Lecture Medical assisting: Administrative and clinical competencies (2/e) - Chapter 36

Chapter 36 - Interviewing the patient. After completing chapter 36, you will be able to: Name the skills necessary to conduct a patient interview; explain the procedure for conducting a patient interview; recognize the signs of anxiety; depression; and physical, mental, or substance abuse;. | Chapter 36 PowerPoint® to accompany Second Edition Ramutkowski Booth Pugh Thompson Whicker Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Medical Assisting Chapter 36 Objectives: 36-1 Name the skills necessary to conduct a patient interview. 36-2 Explain the procedure for conducting a patient interview. 36-3 Recognize the signs of anxiety, depression and physical, mental or substance abuse. 36-4 State the six C’s for writing an accurate patient history. Interviewing the Patient, Taking a History, and Documentation Objectives (cont.) 36-5 Document on the patient’s chart accurately. 36-6 Identify parts of the Health History form. Patient Billing and Collections Introduction You will prepare the patient and the patient’s chart before the physician enters the exam room to examine the patient. Conducting the patient interview and recording the necessary medical history are essential to the practitioner's examination process. | Chapter 36 PowerPoint® to accompany Second Edition Ramutkowski Booth Pugh Thompson Whicker Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Medical Assisting Chapter 36 Objectives: 36-1 Name the skills necessary to conduct a patient interview. 36-2 Explain the procedure for conducting a patient interview. 36-3 Recognize the signs of anxiety, depression and physical, mental or substance abuse. 36-4 State the six C’s for writing an accurate patient history. Interviewing the Patient, Taking a History, and Documentation Objectives (cont.) 36-5 Document on the patient’s chart accurately. 36-6 Identify parts of the Health History form. Patient Billing and Collections Introduction You will prepare the patient and the patient’s chart before the physician enters the exam room to examine the patient. Conducting the patient interview and recording the necessary medical history are essential to the practitioner's examination process. How you conduct yourself during the first few moments with the patient can make a major difference in the patient’s attitude. The Patient Interview and History Ask the patient specific pieces of information called data. Chief complaint is subjective statement by patient describing the most significant symptoms or signs of illness. Medical and Health History Basis for all treatment Provides information for research, reportable diseases and insurance claims. Becomes a legal record of the treatment rendered Must be complete and accurate to be a good defense in case of legal action. All information regarding the patient should be documented precisely and accurately! Patients Rights All data that you obtain are subject to legal and ethical considerations. American Hospital Association’s Patients Bill of Rights written in 1973 and revised in 1992. Each state encourages healthcare workers to be aware of and follow this document. Patient Responsibilities Patients are .

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