Physician Progress Notes/Order Form - vdh virginia 2025

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Progress notes are the core piece of documentation a mental health care provider should write after each session with a client, but its more than just a record of what happened in the session. Progress notes keep a record of the clients progress and the care you provide.
An example of a progress note is: Attended service at 0900 to provide a personal care service. Client John Doe was in bed on my arrival. I picked up all the laundry for the wash, put away the dishes, and went to wake John at 0915 for his 0930 medication.
They become a part of the clients medical record. Progress notes capture the course of treatment in a standardized way that allows medical professionals to be able to see and understand the clients diagnosis and response to treatment, as well as any interventions used thus far.
Progress notes serve as a record of events during a patients care, allow clinicians to compare past status to current status, serve to communicate findings, opinions and plans between physicians and other members of the medical care team, and allow retrospective review of case details for a variety of interested
A patient progress note is a clinical document, written by a hospital physician, describing a patients status and the physicians assessments and care plan for the patient.
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