Documentation Blues: Write a Note, Not a Novel!
Posted by Mike Ferris on Friday, January 16, 2009 and posted in HospiceWhen you go on a visit to register someone, and they choose (or not) your services, make a simple note on the referral form or visit report that they selected your service (or didn’t). There is no need to go into great detail that she’s waiting for her divorced ex-son-in-law to arrive from Bangor next week so that he can celebrate his birthday in his hometown and then take her to the doctor for a visit! Suffice it to say that she’s waiting to talk to the doctor. Remember to document, but keep it short and to the point!
Excerpted from LEGENDARY RESULTS: Managing Referrals & Increasing Admission Vol. 2: The Admissions Process by Michael Ferris and Polly Rehnwall