Medical Record Keeping Course Agenda
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Course Day 1
- Purposes of patient record documentation.
- Documentation and the law of evidence.
- Deficient records.
- Content of the patient records.
- Other information that should be documented.
- Technical issues in documentation.
10:30 am – 12:30 pm:
- Electronic health records.
- Documenting discussions with patient and/or family.
- Records that show fulfillment of legal obligations.
1:30 – 3:30 pm:
- Record keeping errors that increase liability risk.
- Documentation in situations requiring increased caution.
3:45 – 5:00 pm:
- Documenting frequently litigated conditions.
- Medical record workshop with analyses of submitted
Course Day 2
8:00 – 10:15 AM:
- Undermining the credibility of the records.
10:15 – 10:30 AM: BREAK
10:30 AM – 12:30 PM:
- Undermining the credibility of the record keeper.
- Maximizing reimbursement while minimizing the risk of fraud and abuse accusations.
- Medical record confidentiality.
12:30 – 1:30 PM: LUNCH ON YOUR OWN
1:30 – 3:30 PM:
- Confidentiality when contacting the patient.
- Release of medical records with authorization.
- Release of medical records without authorization.
3:30 – 3:45 PM: BREAK
3:45 – 5:00 PM:
- Patients’ access to their own records.
5:00 – 6:00 PM:
- Medical record workshop with analyses of submitted records.
6:00 PM: ADJOURN