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Author: Sherry Borcherding Publisher: SLACK Incorporated ISBN: 9781556427794 Category : Allied health personnel Languages : en Pages : 244
Book Description
Written specifically for occupational therapy assistants, The OTA's Guide to Writing SOAP Notes, Second Edition is updated to include new features and information. This valuable text contains the step-by-step instruction needed to learn the documentation required for reimbursement in occupational therapy. With the current changes in healthcare, proper documentation of client care is essential to meeting legal and ethical standards for reimbursement of services. Written in an easy-to-read format, this new edition by Sherry Borcherding and Marie J. Morreale will continue to aid occupational therapy assistants in learning to write SOAP notes that will be reimbursable under Medicare Part B and managed care for different areas of clinical practice. New Features in the Second Edition: - Incorporated throughout the text is the Occupational Therapy Practice Framework, along with updated AOTA documents - More examples of pediatrics, hand therapy, and mental health - Updated and additional worksheets - Review of grammar/documentation mistakes - Worksheets for deciphering physician orders, as well as expanded worksheets for medical abbreviations - Updated information on billing codes, HIPAA, management of health information, medical records, and electronic documentation - Expanded information on the OT process for the OTA to fully understand documentation and the OTA's role in all stages of treatment, including referral, evaluation, intervention plan, and discharge - Documentation of physical agent modalities With reorganized and shorter chapters, The OTA's Guide to Writing SOAP Notes, Second Edition is the essential text to providing instruction in writing SOAP notes specifically aimed at the OTA practitioner and student. This exceptional edition offers both the necessary instruction and multiple opportunities to practice, as skills are built on each other in a logical manner. Templates are provided for beginning students to use in formatting SOAP notes, and the task of documentation is broken down into small units to make learning easier. A detachable summary sheet is included that can be pulled out and carried to clinical sites as a reminder of the necessary contents for a SOAP note. "Answers" are provided for all worksheets so that the text can be used for independent study if desired. Updated information, expanded discussions, and reorganized learning tools make The OTA's Guide to Writing SOAP Notes, Second Edition a must-have for all occupational therapy assistant students! This text is the essential resource needed to master professional documentation skills in today's healthcare environment.
Author: Ginge Kettenbach Publisher: F. A. Davis Company ISBN: Category : Medical Languages : en Pages : 164
Book Description
-- Chapter on the development and use of forms and documentation-- Coverage of computerized documentation-- Thorough updating, including a discussion of the managed care environment and Medicare-- Additional exercises and examples-- Perforated worksheets-- Basic note-writing rules, including the POMR method, are reviewed-- Examples provided of both correct and incorrect note writing
Author: Sherry Borcherding Publisher: Slack Incorporated ISBN: 9781556427190 Category : Medical Languages : en Pages : 236
Book Description
Manual focusing on documenting the occupational therapy process. Each skill is broken down into small steps and taught individually. Includes a template for writing problems, goals, and each section of the SOAP note. Also includes practice worksheets and detachable checklist and summary.
Author: Sherry Borcherding Publisher: SLACK Incorporated ISBN: 9781556427794 Category : Allied health personnel Languages : en Pages : 244
Book Description
Written specifically for occupational therapy assistants, The OTA's Guide to Writing SOAP Notes, Second Edition is updated to include new features and information. This valuable text contains the step-by-step instruction needed to learn the documentation required for reimbursement in occupational therapy. With the current changes in healthcare, proper documentation of client care is essential to meeting legal and ethical standards for reimbursement of services. Written in an easy-to-read format, this new edition by Sherry Borcherding and Marie J. Morreale will continue to aid occupational therapy assistants in learning to write SOAP notes that will be reimbursable under Medicare Part B and managed care for different areas of clinical practice. New Features in the Second Edition: - Incorporated throughout the text is the Occupational Therapy Practice Framework, along with updated AOTA documents - More examples of pediatrics, hand therapy, and mental health - Updated and additional worksheets - Review of grammar/documentation mistakes - Worksheets for deciphering physician orders, as well as expanded worksheets for medical abbreviations - Updated information on billing codes, HIPAA, management of health information, medical records, and electronic documentation - Expanded information on the OT process for the OTA to fully understand documentation and the OTA's role in all stages of treatment, including referral, evaluation, intervention plan, and discharge - Documentation of physical agent modalities With reorganized and shorter chapters, The OTA's Guide to Writing SOAP Notes, Second Edition is the essential text to providing instruction in writing SOAP notes specifically aimed at the OTA practitioner and student. This exceptional edition offers both the necessary instruction and multiple opportunities to practice, as skills are built on each other in a logical manner. Templates are provided for beginning students to use in formatting SOAP notes, and the task of documentation is broken down into small units to make learning easier. A detachable summary sheet is included that can be pulled out and carried to clinical sites as a reminder of the necessary contents for a SOAP note. "Answers" are provided for all worksheets so that the text can be used for independent study if desired. Updated information, expanded discussions, and reorganized learning tools make The OTA's Guide to Writing SOAP Notes, Second Edition a must-have for all occupational therapy assistant students! This text is the essential resource needed to master professional documentation skills in today's healthcare environment.
Author: Crystal A. Gateley Publisher: ISBN: 9781630912321 Category : Languages : en Pages :
Book Description
Documentation Manual for Occupational Therapy: Writing SOAP Notes, Fourth Edition presents a systematic approach to a standard form of health care documentation: the SOAP note.
Author: Ginge Kettenbach Publisher: F. A. Davis Company ISBN: 9780803600379 Category : Medical protocols Languages : en Pages : 0
Book Description
-- Chapter on the development and use of forms and documentation -- Coverage of computerized documentation -- Thorough updating, including a discussion of the managed care environment and Medicare -- Additional exercises and examples -- Perforated worksheets -- Basic note-writing rules, including the POMR method, are reviewed -- Examples provided of both correct and incorrect note writing
Author: Marie Morreale Publisher: Taylor & Francis ISBN: 1040141935 Category : Medical Languages : en Pages : 354
Book Description
The bestselling, newly updated occupational therapy assistant (OTA) textbook, The OTA’s Guide to Documentation: Writing SOAP Notes, Fifth Edition explains the critical skill of documentation while offering multiple opportunities for OTA students to practice documentation through learning activities, worksheets, and bonus videos. The Fifth Edition contains step-by-step instruction on occupational therapy documentation and the legal, ethical, and professional documentation standards required for clinical practice and reimbursement of services. Students and professors alike can expect the same easy-to-read format from previous editions to aid OTAs in learning the purpose and standards of documentation throughout all stages of the occupational therapy process and different areas of clinical practice. Essentials of documentation, reimbursement, and best practice are reflected in the many examples presented throughout the text. Worksheets and learning activities provide the reader with multiple opportunities to practice observation skills and clinical reasoning, learn documentation methods, create occupation-based goals, and develop a repertoire of professional language. Templates are provided to assist beginning OTA students in formatting occupation-based SOAP notes, and the task of documentation is broken down into smaller units to make learning easier. Other formats and methods of recording client care are also explained, such as the use of electronic health records and narrative notes. This text also presents an overview of the initial evaluation process delineating the roles of the OT and OTA and guidelines for implementing appropriate interventions. New in the Fifth Edition: Incorporation of the Occupational Therapy Practice Framework: Domain and Process, Fourth Edition and other updated American Occupational Therapy Association documents Updated information to meet Medicare Part B and other third-party payer requirements Revised clinical terminology on par with current trends Added examples from emerging practice areas Expanded tables along with new worksheets and learning activities Included with the text are online supplemental materials for faculty use in the classroom, this includes: access to supplemental website worksheets, learning activities, and scenario-based videos to practice the documentation process.
Author: Mark Kauffman Publisher: Jones & Bartlett Learning ISBN: 0763776548 Category : Medical Languages : en Pages : 303
Book Description
COMLEX Level 2-PE Review Guide is a comprehensive overview for osteopathic medical students preparing for the COMLEX Level 2-PE (Performance Evaluation) examination. COMLEX Level 2-PE Review Guide covers the components of History and Physical Examination found on the COMLEX Level 2-PE The components of history taking, expected problem specific physical exam based on the chief complaint, incorporation of osteopathic manipulation, instruction on how to develop a differential diagnosis, components of the therapeutic plan, components of the expected humanistic evaluation and documentation guidelines. The final chapter includes case examples providing practice scenarios that allow the students to practice the cases typically encountered on the COMLEX Level 2-PE These practice cases reduce the stress of the student by allowing them to experience the time constraints encountered during the COMLEX Level 2-PE. This text is a one-of-a-kind resource as the leading COMLEX Level 2-PE board review book. • Offers practical suggestions and mnemonics to trigger student memory allowing for completeness of historical data collection. • Provides a method of approach that reduces memorization but allows fluidity of the interview and exam process. • Organizes the approach to patient interview and examination and provides structure to plan development. Describes the humanistic domain for student understanding of the areas being evaluated.
Author: Karen Sladyk Publisher: SLACK Incorporated ISBN: 9781556423185 Category : Occupational therapy Languages : en Pages : 374
Book Description
The OT Student Primer: A Guide to College Success focuses on advice and tutorials to make a student's journey through OT school more successful and enjoyable. This book is designed to help both OTA and OT students make the best of their education by providing the basic information needed to succeed and build their knowledge of OT. The process of learning OT theories, techniques, terminology, and concepts is challenging and this book addresses the core understanding of the profession that all students should know as they embark on their OT careers. The primer is filled with tutorials, practical skills, advice, helpful hints, and professional skills. The text provides the most up-to-date fieldwork issues, complete coverage of documentation skills and therapeutic communication, plus essential OT concepts. Tables and worksheets are included to gain a better self-understanding and exercises allow students to check what they have learned.