Transcription of Clinical Documentation & Recordkeeping
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Clinical Documentation & Recordkeeping
Rev. 02/05/10 Page - 1 Standards for Clinical Documentation and RecordkeepingProtected by Common Law Copyright - Hillel Bodek, MSW, LCSW-R, BCD 1992, 2003, 2006, 2007, 2008, 2010 Permission to Reproduce for Educational Purposes is Granted Provided Attribution is IncludedCLINICAL Documentation AND RECORDKEEPINGBy: Hillel Bodek, MSW, LCSW-R, BCDC hairperson of the Committee on Ethics and Professional Standardsand the Committee on Forensic Clinical Social WorkNew York State Society for Clinical Social Work, The Purpose and Role of Clinical Documentation & Recordkeepinga. The Legal Mandate for Clinical Documentation in New York Stateb. Purposes of Clinical Documentationc. The Role of Clinical Documentation in Quality Assurance2. Elements of Good Clinical Documentationa. Elements of Good Clinical Documentation - Recording & Organizationb. Elements of Good Clinical Documentation - Writingc. Elements of an Appropriate Initial Assessment & Treatment Pland. Elements of Documentation of a Treatment Sessione.
Clinical documentation and recordkeeping requirements, often viewed as a chore, yet ... New York State Education Department, et. al., 571 NYS2d 123 ... review and reflect on their therapeutic interventions, consider the efficacy of their clinical work
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