
Total Pages: 164
Release: 1990
Genre: Medical
ISBN:

-- Chapter on the development and use of forms and documentation-- Coverage of computerized documentation-- Thorough updating, including a discussion of the managed care environment and Medicare-- Additional exercises and examples-- Perforated worksheets-- Basic note-writing rules, including the POMR method, are reviewed-- Examples provided of both correct and incorrect note writing

Writing SOAP Notes

Writing SOAP Notes
Author: Ginge Kettenbach
Publisher: F A Davis Company
Total Pages: 215
Release: 2003
Genre: Medical
ISBN: 9780803608368

Ginge Kettenbach's workbook leads you through the process of learning two different styles of documentation: SOAP (Subjective/Objective/Assessment/Plan) notes and the Patient/Client Management format. This updated 3rd edition includes hands-on exercises and examples to help you sharpen the writing skills that you will need to prepare clear, concise, and accurate medical documentation. Worksheets at the end of each note section further strengthen your writing skills on the information you have just learned. Explanations of documentation that are consistent with the APTA's Guide to Physical Therapist Practice are given for all decisions. Book jacket.

Evidence Based Physical Therapy

Evidence Based Physical Therapy
Author: Linda Fetters
Publisher: F.A. Davis
Total Pages: 469
Release: 2018-10-02
Genre: Medical
ISBN: 0803695438

Improve outcomes through evidence-based therapy. This practical, easy-to-use guide uses a five-step process to show you how to find, appraise, and apply the research in the literature to meet your patient’s goals. You'll learn how to develop evidence-based questions specific to your clinical decisions and conduct efficient and effective searches of print and online sources to identify the most relevant and highest quality evidence. Then, you'll undertake a careful appraisal of the information; interpret the research; and synthesize the results to generate valid answers to your questions. And, finally, you'll use the Critically Appraised Topic (CAT) tool to communicate your findings. See what practitioners and students are saying about the previous edition… Great resource for applying evidence to practice. “The book is very clearly written with clinical examples, and in-depth questions. If you want a comprehensive book on statistics this is not the book for you, but it is an easily understandable introduction to physical therapy research which will help you to interpret the literature and apply it to your patients.”

The Rehabilitation Specialist's Handbook

The Rehabilitation Specialist's Handbook
Author: Jules M. Rothstein
Publisher: F. A. Davis Company
Total Pages: 0
Release: 1998
Genre: Medical rehabilitation
ISBN: 9780803600478

A reference handbook for rehabilitation specialists, featuring many two-color illustrations, tables, and charts. Contains chapters on musculoskeletal, visceral, pulmonary, and vascular anatomy, as well as neuroanatomy, kinesiology, psychology, massage, general medicine, burns, and AIDS, plus useful phrases in Spanish, Italian, French, and German. This second edition is smaller (4.75x8") yet contains one- third more material, with new sections on the ADA, geriatrics, outcome measures, and pharmacology, and offer features enhancing usability, such as section tables of contents and more information on references. Annotation copyrighted by Book News, Inc., Portland, OR

Documentation for Physical Therapist Practice: A Clinical Decision Making Approach

Documentation for Physical Therapist Practice: A Clinical Decision Making Approach
Author: Jacqueline A. Osborne
Publisher: Jones & Bartlett Learning
Total Pages: 278
Release: 2015-08-03
Genre: Medical
ISBN: 1284105210

Documentation for Physical Therapist Practice: A Clinical Decision Making Approach provides the framework for successful documentation. It is synchronous with Medicare standards as well as the American Physical Therapy Association’s recommendations for defensible documentation. It identifies documentation basics which can be readily applied to a broad spectrum of documentation formats including paper-based and electronic systems. This key resource skillfully explains how to document the interpretation of examination findings so that the medical record accurately reflects the evidence. In addition, the results of consultation with legal experts who specialize in physical therapy claims denials will be shared to provide current, meaningful documentation instruction.

Model Rules of Professional Conduct

Model Rules of Professional Conduct
Author: American Bar Association. House of Delegates
Publisher: American Bar Association
Total Pages: 216
Release: 2007
Genre: Law
ISBN: 9781590318737

The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.

The Clinical Documentation Sourcebook

The Clinical Documentation Sourcebook
Author: Donald E. Wiger
Publisher: John Wiley & Sons
Total Pages: 338
Release: 2010-02-02
Genre: Psychology
ISBN: 0470527781

All the forms, handouts, and records mental health professionals need to meet documentation requirements–fully revised and updated The paperwork required when providing mental health services continues to mount. Keeping records for managed care reimbursement, accreditation agencies, protection in the event of lawsuits, and to help streamline patient care in solo and group practices, inpatient facilities, and hospitals has become increasingly important. Now fully updated and revised, the Fourth Edition of The Clinical Documentation Sourcebook provides you with a full range of forms, checklists, and clinical records essential for effectively and efficiently managing and protecting your practice. The Fourth Edition offers: Seventy-two ready-to-copy forms appropriate for use with a broad range of clients including children, couples, and families Updated coverage for HIPAA compliance, reflecting the latest The Joint Commission (TJC) and CARF regulations A new chapter covering the most current format on screening information for referral sources Increased coverage of clinical outcomes to support the latest advancements in evidence-based treatment A CD-ROM with all the ready-to-copy forms in Microsoft® Word format, allowing for customization to suit a variety of practices From intake to diagnosis and treatment through discharge and outcome assessment, The Clinical Documentation Sourcebook, Fourth Edition offers sample forms for every stage of the treatment process. Greatly expanded from the Third Edition, the book now includes twenty-six fully completed forms illustrating the proper way to fill them out. Note: CD-ROM/DVD and other supplementary materials are not included as part of eBook file.

Guide to Evidence-Based Physical Therapist Practice

Guide to Evidence-Based Physical Therapist Practice
Author: Dianne V. Jewell
Publisher: Jones & Bartlett Publishers
Total Pages: 450
Release: 2014-02-25
Genre: Medical
ISBN: 1284028569

"This text provides readers with the information and tools needed to understand what constitutes evidence, search efficiently for applicable evidence in the literature, evaluate the findings in the literature, and integrate the evidence with clinical judgment and individual patient preferences and values. Students will learn how evaluate research designs, appraise evidence, and apply research in clinical practice"--Provided by publisher.

Note Designer

Note Designer
Author: Patricia C Baldwin
Publisher: Mindhabits Incorporated
Total Pages: 76
Release: 2016-03-23
Genre:
ISBN: 9780995063402

This book provides step-by-step guidelines, tips, and instruction on how to create and write psychotherapy treatment notes. Information and guidance are provided on how to write a treatment intake report, treatment progress notes, and termination summary. A number of sample notes, reports and templates are provided. The book also includes hundreds of representative statements for therapists to use in the design of their own psychotherapy progress notes. A valuable resource for experienced mental health professionals and trainees alike, from the creator of Note Designer therapy note-writing software. ""A time-saving reference to capture the essence and the methods of professional note writing for psychotherapists. Easy to apply and great to keep close-by when writing reports and progress notes."" --Alexandre Smith-Peter, Psy.D. candidate