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Published on: June 5, 2016
Abstract:
The management of medical records in the current climate of fragmented and managed care has created very real and present difficulties for physicians. Florida law protects the patient's right to the medical record and insures confidentiality and access. Similar protections for physicians, to allocate the costs of 20th century record keeping fairly among the parties, and to insure the physician access to information necessary to treat the patient or to defend himself, are essential but so far not forthcoming.
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Purpose of Health Records I
Here's a breakdown of how health records serve these purposes:
Purpose of Health Records II
Types of Records I: Unit and Nurses Records
Unit records can be divided into two main types: administrative records and clinical records.
Administrative records in...
Types of Records II: Educational and Administrative Records
Methods of Documentation II: POMR
Legal Guidelines for Documentation

