In: Nursing
I hope you will rate my answer positively--
1. Attending physician-- A medical doctor who is responsible for the overall care of a patient in a hospital or clinic setting. They may also supervise and teach medical students , interns involved in patients care.
2. Chief complaint -- It is a medical term describe by the patients in his own words. They describe primary problem to seek medical attention , and are important.
3. Consultation-- The process of discussing something with someone in order to get their advice or opinion about it.
4. New patient-- A new patient is defined as one who has not received any professional services from the physicians within the 3 year.
5. Primary care physician-- primary care physician is a healthcare professionals who practices general medicine.
6. Review of system -- It is a technique used by health care providers for eliciting a medical history from a patient.
7. Referral -- an act of referring someone or something for consultation , review, or further action.
8. Critical care-- The specialized care of patients whose conditions are life threatening and who require comprehensive care and constant monitoring , usually in intensive care units.
9. Documentation -- material that provides official information or evidence or that serves as a record.
10. Electronic health record-- it is a systematized collection of patients and population electronically stored health information in a digital format.
11. Referring physician-- A physician that directs a patient to an additional source of medical expertise for assistance , examination, information , or treatment.
12. Ordering physician -- The physician who has ordered diagnostic tests, services, items , or supplies for a patient or study subject.
ABBREVIATIONS --
1. CHEDDAR - stands for cheif complaint , history, examination, details of complaints, drugs and dosage , assessment, return visit.
2.CPT - current procedural terminology.
3.LLQ - left lower quadrant .
4. SOAP - subjective , objective , assessment, plan.
5. WNL - within normal limits.
Thankyou.