A PMHNP conducts an initial psychiatric evaluation of a 28-year-old female patient presenting with symptoms of persistent depressive disorder. The patient reports passive suicidal ideation without plan or intent. The PMHNP completes the evaluation and writes the clinical note. During a subsequent peer chart review, the reviewer identifies that the PMHNP's documentation does not include a formal risk assessment section addressing the patient's suicidal ideation. The PMHNP states she conducted the risk assessment verbally but did not document it separately because the patient denied active suicidal planning. Which of the following best represents the documentation standard that applies to this situation?