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Tag Archives: Medical records
Nursing documentation: if you didn’t chart it you didn’t do it
“If you didn’t chart it you didn’t do it.” In the medical legal world, this expression engenders more fear in nurses than almost any other phrase as it is used to reiterate the importance of documentation. The phrase is also … Continue reading
Top 4 reasons why there is gold in nurses’ notes
1. Comprehension: Nursing documentation is often the key to understanding the events that spawn a nursing or medical malpractice claim. The medical record can refute or support the plaintiff’s or defendant’s version of events. 2. Screen cases: Careful scrutiny of … Continue reading
Obtaining Diagnostic Imaging for a Potential Medical Malpractice Claim based on a chapter by Peter Berge JD, MPA, PA
The liability of a failure to diagnose or delay in diagnosis medical malpractice case often rests on the information revealed by a diagnostic test. Both defense and plaintiff attorneys and their experts will be interested in what the test showed. … Continue reading
Specifying the Format of the Medical Records based on a chapter by Peter Berge JD, MPA, PA
Records are obtained by plaintiff’s counsel prior to filing a medical malpractice suit. Ordering an extract of the medical record (typically containing information such as the admitting history and physical examination, discharge summary and laboratory results) is rarely appropriate in … Continue reading
Reviewing Medical Records in a Potential Medical Malpractice Claim based on a chapter by Peter Berge Esq.
Once medical records are in hand, someone has to review them. Who should review them, and in what sequence, depends on numerous factors. In the case of a plaintiff’s attorney, if the attorney has a solid knowledge of the medical … Continue reading
Which Medical Records are Crucial to Evaluate a Medical Malpractice Claim? based on a chapter by Peter Berge Esq.
Several factors should be considered by a plaintiff’s attorney when deciding which records to request while evaluating a potential medical malpractice claim. They include the likelihood that the attorney will pursue the case, the volume (and potential cost) of the … Continue reading
Being Detailed Oriented by Pat Iyer
When it comes to organizing medical records, being detailed oriented is essential. Records come into our office all states of organization and disorganization. We organize records before reviewing them or forwarding them to experts. Attention to details means that you … Continue reading
