MEDICAL RECORD POLICY STATEMENT

The policy of the Medical Records Department is to be responsible for reviewing the records for completeness and compliance with established rules and regulations regarding the records. It is in the Medical Record Department that errors or deficiencies are discovered and notification given to the responsible parties. The Medical Record Department is responsible for assigning the correct ICD-9-CM code to the final diagnosis and recording it in the Disease Index. The Medical Record Department is also responsible for storing the records in a secure manner, retrieving the records efficiently, and providing access to the records by those so authorized.

The medical record files are located in a separate office area, with locked doors and restricted entry, to prohibit intrusion by unauthorized personnel and promote security.

Revised: February 1995
 

MEDICAL RECORDS - 35-02-001

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