Question

Question 2

Which of the following is the usual spacing between each heading in a history and physical examination report?

		Single spacing
		Double spacing
		Triple spacing
		Quadruple spacing

Question 3

To help with an audit trail, it is common practice to include the date and time of dictation and transcription at the end of each medical report.

True

False

Question 4

Never carry a single line of a report onto a continuation page, and never allow a continuation page to include only the signature block and the data following it.

True

False

Question 5

Findings from a consultation can be dictated in letter format.

True

False

Question 6

Allergies in a medical report are formatted in such a way as to draw attention to their importance. Usually their on written in ALL CAPS.

True

False

Question 7

The legal record that contains written or typed information set down for the purpose of preserving memory that authenticates evidence of facts and events is an/an ? (              )

Question 8

Medical reports include the patient’s name or patient’s identifying number.

True

False

Question 9

Noncontributory means nothing significant was discovered when the physician performed a review of systems (ROS).

True

False

Question 10

The military-style dateline is never used in consultation letters.

True

False

Question 11

Medical reports are vital in which of the following?

		Research
		Compiling statistics
		Evaluating the healthcare delivery system
		All of these

Question 12

Which of the following are the basic four medical reports in medical offices?

		Consultation letter, chart note, history and physical, and pathology
		Chart note, history and physical, diagnostic, and consultation
		Chart note, history and physical, SOAP, and consultation
		Consultation letter, SOAP, history and physical, and pathology

Question 13

Even if only one diagnosis is given, it is preferable to number it, even if it is not dictated.

True

False

Question 14

Operative or other high-risk procedure reports should be dictated immediately after such procedure and should record the name of the licensed independent practitioner and assistants, procedure/s performed, description of the procedure, findings, estimated blood loss, specimens removed, and postoperative diagnosis.

True

False

Question 15

When a skilled MT cannot confidently edit an error or inconsistency in dictation, the MT should leave a blank and flag the report.

True

False

Question 16

The patient had a _____ in 2007.

		D&C
		D & C
		D/C
		none of these

Question 17

How many hard returns do you use below the final line of text (Sincerely,) before typing the originator's full name._______

Question 18

All of the following are true of major headings in a medical report EXCEPT:

		Express major section headings using all capitals.
		Always insert obvious headings that are not dictated.
		Double space between major headings of reports.
		Use initial caps only for subheadings.

Answer 1

2 ANSWER : Single spacing method is used between each heading in a history and physical examination report.

3 ANSWER : TRUE

In an audit trail or any other record documents it is important to mention date, time and transcription at the end of the report for further references and for legal purposes.