Give 2 items you would document in the timeline of events
What is initial impression, reevaluations, updates, meds, consults
200
How many organ systems are required to meet comprehensive guidelines?
What is 9
200
How many points is past medical history and past surgical history?
What is 1
300
Give 2 examples of ancillary studies
What is labs, radiographs, O2's, EKGs
300
How many findings do you need for the area of complaint?
What is 3
300
A patient does not speak English and is unable to provide past family and social history. Is this a valid caveat?
What is no!
400
If there is a consult what do you need to document?
What is time, doctors name, specialty
400
How many findings do you need per organ system?
What is 2
400
Give an example of a valid caveat
What is (not oriented, mental illness, etc.)
500
The initial impression is similar to what part of the HPI?
What is patient attestation
500
Name all of the billable systems for a Comprehensive PE
What is constitutional, eyes, ent, cardiovascular, respiratory, GI, GU, musculoskeletal, skin, neurologic, psychiatric, hematologic
500
A 50 year old male with diabetes and history of smoking 2 packs a day comes to the ER with a complaint of abdominal pain. What would be filed under the PFSH?