Medical Records

Not legally.

Until the minor reaches the age of majority, plus 3 years.

No deletions should be made, as the medical record is also a legal document. But an amending notation should be made and added to the medical record.

It isn't illegal for them to ask, but you need not surrender them, nor can the employer compell you to. Your medical records are yours and no one else has a right to them under federal HIPPA laws.

the prescription must be recorded up to 2 years for normal prescription and five year for psychotic and narcotic prescription

Preferably in black pen. Blue pen does not show up very well when photocopied.

No. Whether you go with in-house transcription or outsource it, the degree of accuracy depends on the staff involved.

Outsourcing however does present some problems. Not all countries adhere to the same privacy requirements others do, and there have been a few horror stories, including one company in India legally refusing to provide medical notes and recordings until their payment negotiation was concluded. In the US at least, this would have been illegal.

Likewise, privacy due diligence is more difficult to perform.

That said, outsourced transcription works well for some and not so well for others. Performance is dependent on the individual groups involved.

I don't think you can say that they are. While paper is by definition "air gapped" from any form of network including the Internet, you can effectively secure networks well, and electronic records can be secured via passwording, encryption, etc -- all modes that don't lend themselves well to securing paper.

Depending on the scenario, both can be equally secure.

Yes, but CCI edit does indicate these are bundled so if the services aren't related, you need to add the -59 to 93000.

Medical records have traditionally been compiled and maintained by health care providers, but advances in online data storage have led to the development of personal health records (PHR) that are maintained by patients themselves, often on third-party websites.

The information contained in the medical record allows health care providers to determine the patient's medical history and provide informed care. The medical record serves as the central repository for planning patient care and documenting communication among patient and health care provider and professionals contributing to the patient's care. An increasing purpose of the medical record is to ensure documentation of compliance with institutional, professional or governmental regulation.

The traditional medical record for inpatient care can include admission notes, on-service notes, progress notes (SOAP notes), preoperative notes, operative notes, postoperative notes, procedure notes, delivery notes, and discharge notes.

Although the storage equipment for medical records generally is the property of the health care provider, the actual record is considered in most jurisdictions to be the property of the patient, who may obtain copies upon request.Recently i have found more information medical records on kensiumlegal.com

Why not? I mean its your body's history and stuff like that so why wouldn't you be able to access your own records?!

FALSE

That's roughly four pages single spaced, give or take a little.

The patient owns the information; the doctor owns the media or paper.

No such instrument would be legally binding. First, there's no "release" specified in HIPAA (the main US body of medical privacy law). The doctor can legally release your medical records to another caregiver in order to facilitate your medical care (unless you object to this) without any form.

Releases of medical information that are not for the purposes of healthcare, bill payment or operations, or not in response to court order, subpoena, etc. must be accompanied by an Authorization signed by the patient. This Authorization exactly which information, to whom the release is authorized, for how long this document will remain active, and should specify the reason. The whole idea behind this is that there should be no easy way to circumvent correct PHI control procedures. A signed but not dated authorization is not only ineffective; it acts against the spirit of the law.

So no -- not legal.

when is national medical records day

NEC = not elsewhere classified

NOS = not otherwise specified

NOS is an unspecified diagnosis whereas a NEC diagnosis just doesn't fit into a different cateogory making it unclassified

An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office. Electronic medical records tend to be a part of a local stand-alone health information system that allows storage, retrieval and modification of records.

list four reason medical records are kept

False