Answers for A+ Results.
Terms in this set (56)
Which of the following is c. It is the record disclosed upon request
characteristic of the legal health
record?
a. It must be electronic
b. It includes the designated record
set
c. It is the record disclosed upon
request
d. It includes a patient's
personal health record
What type of analysis compares c. Gap analysis
omitted
clinical information received
from external providers with
the needed clinical
information to make a correct
diagnosis?
a. Risk management analysis
b. Qualitative analysis
c. Gap analysis
d. Document management analysis
,To comply with the Joint b. Review each patient's health record concurrently to ensure
Commission standards, the the history and physicals are present
HIM director wants to
ensure the history and
physical
examinations are documented
in the patient's health record no
later than 24 hours after
admission. Which of the
following would be the best way
to ensure the completeness of
the health record?
a. Establish a process to
review health records
immediately on discharge
b. Review each patient's health
record concurrently to
ensure the history and
physicals are present
c. Retrospectively review each
patient's health record to
ensure the history and
physicals are present
d. Write a memorandum to all
physicians relating the Joint
Commission requirements for
documenting history and
physical
examinations
.An HIM technician was alerted by b. Overlay
registration that the system has
a record for John Smith with
two different birthdates.
After an investigation the technician
determined the documentation
was for two different patients,
both named John Smith, who
, have the same health record
number in the EHR. This is an
example of:
a. Overlap
b. Overlay
c. Duplicate
d. Purge
A new health information b. Identify data content requirements for all areas of the organization
management (HIM) director has
been asked by the hospital CIO
to ensure data content
standards are identified,
understood,
implemented, and managed for
the hospital's EHR system.
Which of the
following should be the HIM
director's first step in carrying
out this responsibility?
a. Call the EHR vendor and ask
to review the system's data
dictionary
b. Identify data content
requirements for all areas of the
organization
c. Schedule a meeting with all
department directors to get
their input
d. Contact CMS to determine
what data sets are required
to be collected