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Transcript

Assessment. The assessment section includes a medical diagnosis for the purpose of the visit a quick summary of the patient with main symptoms and diagnosis for the annual exam of an otherwise healthy pet. There may not be much in this section for the assessment section of an ill patient, differential diagnosis and ruled out diagnoses would be listed here. The assessment will also include possible and likely causation of the patient's problem. This section could contain the patient's progress since the last visit and overall progress towards the patient's goal from the veterinarians perspective. Again, as with objectives, most times a veterinarian will add the assessment notes themselves or dictate them to you

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