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Polio epidemic- left thousands of children paralyzed. WW1- occured

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Historical Development

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When communicating to the patient explain to them in terms that they can understand. Medical jargon will scare the patient. 4. Humor - Two types Useful humor Destructive humor 5. Tone and Volume- It is not what you say but the way you say it. 6. Effective listening- When you want to find any information from a patient you need to think of it as if you were conducting an interview. Introduction: you are stablishing the purpose of the interaction Body: is aimed in attaining the objectives Closing: give the opportunity for the patient to ask question about her treatment or tell the patient how is the

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Vocabulary

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Balance Budget Act of 1997 (BBA)

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Current Isuess

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Mary McMilliam (1921)

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Who was the first PT in US?

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When did APA changed its name to?

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APA changed to APTA in 1962

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Reconstruction Aides

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How these trained women were known ?

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Where did the headquarter of APTA relocated to?

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To Washington D.C in 1971

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To assist the PT in the delivery of pt services in compliance with federal and state regulations.(Fl practice act) graduated from an accredited PTA associate degree program.

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PTA Function

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In 1962 to American Physical Therapy Association (APTA)

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When did APA change its name ?

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Informed Consent, before initiating treatment, in accordance with standards of practice. The informed consent must provide a clear description of the proposed interventions, expected benefits and risks, a comparison of the benefits and risks with or without the intervention and an explanation of reasonable alternatives.

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Informed Consent

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1.Examination -gathering information. PMH(patient medical history) 2. Initial Assessment- all measurements 3. Diagnosis - is made from the findings from the examination through a defined process. 4. Prognosis - Prediction of the level of improvement and time necessary to reach that level. 5. Plan of Care- incorporates the expectation of the patient. 6. Goals - should be measurable. 7. Treatment interventions - when the PT and PTA conduct procedures with the patient to achieve

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Components of the Initial Assessment

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S - subjective • Information provided by the patient or his caregiver or a family member. O - objective • Measurable data, all treatments done (HP,CP,US), all observations, conversations with the PT or nurse. "Painting a picture" about the patient. A - assessment • Explain note (why you do the treatment) P - plan • What are you going to do for next treatment (gait training 30ft) SIGN NOTE

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SOAP

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1-Useful Humor 2-Destructive Humor

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Types of Humor

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help patients cope with stress

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Useful Humor

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Continual verbal fencing to win the upper hand . Creates a feeling of animosity, that makes work together imposible

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Destructive Humor

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1-Introduction 2-Body 3-Closing

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Parts of an Interview

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1-Districts(automatic membership) 2-Chapters(automatic membership) 3-Sections(optonal) 4-Assembly(optional)

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APTA -Organization(National)

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1. Local. membership is automatic. May be used on location of residence or employment

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Districts

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membership is automatic. It is based on location of residence, employment and education. They require dues. APTA has 52 chapters, one for each state

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Chapters

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organized in the national level If you want to add any section in specific you must pay more money (optional) All members with similar interest (PT, PTA, schools)

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Sections

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organized at the state and national level All members of the same class (category {PTA with PTAS}

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Assembly

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1-House of delegates(HOD) 2-Board of Directors 3-Staff

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APTA Administration Composition

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Policy-making body of APTA(write laws)

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House of Delegates (HOD)

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Composed of six officers: 1-President 2-Vice-President 3-Secretary 4-Treasurer 5-Speaker of the HOD 6-Vice Speaker of the HOD

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Board of Directors members

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Communicate the policies to internal or external personnel oragencies

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Board of Directors Function

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150 members, anyone can call the APTA (member or nonmember)

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Staff

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American Board of Physical Therapist Specialist

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Associated Organizations- within APTA

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150 members, anyone can call the APTA (member or nonmember)

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Staff

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Created by the HOD in 1978 Recognize PT with advance knowledge, skills,experience in a Special Area of Practice

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American Board of Physical Therapist Specialist

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PT must pass a Written Exam and have the qualifications: 1-Licensure to practice in one of the chapters of the APTA 2-Evidence of at least 2000 hrs of clinical practice in the Specialty Area

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American Board of Physical Therapist Specialist: Board Certifications

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1-Federation of State boards of Physical Therapy 2-Foundation for Physical Therapy 3-Trialliance- APTA , AOTA , American Speech-Language and Hearing Association 4-World Confederation of Physical Therapy

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Associated Organizations

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Licensing examination ans State Practice Act for physical therapy

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Federation of State boards of Physical Therapy

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Provides financial support for scientific research

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Foundation for Physical Therapy

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Meet three times a year to discuss issues of mutual concern

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Trialliance- APTA , AOTA , American Speech-Language and Hearing Association

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International organization held every 4 years to share info and collaborate on mutual goals

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World Confederation of Physical Therapy

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1-American with Disabilities Act(ADA) 2-Individual with Disabilities Education Act (PL-94-1420) 3-Social Security Act 4-Medicaid

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Laws, Regulations,and Policies. (FEDERAL STATUS)

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. Create to eliminate discrimination against individuals with disabilities. Services including health care available to the public be made accessible to persons with disabilities

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American with Disabilities Act(ADA)(Federal)

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Requires that special education and related services including physical therapy be provided at public expense to students with disabilities. Ages 6-21 years of age.

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Individual with Disabilities Education Act (PL-94-1420)(Federal)

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Health insurance program for 65 years or older Cover only 80%. Patient is responsible for the other 20 %, if the patient have Medicaid too then Medicaid will cover the 20 %.

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Social Security Act(Federal)

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Jointly funded by the state and federal government Designed to provide health care services to the poor

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Medicaid(Federal,State)

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State Statues: 1-State Practice Act 2-Licensure

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Laws,Regulations,and Policies (STATE)

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Foundation for the scope and Protection of Physical Therapy. There is a Practice Act for each state The PTA is also recognized under the practice act of 43 states.

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State Practice Act(State Statues)

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Legally protects the professional tittle "physical therapist" Creates a scope of practice authorize the individual to practice in a given state. All 50 states license PT.

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Licensure (State Statues)

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1-Health Care Financing Administration (HCFA) 2-Professional misconduct 3-Negligence 4-Malpractice

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Regulations(State)

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Regulation of the Medicare and Medicaid Programs. They regulate how much and for what services they will reimbursed within the Medicare program

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1. Health Care Financing Administration (HCFA)

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Physical/sexual abuse of the patient Patient abandonment (discharge of a patient while services are still needed. Improper delegation and supervision. Provision of unnecessary treatment. Fraud Incompetence Practice while intoxicated

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Professional misconduct (Regulation by state disciplinary agency)

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Failure to act as a reasonable prudent person. I.e. PT failure to mop up water from the floor and someone slipped on it.

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Negligence(Regulation State)

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Failure to do something that reasonable prudent member of that profession would have done with subsequent injury to the patient. I.e. therapist mobilizes a joint thereby fractures it. A prudent person would have known how to mobilize a joint.

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Malpractice (Regulation State)

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Balance Budget Act of 1997 (BBA)

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Current Issues

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Federal regulation to save Medicare program from dissolving. BBA cut the money.

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Balance Budget Act of 1997 (BBA)

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1. Services not provided - filing a claim for services not actually rendered (no shows, dead people etc. 2. Submit claims for services not medically necessary. 3. Services provided by improper person 4. The use of kickbacks or other payments in exchange for or induce patient referrals.

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LAW is looking for

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1. filing a claim for services not actually rendered (no shows, dead people, Medicare #'s in the mall, busloads of people sign Medicare forms)

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1. Services not provided(BBA)

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1-Civil False Claims Act 2-Criminal False Claim

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Types of Punishment

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civil action against Health Care Professionals for defraudation (cheating, deceiving) of Federal Health Care programs Penalty 1. not less than 5,000 and not more that 10,000 plus treble the damages. 2. Loss of License and you can not longer be a Medicare provider.

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Civil False Claims Act

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billing for services not rendered, falsifying the information required on the claim forms, falsely certifying that services were medically necessary, and upcoding. Penalty 1. Fine up to 25,000 up to 5 years in prison for those direct connection. 2. others misdemeanor fine up to 10,000 and up to 1 year in prison.

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Criminal False Claim

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• Examination to determine the Nature and Status of the Condition, examination is interpreted to establish a Diagnosis, Prognosis and Plan of Care. Physical Therapy is provided by or under the direction and supervision of a PT.

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Physical Therapy Definition

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First name of the association

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American Physiotherapy Association ( APA)

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1. Examination- gathering information. PMH 2. Initial Assessment - all measurements 3. Diagnosis - is made from the findings from the examination through a defined process. 4. Prognosis- Prediction of the level of improvement and time necessary to reach that level. 5. Plan of Care- incorporates the Expectation of the Patient. 6. Goals - should be Measurable. 7. Treatment interventions- when the PT and PTA conduct procedures with the Patient to achieve the desired outcomes.

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Component of the Initial Assessment

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When the physician has a financial investment in the clinic.

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Physicians Owned- Physical Therapy Services (POPTS)

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Prohibit patients receiving Medicare from being cared for in a Laboratory or Clinic in which the physician or family members owns an interest.

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Stark Law

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This has to do with Physician and Financial arrangement (relationships, ownership, investment loans) Items of services must not have exceeded $50.00 per gift or $300.00 per year.

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Stark Law II

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Occurs when health care provider performs the skills and techniques of another health care provider. Can't be billed twice for the same treatment provided by 2 different people (PT and OT)

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Encroachment

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The insurance company contracts with health care providers that subscribe to the plan. Private Practitioners are known as "Preferred providers" PPO

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Managed Care

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Is a Group of health care providers who perform a Professional Cooperative relationship for the purpose of Referring individual to health care providers Within the Network. HMO

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Managed Care Network

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Comply with the State Practice Act Follow the professional code of ethics and Standards of Practice Know your facilities policies Document accurately and make sure it matches your billing and bill using CPT codes Services provided and billed are consistent with the plan of care.

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Protect Yourself

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Developed to standardize confidentiality and security of health data. When sending referral to another office they only need to know the medical history and no the medical information.

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Health Insurance Portability and Accountability Act (HIPPA) 1996

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American Board of Physical Therapy Specialist was created by APTA in 1978

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When was the American Board of Physical Therapy Specialist created?

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Legal in 33 states

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Direct access

question

1. Civil False Claims Act Civil action against health care professionals for defraudation (cheating, deceiving) of federal health care programs. Penalty: o Not less than 5,000 and no more than 10,000 plus treble the damages. o Loss of license and you cannot longer be Medicare provider.

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Types of Punishment

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Medicare is managed by HCFA they instituted the following: 1. Diagnostic Related Groups (DRG's) For acute care hospitalization and recently implemented the 2. Prospective Payment System (PPS) For inpatient rehabilitation facilities, and skilled nursing facilities. o In a skilled nursing facility, the Minimum Date Set (MDS) is a measurement tool that has been used to measure the cost of care of a patient in the facility. o In an outpatient basis, the PT providing physical therapy to a patient uses billing codes.

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Reimbursement

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Social: o Help people, usually non-selfish task. o I.e. buying the patients lunch because he/she is hungry. Therapeutic: o When a therapist visit the patient for the first time and does an evaluation, makes an assessment and formulate a treatment plan to help the patient attain their personal goal.

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Patient Relationships

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1. Loss of home 2. Loss of privacy 3. Loss of independence

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Challenges to the patients

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The person remains the patient role making up symptoms long after they are gone or fabricate them if they never existed at all. (document if you notice this behave)

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Malingering

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1. the way the material is presented, the voice, purpose, and the organization. If you want to answer questions you need to be clear, concise, and organized. 2. The attitude of the speaker, patients perceive a bad attitude and they will not relay any information to you if you are rude; 3. the degree in which the speaker and the receiver are able to listen effectively.

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Verbal communication

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Need to determine if the patient is oriented to time and place and to person. Facial expression Show me what I explain to you Tell me in your words what I said

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How to determine the patient mental status

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Patients are often too embarrassed to ask you to repeat something so they interpret in their own way, or hear a portion of what was actually discussed. It is important to be very clear, and ask them repeatedly if they understand especially with exercise instruction.

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Clarity

question

Most health professionals maintain a caring attitude with their patients which is manifested in the way they interact with the patient.

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Attitudes

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Useful humor Destructive humor

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Humor Types

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It is not what you say but the way you say it

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5. Tone and Volume

question

When you want to find any information from a patient you need to think of it as if you were conducting an interview.

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6. Effective listening

question

1-Introduction 2-Body 3-Closing

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Parts of an Interview

question

you are stablishing the purpose of the interaction

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Introduction

question

is aimed in attaining the objectives

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Body

question

give the opportunity for the patient to ask question about her treatment or tell the patient how is the progress.

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Closing

question

1. Pantomime 2. Demonstration 3. Facial expression 4. Physical appearance 5. Touch 6. Proxemic

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Non-Verbal Communication

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Gestures and body language I.e. pointing to the body area, pointing to the assistive device they will be using. Showing your ID badge to let them know your purpose for the visit.

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Pantomime

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Is used to supplement verbal instructions Always demonstrate in front of the patient Continual re-enforcement.

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Demonstration

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Always look at your patient's face!

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Facial expression

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important aspect of personal appearance is grooming, when is the hair to long for men, too much make-up worn in the female, or beards or sideburns not groomed properly. Do not forget personal hygiene, sometimes certain fragrances might offend the patient.

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Physical appearance

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You should keep in mind that patients are picking signals conveyed by your manner of touching. This is often related to your appearance, the speed, and ease with which you move and the quality of your touch. Patient respond favorably to thoughtful expressions of caring conveyed through touch

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Touch

question

The study how space is used. Height is sometimes an unwitting message to a patient when the person is confined to a bed, a treatment table, or a wheelchair. The health care professional should move down to the patient's level and the relationship will improve.

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Proxemic

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