Medical Records and Documentation

COURSE DESCRIPTION

This Continuing Education course will provide the Healthcare provider with two (2) Contact
hours of Continuing Education units (2 CEUs) that may be used for their license or certification
requirements for continuing education.
This course will cover such issues as various documentation formats and principles of various
forms of documentation. Common mistakes in charting to avoid will be addressed.
Recommendations will be presented to assist in quality medical record keeping and
documentation.

COURSE REQUIREMENTS

Satisfactory completion of this two-hour Medical Record and Documentation course will earn
the participant two Contact Hours of Continuing Education. The participant must successfully
pass the post course written examination with a minimum score of 80% and complete the post
course evaluation form. A course completion certificate will be issued after all course completion
requirements are met.

COURSE OBJECTIVES

The goal of this training program is to help the healthcare Provider to document properly. This
program will help to identify preventable errors of documentation and describe how to document
correctly in order to provide a safer health care environment for the patient.
After you study the information presented here, you will be able to:
Identify avoidable medical documentation errors
Provide constructive changes to prevent such errors
Correct medical documentation errors or change a record for the right reason and in the right
way
Provide a safer heath care environment for the patient by documenting proactively