The HIM Department receives a request for a certified copy of a birth certificate on a patient born in the hospital 30 years ago. The Department should
A. issue a copy of the birth certificate from the patient's record.
B. direct the request to the state's office of vital records.
C. direct the request to the attending physician.
D. issue a copy of the newborn's record.
Answer: B
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Information Retention and Access
- Which of the following is NOT a factor to consider when developing a record retention program?
- When implementing the electronic health record, what is the technical security standard that requires unique user identification, emergency access procedures, automatic log-off, and encryption and decryption of data?
- Which of the following is a major management challenge in the storage and retention of electronic health record systems?
- A 16-year-old female delivers a stillborn infant in Mercy Hospital. The clinical documentation on the stillborn infant would
- University Hospital, a 900-bed tertiary health care organization, is undergoing an information systems development. What system would best meet its needs?
- The Director of the HIM Department is explaining incentives to physicians for entering their clinical documentation in the electronic health record. Which of the following would be the key advantage in using this type of data entry?
- The function of a(an) ___ is limited to data retrieval.
- Health Informatics, Inc. is a vendor with a large collection of clinical information systems and hospital information systems that are designed to share data without human or technical intervention. This is a(an)
- As HIM director, you must ensure a means to regulate access and ensure preservation of data in the health care facility's computer system. Which of the following security measures can be implemented to prevent privacy violations in this computer system?
- The HIM practitioner's duty to retain health information by archiving and storage of health data includes
- University Hospital has the messaging technology to securely route an alert for a patient's possible drug interaction or abnormal lab result to the appropriate physician's pager number. Which one of the following is the medical staff using?
- The hospital administrator is making a strategic decision by querying various institutional databases for information. What type of system is the hospital administrator using?
- The Assistant Director of HIM is evaluating software that would use electronic logging of the location of incomplete and delinquent records as they move through the completion process. What departmental function is this most useful for?
- Lewis-Beck Medical Center has been collecting data on patient satisfaction for six months. It is ready to start retrieving data from the database to improve clinical services. Which tool should be used?
- Concern for health data loss and misuse within the HIM department requires that the health information practitioner evaluate
- The Assistant Director of Record Processing is evaluating software packages for a chart tracking system in the HIM Department. What is the BEST method to verify that the software will work as marketed?
- The Director of Health Information Management has been asked by the Board of Trustees to justify support for the use of handheld devices by the medical staff for point-of-service input. Which one of the following reasons would NOT be included in the Director's response?
- General Hospital utilizes various related files that include clinical and financial data to generate reports such as MS-DRG case mix reports. What application would be MOST effective for this activity?
- As the record retention supervisor, you are evaluating storage devices for a new health information management system Which one of the following would you NOT consider as an option for storing health information?
- What data cannot be retrieved from the MEDPAR?
- How many years does the Food and Drug Administration require research records pertaining to cancer patients be maintained?
- Which one of the following would NOT be a strategy when purchasing an electronic health record system?
- Fetal monitoring strips are part of the record and should be maintained
- Which of the following is NOT considered a challenge in the adoption of an electronic health record system?
- An example of a primary data source is the