M4 Application Exercise: Health Record Components

  • Due No due date
  • Points 15
  • Questions 16
  • Time Limit None
  • Allowed Attempts 2

Instructions

  M4 Application Exercise: Health Record Components

Purpose

The medical record can be as simple or as complex as the patient encounter. The simple visits with your PCP and a routine lab draw generate a much smaller amount of data compared to someone who is having surgery as a result of a condition leading to their hospitalization. Part of being a health information professional is becoming familiar with what the medical record contains and where it might be located in your EHR (sometimes paper too!). For the purposes of this assignment, we are going to focus on an acute-care record but keep in mind that different settings can generate different/unique information that you wouldn't necessarily see in a clinic or hospital visit.

Instructions

Identify the acute-care record component where the following information would be found. This assignment will be hand-graded.

Criteria for Success

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