The Medical Record As A Forensic Resource / Edition 1

The Medical Record As A Forensic Resource / Edition 1

by Campion E. Quinn
     
 

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ISBN-10: 0763727598

ISBN-13: 9780763727598

Pub. Date: 10/07/2004

Publisher: Jones & Bartlett Learning

The Medical Record as a Forensic Resource describes what a medical record is, what it should contain and how to acquire, review, and report on its content. It contains valuable information on the basics of malpractice and personal injury litigation as well as how the medical chart review can be integral to the proper adjudication of a case. A must for anyone working

Overview

The Medical Record as a Forensic Resource describes what a medical record is, what it should contain and how to acquire, review, and report on its content. It contains valuable information on the basics of malpractice and personal injury litigation as well as how the medical chart review can be integral to the proper adjudication of a case. A must for anyone working in the legal field, this book will also educate readers without a legal background on the basics of malpractice and personal injury.

Product Details

ISBN-13:
9780763727598
Publisher:
Jones & Bartlett Learning
Publication date:
10/07/2004
Edition description:
1E
Pages:
277
Product dimensions:
6.06(w) x 9.00(h) x 0.58(d)

Table of Contents

Contributorsvii
Acknowledgmentsix
Introductionxi
1What Is the Medical Chart?1
2Acquiring a Medical Record5
3Authorization for Release of Medical Information15
4Determining What Is Missing from a Medical Chart17
5How to Examine an Individual Medical Chart21
6Face Sheet27
7Consent Forms31
8Living Will/Power of Attorney35
9Preadmission Records41
10Ambulance Call Report45
11Emergency Department Record51
12Admission Note65
13Physician Order Sheet73
14Progress Note79
15Consultation Note85
16Anesthesia Note89
17Procedure Note95
18Discharge Summary99
19Radiology Report103
20Laboratory and Pathology Reports107
21Autopsy Report111
22Nursing Notes115
23Medical Policies123
24Incident Reports127
25Medication Errors135
26The Medical Chart as Evidence155
27Tampering or Falsification?165
28Malpractice Basics171
29Pain and Suffering181
30Personal Injury Claims195
31Appendix I-Glossary of Malpractice Terms209
32Appendix II-Medical Abbreviations225
33Appendix III-Medical Chart Checklists261
Index265

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