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How do accreditation organizations such as the Joint Commission use the health record?
Which of the following specialized patient assessment tools must be used by Medicare-certified home care providers
Before healthcare organizations can provide services, they usually must obtain this from government entities such as the state or country in which they are located
The following descriptors about the data element ADMISSION_DATE are included in a data dictionary -- definition: date patient admitted to the hospital; data type: date; field length: 15; required field: yes; default value: none; template: none. For this data element, data integrity would be better assured if:
In designing an input screen for an EHR, which of the following would be best to capture structured data?
A medical group practice has contracted with an HIM professional to help define the practice's designated record set. Which of the following should the HIM professional perform first to identify the components of the designated record set?
Hospital documentation related to the delivery of patient care such as health records, x-rays, laboratory reports, and consultation reports are owned:
Which of the following is part of qualitative analysis review?
Copies of personal health records (PHR) are considered part of the designated record set when:
Which of the following is a true statement about the content of the legal health record?
The clinical forms committee is the entity within a healthcare facility that:
Erin is a HIM professional. She is teaching a class to clinicians about proper documentation in the health record. She should educate the class against doing which of the following?
Which of the following is a risk of copy and pasting documentation in the electronic health record?
Which of the following is the health record component that addresses the patient's current complaints and symptoms and lists that patient's medical, personal, and family conditions?
How is the patient registration department assisted by the HIM department?
Community Hospital is terminating its business associate relationship with a medical transcription company. The transcription company has no further need for any identifiable information that it may have obtained in the course of it business with the hospital. The CFO of the hospital believes that to be HIPAA compliant, all that is necessary is for the termination to be in a formal letter signed by the CEO. In this case, how should the director of HIM advise the CFO?
Which of the following statements is true regarding HIPAA security?
Access to health records based on protected health information within a healthcare facility should be limited to employees who have a:
The release of information function requires the HIM professional to have knowledge of:
When data hs been lost in an EHR, which action is taken to remedy this problem?