Jane Dares Record

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Instructions Complete the medical abbreviations chart. (Note that the medical abbreviations are the same as those highlighted in yellow in Jane Dare’s Health Record). In the second column, list what each of the individual letters in the abbreviation represents. In the third column define the context or meaning of the term that the abbreviation represents. Use simple terms. Finally, in the far right column, identify the source document. For example, face sheet, discharge summary, progress notes, or x-ray report. Abbreviation | Letters Represent | Context Definition or Application within the Patient’s Chart | Source Document | 1. ICD | International classification of diseases. | States the classification of coding use | Admission…show more content…
> | More than | Comparative of much used. | Physician order & Progress notes | 27. MOM | Milk of magnesia | A milky white aqueous suspension of magnesium hydroxide use as antacid and a laxative. | Physician order & progress notes | 28. UA | Urinalysis | Analysis of urine by physical, chemical, microscopical means to test for the presence of disease drug. | Physician order & Progress notes | 29. GI | Gastrointestinal | Of or relating to the stomach and the intestine. | Physician Order & Progress notes | 30. IM | Intramuscular | Within the substance of a muscle. | Physician order & Progress notes | 31. D/T | Day time | The time between sunrise and sunset | Physician order & Progress notes | 32. DT | Diphtheria toxoid | diphtheria toxoid a sterile preparation of formaldehyde-treated products of the growth of Corynebacterium diphtheria, used as an active immunizing agent, generally in mixtures with tetanus toxoid and pertussis vaccine (DTP) or with tetanus toxoid alone (DT for pediatric use and Td, which contains less diphtheria toxoid, for adult use | Physician order & Progress notes | 33. DP | Doctor of Pharmacy | The first level professional degree that prepares the graduate for pharmacy practice | Physician order & Progress notes | 34. UTI | Urinary tract infection | Term for any infection in the urinary tract, including cystitis and pyelonephritis. It can be
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