Dynamics of Healthcare - Chapter 17 Exam Questions and Correct Answers Latest Update 2024 (Rated
A+)
Charting by exception format - Answers An abbreviated documentation method that makes use of well
defined standards of practice and documents only significant or abnormal findings
Familial - Answers When a disease tends to occur often in a particular family
Military time - Answers A 24 hour cycle
Narrative format - Answers The oldest and least structured documentation style that consists of a
paragraph indicating the contact with the patient, what was done, and what outcomes resulted
Problem-oriented medical record - Answers Organizes info by patient's problems
SOAP format - Answers Documentation format made up of four parts: subjective data, objective data,
assessment and plan
Source-oriented medical record - Answers Groups information by type
Subjective data - Answers Any statements from the patient describing his or her condition
Objective data - Answers Information from the observations of the health care professional of the
patient
Assessment - Answers Contains patient's diagnosis, based on analysis of objective and subjective data
Plan - Answers What should be done about the problem
Admission sheet - Answers Used to gather information from the patient before the visit with provider
Graphic sheet (flow chart) - Answers A recording of vital signs
Progress notes - Answers Record each contact a provider has with the patient
A+)
Charting by exception format - Answers An abbreviated documentation method that makes use of well
defined standards of practice and documents only significant or abnormal findings
Familial - Answers When a disease tends to occur often in a particular family
Military time - Answers A 24 hour cycle
Narrative format - Answers The oldest and least structured documentation style that consists of a
paragraph indicating the contact with the patient, what was done, and what outcomes resulted
Problem-oriented medical record - Answers Organizes info by patient's problems
SOAP format - Answers Documentation format made up of four parts: subjective data, objective data,
assessment and plan
Source-oriented medical record - Answers Groups information by type
Subjective data - Answers Any statements from the patient describing his or her condition
Objective data - Answers Information from the observations of the health care professional of the
patient
Assessment - Answers Contains patient's diagnosis, based on analysis of objective and subjective data
Plan - Answers What should be done about the problem
Admission sheet - Answers Used to gather information from the patient before the visit with provider
Graphic sheet (flow chart) - Answers A recording of vital signs
Progress notes - Answers Record each contact a provider has with the patient
