HIMT 1100 4.docx - 1. The overall goal of documentation standards is: Ensure what is documented in the health record is complete and accurately

1.The overall goal of documentation standards is:

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2.A hospital that participates in the Medicare and Medicaid programs must follow:

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3.When defining its legal health record, a healthcare provider organization must do which of the following?

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4.Which of the following is the health record component that addresses the patient’s current complaints and symptoms and lists the patient’s past medical, personal, and family history?

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Unformatted text preview:Medical history 5. General documentation guidelines apply to: All categories of healthcare record 6. True or false: Health record entities should be documented at the time the services they describe are rendered. 7. True or false: Only individuals authorized by the organization's policies should be allowed to enter documentation in the health record 8. True or false: Auto-authentication is the preferred method of authentication. 9. True or false: When an error is made, the erroneous information can be obliterated.