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Intro to Health Records

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Term
Definition
SOAP method   show
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show what the patient says  
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show what the test reveal, body images, provider observations  
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show the analyisis of the subjective and objective information, performed by the health care provider  
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show the course of action for the patient  
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show occurs recently, or sharp severe symptoms  
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chronic   show
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abrupt   show
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febrile   show
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show does not have a fever  
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malaise   show
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show worsening of symptoms  
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exacerbation   show
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symptom   show
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noncontributory   show
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show a decrease in level of consciousness  
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show it runs in the family  
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alert   show
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oriented   show
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show to listen (with a stehoscope)  
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percussion   show
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palpation   show
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show normal  
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marked   show
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show another word for assessment  
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diagnosis   show
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differential diagnosis   show
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benign   show
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malignant   show
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degeneration   show
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show the cause  
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idopathic   show
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remission   show
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recurrent   show
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show risk of being sick or diseased  
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mortality   show
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prognosis   show
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localized   show
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system/generalized   show
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occult   show
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show organism that causes the disease  
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show diseased tissue  
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show result of disease or injury  
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show waiting for  
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dispostion   show
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discharge   show
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prophylaxis   show
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show relieve symptoms, but not cure  
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show to watch  
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show actions that make the patient feel better  
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show treat symptoms to make the patient feel better  
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show extremely clean, germ-free conditions  
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proximal   show
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show pertaining to the trunk of the body-further away  
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show away from the center of the body  
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medial   show
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ventral, antral, anterior   show
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show back of the body  
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superior   show
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show below  
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cranial/caudal   show
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show lying on the back  
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prone   show
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ipsilateral   show
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contralateral   show
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show one side/two sides  
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show sole of the foot, palm of hand  
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dorsum   show
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coronal plane   show
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show divides body right and left  
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transverse plane   show
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chief complaint/ CC   show
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show story of the patient's problem  
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review of systems /ROS   show
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past medical history /PMHx   show
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past surgical history / PSHx   show
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show any significant illnesses that run in the patient's family  
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social history   show
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show fluid input/output  
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H&P   show
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show physical exam  
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PCP   show
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f/u   show
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show history of  
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PERRLA   show
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NOS   show
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RRR   show
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CTA   show
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A&O   show
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show no acute distress  
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PO   show
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show nothing by mouth (nil per os)  
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show intravenous  
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show subcutaneous  
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show central venous line  
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IM   show
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show per rectum (anal)  
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show as needed  
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QID   show
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show every day  
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AC   show
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show 3xs a day  
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BID   show
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PC   show
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show at night  
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