HLTCCD004 - Interpret clinical documentation using knowledge of anatomy and physiology

Unit code: HLTCCD004 | Study level: TAFE
Nominal hours:
100
Location
Online
Prerequisites
N/A
Overview
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Overview

This unit describes the performance outcomes, skills and knowledge required to establish an understanding of human anatomy and physiology, diseases and conditions and surgical procedures and interventions in order to interpret clinical documentation.This unit applies to health care professionals who are responsible for interpreting and extracting patient clinical information for the purposes of providing health care services. Work may be performed as an individual or as part of a team under limited supervision.

Assessment

For Melbourne campuses

Assessment tasks will be designed to reinforce & extend knowledge and skill competence within set & controlled parameters in accordance with each units learning outcomes & performance criteria requirements, including the setting of work based practical application tasks designed to provide evidence of competence outcomes, within periodic and scheduled timelines.

Students will be expected to demonstrate the following required skills:

  • source and interpret clinical information on diseases and conditions affecting each of the body systems and specialities including:
  • infectious and parasitic diseases
  • neoplasms
  • diseases of the blood and blood-forming organs and common disorders involving the immune mechanism
  • endocrine, nutritional and metabolic diseases
  • mental and behavioural disorders
  • diseases of the nervous system
  • diseases of the eye and adnexa
  • diseases of the ear and mastoid process
  • diseases of the circulatory system
  • diseases of the respiratory system
  • diseases of the digestive system
  • diseases of the skin and subcutaneous tissue
  • diseases of the musculoskeletal system and connective tissue
  • diseases of the genitourinary system
  • pregnancy, childbirth and the puerperium conditions originating in the perinatal period including congenital malformations, deformations and chromosomal abnormalities
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
  • injury, poisoning and other causes of morbidity and mortality
  • for each of the diseases or conditions above, interpret clinical information to:
  • identify the investigations or interventions used to diagnose the disease or condition
  • identify medical and surgical interventions used to treat the disease or condition.

Students will also be expected to demonstrate the following knowledge:

  • common diseases and conditions affecting each of the following body systems and specialities including:
  • infectious and parasitic diseases
  • neoplasms
  • diseases of the blood and blood-forming organs and common disorders involving the immune mechanism
  • endocrine, nutritional and metabolic diseases
  • mental and behavioural disorders
  • diseases of the nervous system
  • diseases of the eye and adnexa
  • diseases of the ear and mastoid process
  • diseases of the circulatory system
  • diseases of the respiratory system
  • diseases of the digestive system
  • diseases of the skin and subcutaneous tissue
  • diseases of the musculoskeletal system and connective tissue
  • diseases of the genitourinary system
  • pregnancy, childbirth and the puerperium conditions originating in the perinatal period including congenital malformations, deformations and - chromosomal abnormalities
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
  • injury, poisoning and other causes of morbidity and mortality
  • common surgical procedures, interventions and pharmacotherapy used to treat diseases and conditions of the human body system
  • concepts underpinning human anatomy and physiology to enable accurate interpretation of clinical information including:
  • levels of structural organisation of body systems
  • human life processes
  • homeostasis and the relationship between homeostatic imbalance and disease
  • medical references and resources used for interpreting clinical information, including:
  • medical dictionary
  • drug handbook
  • organisational policies and procedures relevant to health care service.

Required reading

The qualified trainer and assessor will provide teaching and learning materials as required in the form of workbooks produced by Victoria University and/or via the Victoria University e-learning system.

As part of a course

This unit is studied as part of the following course(s):

Diploma of Clinical Coding
HLT50321 | Diploma | Duration:

Refer to the course page for information on how to apply for the course. VU takes care to ensure the accuracy of this unit information, but reserves the right to change or withdraw courses offered at any time. Please check that unit information is current with the Student Contact Centre.

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