All my university docs tell me it is diagnoses, so I have used that for 8 years.
Posted By: kathyR on 2006-07-23
In Reply to: Psychiatric reports. - Diana Mejia
Subject: All my university docs tell me it is diagnoses, so I have used that for 8 years.
nm
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- Psychiatric reports. - Diana Mejia
- All my university docs tell me it is diagnoses, so I have used that for 8 years. - kathyR
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I forgot to add, this seems to be University of Florida Hsp nm
Subject: I forgot to add, this seems to be University of Florida Hsp nm
x
I went to an accredited 4-year university and
Subject: I went to an accredited 4-year university and
did not misunderstand. Our instructor was a 20+ year MT/AMT/ART. We were told that if the doctor said it, the cominbing forms were correct and related to each other/complaint to use what he said.
I learned 27 years ago to use q.4h. (no spaces), past few years q.4 h. (see msg)
Subject: I learned 27 years ago to use q.4h. (no spaces), past few years q.4 h. (see msg)
Now some are saying it's q. 4h.?? UGH, YUCK!! I have also worked on accounts where it had to be "every 4 hours," and we had to spell out p.r.n. (as needed for). At least we got more characters.
First rule: It is all what the "client/account" wants, not always what the BOS says it is. I realize that language and its usage is constantly changing, but I've seen so many BOS and client flip-flops on so many other things in nearly 3 decades that it's laughable. What isn't laughable is when we get penalized for not knowing what they want, even when they, themselves, don't know or are wrong.
Oh, and I still prefer the old no spaces: q.4h., q.4-6h., q.12h., and so on.....
It stands for University of the Philippines Population Institute, but
Subject: It stands for University of the Philippines Population Institute, but
There is Humboldt State University in California, not Utah (nm)
Subject: There is Humboldt State University in California, not Utah (nm)
xxx
Wow, thank you. Just years, years and more years of experience
Subject: Wow, thank you. Just years, years and more years of experience
and a constant thirst for learning something new everyday. As we all know this can get to be somewhat boring, but learning from what I transcribe as well as from other transcriptionists keeps me going (money is not bad either). It becomes a challenge. But I can't thank you enough for the kind words.
Use to be younger...
So, is Yale correct? Perhaps the score was developed at Yale University?? nm
Subject: So, is Yale correct? Perhaps the score was developed at Yale University?? nm
.
2 years' time because years is plural. One year's time because it is singular, only one year.
Subject: 2 years' time because years is plural. One year's time because it is singular, only one year.
I think it is only the diagnoses that need....
Subject: I think it is only the diagnoses that need....
to be spelled out. This part is more like the plan.
diagnoses
Subject: diagnoses
Axis I - VI are not arms of one diagnosis, but of many diagnoses, in different systems and considerations. They include psychiatric diagnoses, functional diagnoses, physical illness diagnoses, etc., etc.
Diagnoses...
Subject: Diagnoses...
Croup and bronchitis.
Procedures: nasogastric tube feed and OPM study. Also says that OPM study indicated silent aspiration.
Any other diagnoses?
Subject: Any other diagnoses?
diagnoses
Subject: diagnoses
Debility.
Dementia with acute confusional state.
Abrasion to shoulder.
Metastatic disease.
Dehydration.
End-stage COPD.
Arthritis.
SIADH.
Hypokalemia.
Hyponatremia.
Bowel obstruction, etiology undetermined.
Urinary tract infection.
Septic condition of blood.
diagnoses
Subject: diagnoses
Diagnoses as follows:
paroxysmal atrial fibrillation, end-stage renal disease, Lown-Ganong-Levine syndrome, hypertension, hypopituitarism, acromegaly, hyperparathyroidism, hypothyroidism, insulinoma.
does that help?
Diagnoses....
Subject: Diagnoses....
Hypertension, chronic edema, hypothyroidism, pacemaker placement, mitral valve prolapse, DVT, hyperlipidemia, GERD, proteinuria, right-sided heart failure
No, see diagnoses. Thanks.
Subject: No, see diagnoses. Thanks.
1. Acute left chest pain.
2. Esophagitis.
3. Coronary artery disease.
4. Hypertension, severe.
5. Probable renal artery stenosis.
6. Peripheral vascular disease.
7. AKI.
8. Malnutrition.
9. Anemia.
Two diagnoses nm
Subject: Two diagnoses nm
k
are these diagnoses...
Subject: are these diagnoses...
correct? He rambles them all together, not sure if I am correct with what I am hearing.
DIAGNOSES:
1. HARDWARE PAIN, RIGHT SECOND METATARSAL FUSION WITH A HISTORY OF DEEP INFECTION AFTER HAMMERTOE PROCEDURE, RIGHT SECOND TOE
2. PAIN AFTER KNEE REPLACEMENT
3. PAIN, LEFT FOOT
tia.
is this 2 or 3 diagnoses?
Subject: is this 2 or 3 diagnoses?
DIAGNOSES:
1. LEFT KNEE LATERAL MENISCUS TEAR
2. OSTEOCHONDRAL DEFECT
3. RIGHT KNEE DEGENERATIVE JOINT DISEASE
Not sure if Right knee degenerative joint disease should be number 3. tia.
I should have put the diagnoses which are..
Subject: I should have put the diagnoses which are..
1. GOUTY ARTHROPATHY
2. NEURALGIA PAIN
3. FAT PAD ATROPHY
Would it still be hallux shoes and also if so would Hallux be capitalized? Thanks for your help.
on diagnoses -diseases
Subject: on diagnoses -diseases
DISCHARGE DIAGNOSES
- Relapse acute myelomonocytic<soundslike> leukemia.
- Severe pancytopenia due to bone marrow hypopasia secondary to cancer chemotherapy.
- Sepsis, possibly due to staphylococcus lubdenensis.
- Ogroshong<soundslike> catheter exit site infection.
- Hypocholemia.
Any diagnoses for the patient? nm
Subject: Any diagnoses for the patient? nm
s
Doc says in diagnoses list...
Subject: Doc says in diagnoses list...
Status post PCIA with stents in the left anterior descending.
Can't find PCIA. Did find PCI - percutaneous coronary intervention. Or does he mean PTCA?
Are they receiving TPN? Or do you have any diagnoses? nm
Subject: Are they receiving TPN? Or do you have any diagnoses? nm
s
Any diagnoses on this patient? nm
Subject: Any diagnoses on this patient? nm
s
Yes, it's discharge diagnoses-First
Subject: Yes, it's discharge diagnoses-First
one is enterobacter septicemia due to line infection.
could definitely fit in with diagnoses and problems
Subject: could definitely fit in with diagnoses and problems
Thanks so much!
Have a great day!
any diagnoses or dosage?
Subject: any diagnoses or dosage?
one diagnosis or more diagnoses
Subject: one diagnosis or more diagnoses
DIAGNOSIS: INTERNAL DERANGEMENT, RIGHT KNEE
TEAR OF THE LATERAL MENISCUS, RULE OUT MEDIAL MENISCUS TEAR
EARLY DEGENERATIVE ARTHRITIS
Not sure if this is all one diagnosis or more. Any ideas. The only thing that I think makes it sound to be one is because he doesn't mention which knee for any of the others. If it is one how would you punctuate. Sorry for so many questions but I am confused..tia.
Final Diagnoses
Subject: Final Diagnoses
1. Congestive heart failure.
2. Cellulitis, right leg.
3. Cardiomyopathy.
4. Morbid obesity.
Do you know the diagnosis or diagnoses?
Subject: Do you know the diagnosis or diagnoses?
Normally, you don't number diagnoses
Subject: Normally, you don't number diagnoses
within an axis. We do this.
Axis I: xxxxx
xxxxxx
Axis II: xxxxx
etc. Each diagnosis is on a separate line, but not numbered.
The SSA was given in a list of diagnoses. sm
Subject: The SSA was given in a list of diagnoses. sm
Totally occluded bilateral SSA stenosis. Patent s/l "profundal" arteries.
Also in list is of diagnoses is the following....Coronary artery bypass graft and "SVG to LAD", "SVG to OM"... not sure on these abbreviations... can you tell I am completely lost....
It's a list of discharge diagnoses...
Subject: It's a list of discharge diagnoses...
DKA, then s/l Right leg varicose, then obesity. He says it later in the report and it definitely s/l varicose.
listed in diagnoses, no sentence
Subject: listed in diagnoses, no sentence
.
Was that a typo? I've never had VI diagnoses, only 5.nm
Subject: Was that a typo? I've never had VI diagnoses, only 5.nm
I believe the are 2 separate diagnoses and would transcribe as such.
Subject: I believe the are 2 separate diagnoses and would transcribe as such.
.
whats the diagnoses?---this ending could be a lot of
Subject: whats the diagnoses?---this ending could be a lot of
diff meds, first one that comes to my mind is
fluoxetine
Can you look in the pt's diagnoses for clues? Think your PT/INR phrase
Subject: Can you look in the pt's diagnoses for clues? Think your PT/INR phrase
s
context, sentence? - diagnoses?....nm
Subject: context, sentence? - diagnoses?....nm
can you give the patient's diagnoses?
Subject: can you give the patient's diagnoses?
Any past history or diagnoses? nm
Subject: Any past history or diagnoses? nm
s
any diagnoses or problem list?
Subject: any diagnoses or problem list?
Differential diagnosis or diagnoses? nm
Subject: Differential diagnosis or diagnoses? nm
senescent changes (fyi no abbrev in your diagnoses too...) nm
Subject: senescent changes (fyi no abbrev in your diagnoses too...) nm
I would keep it as you have it, (3 diagnoses) just put periods at the end of each sentence. :)
Subject: I would keep it as you have it, (3 diagnoses) just put periods at the end of each sentence. :)
3 diagnoses, the 2nd and 3rd caused by Diabetes...nm
Subject: 3 diagnoses, the 2nd and 3rd caused by Diabetes...nm
nm
I would say in this instance if dictator is referring to diagnoses, sm
Subject: I would say in this instance if dictator is referring to diagnoses, sm
it probably is hyper given that he is diagnosed with hypertension but is on meds for that. his bp is low today so he wants to decrease the norvasc as it is over working. the patient isn't diagnosed with hypotension, it is only hypo due to medication dosaging.
Is this on a list? Dosage information? Diagnoses? nm
Subject: Is this on a list? Dosage information? Diagnoses? nm
s
My workplace allows lab abbrvns to stay in diagnoses, too. nm
Subject: My workplace allows lab abbrvns to stay in diagnoses, too. nm
s
What medical conditions/diagnoses are we talking about?
Subject: What medical conditions/diagnoses are we talking about?
x
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