Medical Records

Medical Records
Scope of Service
  • Provide systemic and timely flow of files to units/clinics in order to avoid any delay of delivery.
  • Ensure confidentiality and completeness of medical records through proper and safe handling of files
Confidentiality & Security of Information
  • Every hospital employee has to be oriented by the confidentiality of the Medical record and sign a confidentiality agreement at the time of employment.
  • Medical Record File (MRF) is a confidential matter and not to be handled by patient.
  • All files will not be accessed except by those who are authorized to make access of entries on the patient clinical record.
Medical Records System
  • Keep a well organized medical record system in order to render good services to the patients.
  • Maintains International standard medical records.
  • Daily transactions in Medical Records Department like appointments daily statistics in and out of files and filing system.
  • Medical Record Department issue only one medical record No. for a patient and the other must be cancelled.
  • Adapt a well organized system of transferring and handling files from one clinic to another in case the patient has more than one doctor to consult with.
  • Follow standardized filing system in accordance to chronological order.
  • Prepares, monthly / yearly comparison statistics based on the daily census tabulated in the computer.
  • For patients who did not come back to the hospital after five (5) years, their files are considered in-active and will be stored in the scanning system.
  • Encodes Final diagnosis (ICD 9CM coding) for the patient admitted in the hospital. It helps for searching and also statistics for the DISEASES – PROCEDURES done during the patient admitted in the hospital.