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Introduction to Health Records

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Question
Answer
Where can health records be found?   Paper charts or Electronic health record (EHR)  
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What does SOAP stand for?   Subjective, Objective, Assessment, and Plan  
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What does Subjective mean in SOAP?   These are any problems or issues a patient is having  
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What does Objective mean in SOAP?   Data that a health care provider collects  
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What are the general objective terms?   Things that are seen, heard, felt, and descriptions of anything that was observed  
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What is the Assessment part of SOAP?   This is the combination of the two, subjective/objective, in which the information gathered leads to a diagnosis.  
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What is the Plan part of SOAP?   This is where the health provider gives a recommendation to the patient as of what to do to solve their current medical issue  
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What is a physician?   A person who graduated from a medical school and is providing health care  
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What is a pediatrician?   This would be a physician that specializes in caring for children  
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What does this symbol mean? ♂   Male  
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Created by: bk282
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