Health Assessment Check-Off Project Discussion

Health Assessment Check-Off Project Discussion

Health Assessment Check-Off Project Discussion

Complete the “Health Assessment Check-Off Project” template using a patient that you have previously worked with. Ensure that you have adequately completed the assessment steps and given a proper recommendation.

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APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Health Assessment Check-Off Project

Physical Exam Documentation

Chief Complaint:

History of Present Illness:

Past Medical History (Hx):

Past Surgical Hx:

Family Hx:

Social Hx:

Allergies:

Medications:

Review of symptoms by system:

Physical Exam:

Assessment:

Treatment Plan:

Criteria Percentage 1: Unsatisfactory (0.00%) 2: Less Than Satisfactory (80.00%) 3: Satisfactory (88.00%) 4: Good (92.00%) 5: Excellent (100.00%) Comments Points Earned
Critera 100.0%
Chief Complaint 8.0% A description of the chief complaint is not included. A description of the chief complaint is incorrect or incomplete. A description of the chief complaint is included but lacks details. A description of the chief complaint is complete and lacks supporting details. A description of the chief complaint is extremely thorough and includes substantial details.
History of Present Illness 8.0% A description of present history of illness is not included. A description of present history of illness is incorrect or incomplete. A description of present history of illness is included but lacks details. A description of present history of illness is complete and lacks supporting details. A description of present history of illness is extremely thorough and includes substantial details.
Past Medical History (Hx) 8.0% A description of past medical history is not included. A description of past medical history is incorrect or incomplete. A description of past medical history is included but lacks details. A description of past medical history is complete and lacks supporting details. A description of past medical history is extremely thorough and includes substantial details.
Past Surgical Hx 8.0% A description of past surgical history is not included. A description of past surgical history is incorrect or incomplete. A description of past surgical history is included but lacks details. A description of past surgical history is complete and lacks supporting details. A description of past surgical history is extremely thorough and includes substantial details.
Family Hx 8.0% A description of family history is not included. A description of family history is incorrect or incomplete. A description of family history is included but lacks details. A description of family history is complete and lacks supporting details. A description of family history is extremely thorough and includes substantial details.
Social Hx 8.0% A description of social history is not included. A description of social history is incorrect or incomplete. A description of social history is included but lacks details. A description of social history is complete and lacks supporting details. A description of social history is extremely thorough and includes substantial details.
Allergies 8.0% A description of allergies is not included. A description of allergies is incorrect or incomplete. A description of allergies is included but lacks details. A description of allergies is complete and lacks supporting details. A description of allergies is extremely thorough and includes substantial details.
Medications 8.0% A description of medications is not included. A description of medications is incorrect or incomplete. A description of medications is included but lacks details. A description of medications n is complete and lacks supporting details. A description of medications is extremely thorough and includes substantial details.
Review of Symptoms by System 8.0% A review of symptoms by system is not included. A review of symptoms by system is incorrect or incomplete. A review of symptoms by system is included but lacks details. A review of symptoms by system is complete and lacks supporting details. A review of symptoms by system is extremely thorough and includes substantial details.
Physical Exam 8.0% A description of the steps taken during the physical exam is not included. A description of the steps taken during the physical exam is incorrect or incomplete. A description of the steps taken during the physical exam is included but lacks details. A description of the steps taken during the physical exam is complete and lacks supporting details. A description of the steps taken during the physical exam is extremely thorough and includes substantial details.
Assessment 8.0% A description of the assessment steps is not included. A description of the assessment steps is incorrect or incomplete. A description of the assessment steps is included but lacks details. A description of the assessment steps is complete and lacks supporting details. A description of the assessment steps is extremely thorough and includes substantial details.
Treatment Plan 8.0% A description of the treatment plan recommended for the patient is not included. A description of the treatment plan recommended for the patient is incorrect or incomplete. A description of the treatment plan recommended for the patient is included but lacks details. A description of the treatment plan recommended for the patient is complete and lacks supporting details. A description of the treatment plan recommended for the patient is extremely thorough and includes substantial details.
Mechanics of Writing (includes spelling, punctuation, grammar, and language use) 2.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is employed. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. The writer is clearly in command of standard, written, academic English.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 2.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
Total Weightage 100%

Health Assessment Check-Off Project Discussion

 

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