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Chpt. 7 Medical Records and Informed Consent Flashcards | StudBud
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Chpt. 7 Medical Records and Informed Consent
Chpt. 7 Medical Records and Informed Consent
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Medical Records and Informed Consent Judson Chapter 7
Flashcards
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Questions
10
Answers
1
A physician has a practice and privileges. Who owns the records the staff creates in house?
hospital
office
both
2
Which of the following are included in the 5 C's?
clean
concise
clear
complete
3
The proper way to correct an error in the records is:
destroy the entry and start over
draw a line through and enter the new information
line through it, make, label correct, initial and date it
4
A physician can decide whether or not a patient can see their record. This is called
doctrine of professional discretion
Informed consent
doctrine of Paren's Patrie
authorization
5
Who owns the records for hospitals who treat patients?
Hospital
Patient
Doctor
6
If a third party pay for a service, the employer should keep the record:
destroyed after viewing it
until they return to the patient
in the personnel record
in a separate file from the personnel record
7
A significant change to the record is called
an addendum
a side note
discharge summary
an error
8
Medical records are:
legal documents only when a subpoena is issued
never the property of the patient
always the property of the patient
legal documents
9
A patient's participation in a football game
should be included in the record
should not be included in the record
10
This law provides rules for patient access and has mandated EHR.
HIPAA
OSHA
JCAHO
