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- التقييم والخطة (بالإنجليزية: assessment and plan) (واختصارها: A/P أو A&P) هو أحد مكونات من مذكرة قبول المريض لدخول المستشفى أو مرفق الرعاية الصحية ليكون تحت رعاية «المرضى الداخليين» (بالإنجليزية: Inpatient care). (ar)
- The assessment and plan (abbreviated A/P" or A&P) is a component of an admission note.
* Assessment includes a discussion of the differential diagnosis and supporting history and exam findings.
* The plan is typically broken out by problem or system. Each problem should include:
* brief summary of the problem, perhaps including what has been done thus far
* orders for medications, labs, studies, procedures and surgeries to address the problem.
* problems are commonly derived from
* chief complaint
* history of present illness
* review of systems (rarely; these should have been picked up and incorporated as new chief complaints during the interview)
* physical exam (rarely; these should have been picked up and incorporated as new chief complaints during the exam)
* social history, including counseling for smoking, alcohol, and illicit drug use
* family history
* medications may indicate problems that need to be addressed in the treatment of the other problems, such as dyslipidemia controlled with a statin. (en)
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- 1714 (xsd:nonNegativeInteger)
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- التقييم والخطة (بالإنجليزية: assessment and plan) (واختصارها: A/P أو A&P) هو أحد مكونات من مذكرة قبول المريض لدخول المستشفى أو مرفق الرعاية الصحية ليكون تحت رعاية «المرضى الداخليين» (بالإنجليزية: Inpatient care). (ar)
- The assessment and plan (abbreviated A/P" or A&P) is a component of an admission note.
* Assessment includes a discussion of the differential diagnosis and supporting history and exam findings.
* The plan is typically broken out by problem or system. Each problem should include:
* brief summary of the problem, perhaps including what has been done thus far
* orders for medications, labs, studies, procedures and surgeries to address the problem.
* problems are commonly derived from
* chief complaint
* history of present illness
* review of systems (rarely; these should have been picked up and incorporated as new chief complaints during the interview)
* physical exam (rarely; these should have been picked up and incorporated as new chief complaints during the exam)
* social history, (en)
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- تقييم المرض وخطة العلاج (طب) (ar)
- Assessment and plan (en)
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