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Medical documentation refers to notes and documents that health care workers add to the medical record.

A) True
B) False

User Juraj
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1 Answer

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Final answer:

Medical documentation refers to the notes and documents added by health care workers to the patient's medical record. It contains essential information about the patient's care and serves as a comprehensive record.

Step-by-step explanation:

Medical documentation refers to notes and documents that health care workers add to the medical record. This documentation includes important information such as the patient's medical history, diagnoses, treatments, medications, and test results. It serves as a comprehensive record of the patient's care and is essential for providing quality healthcare.

In the United States, the Health Insurance Portability and Accountability Act (HIPAA) sets strict guidelines for the privacy and security of medical records. These guidelines ensure that patient information is kept confidential and only accessible to authorized individuals involved in the patient's care.

Therefore, the statement is True. Health care workers do add notes and documents to the medical record, which is a part of the medical documentation process.

User Tunmee
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