u/AminoAcidTripper

Hello Everyone,

I have transitioned Careers to a facility from a clinic that used a standardized navigation click and check box system for a majority of the documentation, which was basically spoon fed guided to clinicians (That didn't need to be super high quality due to same day evals.) My new role basically gives you a blank SOAP note to fill out and I have spent an aggressive amount of time trying to document with safe and defensive documentation. I am asking if any licensed PTs have tips, recommendations, or key information suggestions that need to be in notes to be the bare minimum without over documenting? Thank you all!