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The Ten Documentation Commandments L Hicks
A Inpatient by Sequence see pp Table of Contents for overall picture
63 other sections not shown
ability abuse activities Address akathisia alcohol and/or antidepressant areas assessment atric Axis bipolar disorder Birth Date Bronzo City/State clinical clinician Clozapine cognitive consultation depression diagnosis dietitian discharge disorder documentation drugs dyskinesia Ethnicity Evaluation Date example Facility factors feels Female Marital Status Fluphenazine Format with Annotation functioning geriatric goals Haloperidol HCFA Hospital Admission Date identified inpatient interventions interview July 15 lithium Male/C Female Marital Medical History Medical Record ment Mental Health Mental Status Examination months movements Name Printed neuroleptic Nursing Nursing Assessment Nursing Care Plan Occupation outpatient past Perphenazine physician problems psychi Psychiatric History psychotherapy References relationship relevant religious response risk schizophrenia score Signature sleep Smith social specific staff suicidal symptoms tardive dyskinesia tests therapist therapy Thioridazine tient tion Title treatment plan violent behavior Ward Admission week Westborough Westborough State Hospital