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HEIM360
Record Documentation Terms
Term | Definition |
---|---|
Certification | when an accredited organization addresses a company or employee in an effort to make sure they are following certain standards and qualifications |
Corporate Negligence | an organization takes responsibility for causing harm to a patient that could have been prevented. understanding the company can be held responsible for mistakes made in the facility. |
Loss Reduction | minimizing the risks with current issues already in a facility, maintaining a good reputation by handling current risks properly. |
Subpoena | a court issued paper that requires an organization member to attend court or to bring certain documents to court. |
Sentinel Event | a severe unforeseen case in a hospital that requires strict documentation and prompt attention |
Diagnostic | a symptom or tool that can help determine a problem |
Risk Management | addressing potential hazards in your place of work and coming up with action plans to prevent unwanted situations. |
Face Sheet | the front page of a health record similar to a cover sheet. it gives basic information about the patient that can be found easily. |
Transcriptionists | a health care profession where you revise medical documents and act somewhat as a translator by understanding the medical terminology used and inputting the information correctly. |
Clinical Data | the information taken that actually applies to the reasoning behind a doctors visit; the medical information in a patient record. |