病案首页更正单的应用

The Application of Correction Form of Front Page in Medical Records

目的针对病案首页基本信息填写出现的问题,建立病案首页更正单,以校正病案首页基本信息出现的错误,提高病案首页质量。方法由临床科室填写首页更正单,需填写更正理由及更正内容,并由相关人员签字,然后病案科复印盖章,将复印件交给患者。结果采用病案首页更正单,可以确保患者信息准确完整。结论病案首页更正单,对报销医药费、开具医疗证明等具有重要的作用。同时在临床、教学、科研和医院管理等方面也具有积极的作用。

Objectives Applying correction form of front page in medical records aimed at the filling in problems of basic information in front page of medical records,which can correct errors in front page for improving quality of front page in medical records.Methods The correction forms of front page are filled in by clinical department,which need to fill in the reasons and content of correction and signed by related person,then sealed by medical records department and given duplicate to patients.Results It can make sure that the information of patients are correct and complete by using correction form of front page in medical records.Conclusions It not only plays important role for reimbursement of medicine fee and medical certification,but also plays positive role in clinical,teaching,scientific research and hospital management.