Your client falls while you are providing care. In addition to your regular charting, you will probably be required to complete a(n):
1. incident report that is included in the client's chart.
2. interval note in the client's chart.
3. incident report that is kept separate from the client's chart.
4. progress note in the client's chart.
Question 2
To better understand your client's condition, you read the notes of the physician, the respiratory therapist, and the last shift's nurse, all of which are in different divisions of the client's chart.
What type of medical record is your facility using?
1. narrative charting
2. source-oriented medical records
3. problem-oriented medical records
4. clinical pathways