The terms medical record, health record and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's...

(Electronic Health Record) Medical imaging Medical privacy Medical record Personal health record Personally Controlled Electronic Health Record, the Australian...

The Virtual Medical Record (vMR) is a simplified, standardised electronic health record data model designed to support interfacing to clinical decision...

A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an...

data then become part of the medical record.[citation needed] The routine physical, also known as general medical examination, periodic health evaluation...

court (US) Medical record, of a person's medical history and treatments Minutes, a summary of the proceedings at a meeting Public records, information...

Medical transcription, also known as MT, is an allied health profession dealing with the process of transcribing voice-recorded medical reports that are...

using a medical office's electronic health record (EHR) and existing templates. Responsibilities will vary with the scribe’s department rules. Medical scribes...

Terminology codes—this part of the process is known as medical coding. These coded records are submitted by medical billing to the health insurance company or the...

of the illness to record details of future progress and results after treatment or discharge. This is known as a catamnesis in medical terms. Whatever system...

times medical criteria are presented voluntarily by an applicant in a self-assessment, without either a doctor or access to the person's medical record. Specific...

The Medical Record: A Weekly Journal of Medicine and Surgery was an American medical journal founded in 1866 by George Frederick Shrady, Sr., who was its...

algorithms to improve communication, understanding, and management of medical information. It can be viewed as a branch of engineering and applied science...

"Abbreviation List for Medical Record Documentation V20" (PDF). Madison Memorial Hospital. "Title Change". Hanley, Sharita. "PERRLA Eye Assessment: What...

Medical diagnosis (abbreviated Dx, Dx, or Ds) is the process of determining which disease or condition explains a person's symptoms and signs. It is most...

the patient's medical history and medical record, followed by a medical interview and a physical examination. Basic diagnostic medical devices (e.g.,...

record (EHR) – An EHR contains a patient's comprehensive medical history, and may include records from multiple providers. Electronic Medical Record (EMR)...

Inviolability Involuntary commitment Involuntary treatment Medical ethics Medical malpractice Medical record Privacy law Quality of life (healthcare) Reproductive...

Frederick (March 28, 1896). "Opening of the Columbus Hospital, New York". Medical Record. 49 (13): 451. ISSN 0363-0803. "Columbus Hospital; Seeks to Increase...

Auguste Deter had died. He requested that her medical records and brain be sent to him. Her chart recorded that in the last years of her life, her condition...

treatments.[citation needed] Prescriptions may be entered into an electronic medical record system and transmitted electronically to a pharmacy. Alternatively,...

more than $6 billion, by 2010, it was the largest civilian electronic medical record system, serving more than 8.6 million Kaiser Permanente members, implemented...

treated. The information comes from a variety of sources within the medical record, such as clinical notes, laboratory and radiology results, and operation...

medical information vital to providing quality patient care. With the widespread computerization of health records, traditional (paper-based) records...

Medical privacy, or health privacy, is the practice of maintaining the security and confidentiality of patient records. It involves both the conversational...

sometimes the 'rendering physician' listed on the patient's official medical record, but if they are overseeing a resident or another staff member, they...

majority of columns would be null. To complicate things, in a longitudinal medical record that follows the patient over time, there may be multiple values of...

is interpreted rather broadly and includes any part of a patient's medical record or payment history. Instead of being anonymized, PHI is often sought...

patient. This stands in contrast to the more widely used electronic medical record, which is operated by institutions (such as hospitals) and contains...

overlap in many ways with those of health and medical informatics. Worldwide adoption of electronic medical records has been on the rise since 1990 and is closely...