1
Comprehensive Assessment Results | Turned In
Advanced Health Assessment - September '17 , NREO81 NRE-662 01A
Return to Assignment
Your Results Lab Pass
Overview
Documentation / Electronic Health Record
Transcript
Subjective Data Collection Documentation
Objective Data Collection
Documentation Vitals
Plan My Exam
Student Documentation Model Documentation
Self-Reflection
• Height: 170 cm
128/82 mm Hg (97.3 MAP) • Weight: 84 kg
HP 78 • BMI: 29.0
99% SpO2 • Blood Glucose: 100
98.9 degrees F • RR: 15
FVC 3.91 L • HR: 78
FEV1 3.15 L • BP:
FEV1/FVC - 0.81 • Pulse Ox: 99%
• Temperature: 99.0 F
Health History
Student Documentation Model Documentation
Identifying Data & Reliability
Able to state name and date of birth that matches Ms. Jones is a pleasant, 28-year-old African
EHR records. Oriented x3. American single woman who presents for a pre-
employment physical. She is the primary source of
the history. Ms. Jones offers information freely and
(For the record, I did stop before starting asking without contradiction. Speech is clear and coherent.
questions. There should be a lapse in time. I was She maintains eye contact throughout the interview.
documenting)
General Survey
Ms. Jones is a 28 year old obese, African American Ms. Jones is alert and oriented, seated upright on
woman who is clearly able to keep up with her ADLs. the examination table, and is in no apparent distress.
Her hair is braided, her clothes are clean, she seems She is well-nourished, well-developed, and dressed
to be able to keep up with hygiene. She does not appropriately with good hygiene.
seem to be in any acute distress.
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, https://www.coursehero.com/file/32969532/comp-docpdf/
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Comprehensive Assessment Results | Turned In
Advanced Health Assessment - September '17 , NREO81 NRE-662 01A
Return to Assignment
Your Results Lab Pass
Overview
Documentation / Electronic Health Record
Transcript
Subjective Data Collection Documentation
Objective Data Collection
Documentation Vitals
Plan My Exam
Student Documentation Model Documentation
Self-Reflection
• Height: 170 cm
128/82 mm Hg (97.3 MAP) • Weight: 84 kg
HP 78 • BMI: 29.0
99% SpO2 • Blood Glucose: 100
98.9 degrees F • RR: 15
FVC 3.91 L • HR: 78
FEV1 3.15 L • BP:
FEV1/FVC - 0.81 • Pulse Ox: 99%
• Temperature: 99.0 F
Health History
Student Documentation Model Documentation
Identifying Data & Reliability
Able to state name and date of birth that matches Ms. Jones is a pleasant, 28-year-old African
EHR records. Oriented x3. American single woman who presents for a pre-
employment physical. She is the primary source of
the history. Ms. Jones offers information freely and
(For the record, I did stop before starting asking without contradiction. Speech is clear and coherent.
questions. There should be a lapse in time. I was She maintains eye contact throughout the interview.
documenting)
General Survey
Ms. Jones is a 28 year old obese, African American Ms. Jones is alert and oriented, seated upright on
woman who is clearly able to keep up with her ADLs. the examination table, and is in no apparent distress.
Her hair is braided, her clothes are clean, she seems She is well-nourished, well-developed, and dressed
to be able to keep up with hygiene. She does not appropriately with good hygiene.
seem to be in any acute distress.
https://app.shadowhealth.com/assignment_attempts/2841794 1/7
, https://www.coursehero.com/file/32969532/comp-docpdf/
2
https://app.shadowhealth.com/assignment_attempts/2841794 2/7
