Forum - Questions & Answers
Oct 3rd, 2012 - rphelps 615 1
Documentation
I have a doctor who want the HPI in with the Chief complaint in EMR. Is this ok? Also if some elements of the exam are normal is it ok to say normal.
Oct 3rd, 2012 - nmaguire 2,606
re: Documentation
For code assignment, the CC could be found along with the HPI elements.
It is OK to document normal, many suggest "normal, what". Example: normal response to light and accomodation