Chiropractic Documentation Class, Part 1
4 hours


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Chiropractic Documentation Class, Part 1
Dr. Ron Short, DC, MCS-P, CPC, CPCO
4 hours of Documentation $60.00 $49.00

Objective: To teach the doctor how to properly document the patient encounter in such a manner as to effectively convey the patient’s subjective problems, the doctor’s objective observations, the doctor’s assessment including the doctor’s rationale, and the plan of care for the patient.


Hour 1:  Hour 1 contains the following:               

  • Course information
  • Instructor Introduction
  • Introduction to documentation
  • Medical Necessity
  • Maximum Medical Improvement
  • Documentation Standards
    • NCQA Standards
    • CMS Evaluation and Management Standards
    • Medicare Guidelines
  • Medically Necessary Care vs. Clinically Indicated Care
  • Proving Medical Necessity of the Care Rendered

Hour 2:  Hour 2 contains the following:               

  • Review of Quiz Answers
  • Complexity of Documentation
  • Chiropractic Assessment Visit / Treatment Visit Paradigm
  • The Episode of Care
  • The S.O.A.P. Documentation Format
  • Additional Information
    • Patient Demographics
    • Consent to Treat and Other Notices

Hour 3:  Hour 3 contains the following:               

  • Review of Quiz Answers
  • Additional Information
    • HIPAA
    • Documentation from Outside Sources
      • Documentation from Other Doctors
      • Police Reports
      • Emergency Room Documentation
      • Essential Job Function requirements
  • General Considerations for Documentation
  • The Subjective Element of Documentation
    • OPQRST
    • Initial History

Hour 4:  Hour 4 contains the following:               

  • Review of Quiz Answers
  • The Subjective Element of Documentation
    • Initial History
    • Initial Consultation
    • The Re-examination
    • Medicare
    • Treatment Visit Subjective Element
    • Proving Medical Necessity in the Subjective Element
  • The Objective Element of Documentation
    • Range of Motion Testing
    • Muscle Strength Testing
    • Outcomes Assessment Questionnaires

Click Here For Course Outline

Approved For Continuing Education Credit in Illinois, Kansas, and Missouri.
PACE courses are accepted for Continuing Education Credit by The State Boards of Alaska, Connecticut, District of Columbia, Idaho, Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington, and Wyoming. The State Board of Colorado does not pre-approve courses, but this class meets the criteria set forth by their respective board.


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