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PRACTICAL CLINICAL COURSES A Service of the Gordon J. Christensen Career Development ProgramV4733 Protecting Yourself against Malpractice Suits David H. Person, JD & Gordon J. Christensen, DDS, MSD,
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To fill out a charting checkup, follow these steps:
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Begin by gathering all the necessary medical information and records of the patient.
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Start by documenting the patient's basic information, such as name, date of birth, and contact information.
04
Record the patient's medical history, including any previous illnesses, surgeries, or allergies.
05
Document the reason for the checkup and any symptoms or complaints the patient may have.
06
Perform a physical examination and note down any findings or abnormalities.
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Order and interpret any necessary diagnostic tests, such as blood work or imaging studies.
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Make a list of the patient's current medications and update any changes.
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Write a comprehensive assessment of the patient's health status based on the information gathered.
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Develop a treatment plan and document any prescribed medications or recommended interventions.
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Sign and date the charting checkup to validate its accuracy and completion.
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Anyone who requires a routine or diagnostic checkup should undergo charting checkup.
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This includes individuals seeking regular health maintenance, those with ongoing medical conditions, or those experiencing new symptoms or concerns.
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Charting checkup helps healthcare providers to monitor patients' health, identify any potential issues, and make informed treatment decisions.
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