What are pertinent documents?

What are pertinent documents?

Pertinent Document means: (a) any Finance Document; (b) any policy or contract of insurance contemplated by or referred to in Clause 13 or any other provision of this Agreement or another Finance Document; (c) any other document contemplated by or referred to in any Finance Document; and (d) any document which has been …

What is a pertinent person?

adj relating to the matter at hand; relevant.

What fundamental information and documentation should every patient’s file contain?

Every medical record needs to have information that ties it to a patient. Examples of this could be as simple as your name and date of birth, extending to your social security, state, or government-issued identification number.

What does pertinent medical history mean?

An element of a patient’s history that aids diagnosis because the patient affirms that it is present.

What types of information should not be included in a patient’s medical record?

The following is a list of items you should not include in the medical entry:

  • Financial or health insurance information,
  • Subjective opinions,
  • Speculations,
  • Blame of others or self-doubt,
  • Legal information such as narratives provided to your professional liability carrier or correspondence with your defense attorney,

How do you spell pertinent information?

pertaining or relating directly and significantly to the matter at hand; relevant: pertinent details.

What are some of the pertinent information to gather or include in getting the health history of a patient?

General suggestions.

  • Elicit current concerns.
  • Ask questions.
  • Discuss medications with your older patient.
  • Gather information by asking about family history.
  • Ask about functional status.
  • Consider a patient’s life and social history.
  • For more information about obtaining a medical history.

    • Which record is used to store pertinent information?

    ch 4 medical documet

    Question Answer
    the key to substaining procedure and diagnostic code selections for proper reimbursment is supporting documentation in the electronic health record
    the chronological recording of pertinent facts and observations about the patient’s health is known as documentation

    Which information should be included in patient documentation?

    What should be documented

    • The most current information.
    • Clinically pertinent information.
    • Rationale for decisions.
    • Informed Consent discussions or the patient’s refusal of care.
    • Discharge instructions.
    • Follow-up plans.
    • Patient complaints and response.
    • Clinically pertinent telephone calls.