The basics. What the patient said, what the doctor observed/found. What the doctor decides it means. What they plan to do about it. The write up can be brief or run pages.
Answered 4/24/2023
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Pertinent subjective events, objective exam, an assessment and plan, including estimated discharge or what has to happen prior to discharge are the main elements in an inpatient progress note.
Answered 4/24/2023
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