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2. 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.

3. 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.

4. Medical record - Wikipedia

   en.wikipedia.org/wiki/Medical_record

   The information contained in the medical record allows health care providers to determine the patient's medical history and provide informed care. The medical record serves as the central repository for planning patient care and documenting communication among patient and health care provider and professionals contributing to the patient's care.

5. Case report form - Wikipedia

   en.wikipedia.org/wiki/Case_report_form

   Case report forms contain data obtained during the patient's participation in the clinical trial. Before being sent to the sponsor, this data is usually de-identified (not traceable to the patient) by removing the patient's name, medical record number, etc., and giving the patient a unique study number.

6. Google Docs - Wikipedia

   en.wikipedia.org/wiki/Google_Docs

   Google Docs is an online word processor and part of the free, web-based Google Docs Editors suite offered by Google. Google Docs is accessible via a web browser as a web-based application and is also available as a mobile app on Android and iOS and as a desktop application on Google's ChromeOS .

7. SBAR - Wikipedia

   en.wikipedia.org/wiki/SBAR

   Another disadvantage to using SBAR when bedside charting is the issue of disclosing sensitive topics or new information that has not been shared with the patient or family before or after the bedside charting takes place. An alternative to this can be for nurses to makes plans to share new or sensitive information before or after bedside report ...

8. AOL Mail

   mail.aol.com/d?reason=invalid_cred

   Get AOL Mail for FREE! Manage your email like never before with travel, photo & document views. Personalize your inbox with themes & tabs. You've Got Mail!

9. Nursing documentation - Wikipedia

   en.wikipedia.org/wiki/Nursing_documentation

   Quality of documentation process: the procedural issues of capturing client data such as nurse's signature and designation, date, chronological order, timeliness, regularity of documentation and concordance between documentation and reality. Quality of documentation content: refers to the message from data about a care process.