Question

0 % 0 of 1 topics complete Unit 3 Discussion Discussion Topic Incident Reports Should incident reports be filed in the patient health record? Why, or why not? Discuss your opinion of the reporting purpose and process.

Answer 1

Incident Reports Should incident reports be filed in the patient health record? Why, or why not? Discuss your opinion of the reporting purpose and process. The medical record of patient is a documented evidence of his/health history. A medical record can be a written paper or digital record The medical record serves as a basis for planning health care and treatment. It allows all the healthcare professionals involved in providing care to the patient to communicate. So, it it important to include the patient's health record in the incident reports. The generalc s of a medical record include the following a) Patient data b) Medical history (Hx) c) Physical examination (PE) d) Consent form e) Informed consent form f) Physician's orders Nurse's Notes h) Physician's Progress Notes ) Consultation Reports j) AncillaryMiscellaneous Reports k) Diagnostic Tests/Laboratory Reports I) Operative Report m) Anesthesiology Report n) Pathology Report o) Discharge Summary