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  2. Admission note - Wikipedia

    en.wikipedia.org/wiki/Admission_note

    Health care professionals use them to record a patient's baseline status and may write additional on-service notes, progress notes , preoperative notes, operative notes, postoperative notes, procedure notes, delivery notes, postpartum notes, and discharge notes. These notes constitute a large part of the medical record.

  3. Virtual ward - Wikipedia

    en.wikipedia.org/wiki/Virtual_ward

    A discharge summary is recorded at the practice, and a discharge letter (written using lay terminology) is sent to the patient. After discharge the patient is still able to contact the virtual ward for advice, and may be readmitted if their clinical need dictates it. This not only ensures that the patient is borne in mind, but these quarterly ...

  4. SOAP note - Wikipedia

    en.wikipedia.org/wiki/SOAP_note

    The four components of a SOAP note are Subjective, Objective, Assessment, and Plan. [1] [2] [8] The length and focus of each component of a SOAP note vary depending on the specialty; for instance, a surgical SOAP note is likely to be much briefer than a medical SOAP note, and will focus on issues that relate to post-surgical status.

  5. Inpatient care - Wikipedia

    en.wikipedia.org/wiki/Inpatient_care

    When considering the patient's current state, although the patient may be eligible for discharge it is important to examine factors such as the likelihood of re-injury to avoid higher health care costs. Patients' homes should also be visited and examined before they are discharged from the hospital to determine any immediate challenges and ...

  6. Progress note - Wikipedia

    en.wikipedia.org/wiki/Progress_note

    Another example is the DART system, organized into Description, Assessment, Response, and Treatment. [2] Documentation of care and treatment is an extremely important part of the treatment process. Progress notes are written by both physicians and nurses to document patient care on a regular interval during a patient's hospitalization.

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  8. List of abbreviations used in medical prescriptions - Wikipedia

    en.wikipedia.org/wiki/List_of_abbreviations_used...

    This is a list of abbreviations used in medical prescriptions, including hospital orders (the patient-directed part of which is referred to as sig codes).This list does not include abbreviations for pharmaceuticals or drug name suffixes such as CD, CR, ER, XT (See Time release technology § List of abbreviations for those).

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