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3rdEdition by Debra D Sullivan
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GUIDE
Clinical
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Documentatio
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n
T H IR D cc cc c cc c c EDIT ION
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Debra D. Sullivan, PhD, RN, PA-C cc cc cc cc cc
Lead Advanced Practice Provider
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Academic Urology and Urogynecology of c c c c c c c c
Arizona Litchfield Park, AZ
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Owner, Sullivan Consulting c c c c
Services Medicolegal Consulting
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Glendale, AZ c c
,F. A. Davis Company
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1915 Arch Street
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Philadelphia, PA
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19103www.fadavis.co
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Copyright © 2019 by F. A. Davis Company cc cc cc cc cc cc cc
Copyright © 2019 by F. A. Davis Company. All rights reserved. Łis product is protected by copyright. No part of it may be
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reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying,
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recording, or otherwise,without written permission from the publisher.
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Printed in the United States of America
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Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
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Senior Acquisitions Editor: Melissa A. Duffield
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Director of Content Development: George W.
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LangDevelopmental Editor: Stephanie Kelly
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Art and Design Manager: Carolyn O’Brien
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Content Project Manager: Megan Suermann
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As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies
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undergo changes. Łe author(s) and publisher have done everything possible to make this book accurate, up to date, and in
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accord with accepted standards at the time of publication. Łe author(s), editors, and publisher are not responsible for errors
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or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the
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contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards
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of care used in regard to the unique circumstances that may apply in each situation. Łe reader is advised always to check product
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information (package inserts) for changes and new information regarding dose and contraindications before administering any drug.
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Caution is especially urged when using new or infrequently ordered drugs.
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Library of Congress Cataloging-in-Publication Data
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Names: Sullivan, Debra D., author. cc cc cc cc
Title: Guide to clinical documentation/Debra D. Sullivan.
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Description: Łird edition. | Philadelphia: F.A. Davis Company, [2019] | cc cc cc cc cc cc cc cc cc
Includes bibliographical references and index.
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Identifiers: LCCN 2018019472 (print) | LCCN 2018019898 (ebook) | cc cc cc cc cc cc cc cc
ISBN9780803669994 | ISBN 9780803666627 (pbk.)
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Subjects: | MESH: Forms and Records Control--methods | cc cc cc cc cc cc cc
MedicalRecords--standards
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Classification: LCC R697.P45 (ebook) | LCC R697.P45 (print) | NLM W 80 | cc cc cc cc cc cc cc cc cc cc cc cc
DDC651.5/04261--dc23
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LC record available at https://lccn.loc.gov/2018019472
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Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A.
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Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the
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978-0-8036-6662-7/18 0 + $.25. cc cc cc
, Dedication
When I think back to 2004, when the first edition of this
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cc book was published, I think of a wonderful group of friends
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cc who were there to celebrate with me. As I anticipate the
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publicationof the third edition, almost all of those same
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cc wonderful friendsare still here, encouraging and supporting
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cc me, and cheering meon to the finish line. Sadly, my dear
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cc friend Candy left us muchtoo soon, and I miss her sweet
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cc presence more than words can say. 7e essence of her heart
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cc and soul is with me always. For the remaining STUB-C
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cc friends (Kent, Donna, Paige, Jeff, John, Brianna, Justin,
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cc Tim, Carla, and Jeff ), thanks for your friendship, your love,
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cc and your constancy in my life through the past two decades. I
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cc couldn’t ask for a better group of people to share life with! I
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cc hope there are many more decades to come!
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Not only have I been blessed with these incredible friends,
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cc butI am fortunate to have the most loving, caring, and
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cc supportivehusband any woman could hope for. Greg is an c cc cc cc cc cc cc cc cc
cc unwavering source of encouragement and inspires and cc cc cc cc cc cc
cc challenges me to be the best I can be. He has stood besidecc cc cc cc cc cc cc cc cc cc cc cc
cc me without complaint through the days of writer’s block,
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looming deadlines, malfunctioning computers, and the often-
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self-imposed frenzy of my world. He has the insight to know cc cc cc cc cc cc cc cc cc cc
cc when to cheer me on,when to make me take a break, and
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cc when to give me space. I am so grateful for his calming
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cc influence, his ability to make me laugh and not take myself
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cc too seriously, and all he does
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to keep things running smoothly in the Sullivan household.
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cc 7anks, Greg, for all this, and so much more. And I
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Copyright © 2019 by F. A. Davis Company. All rights
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reserved.
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