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I never thought of this before--but patients who like to leave the floor to "get some fresh air", i.e. go to the parking lot for cigarette breaks or making purchases of a different sort, often give the nurse their cell phone numbers. The doctor need not slow his daily rounds by making second visits, simply phone the wanderer to tell him he's being discharged. If he races back to the floor to argue, you can at least still bill for the visit. If he says, "That's cool," you can start the discharge paperwork and he will probably be back on the floor by the time you dictate the discharge summary.

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