患者使用病案遇到的问题与对策

The problems Faced by The Patisins Using The Medical Cases and Countermeesures for Them

目的：针对患者复印病案后因个人信息与实际情况不符而影响患者报销、保险理赔，因而要求修改病案信息等问题，探讨解决问题的对策。方法：对患者使用病案中遇到的各种问题进行分析，找出出现问题的原因。结果：提出完善患者入院时医患沟通、医保患者在院身份核实等制度，实行实名制入院以及加强病历书写和质量监控，依法修改和管理病案等措施。结论：通过加强全院医护人员对病案重要性的认识，完善病历书写和病案管理制度，确保患者能够得到及时准确的病案服务，从而提高患者的满意度。

For patients after medical record copy for personal information and reality and affect patients reimbursement, insurance claims, and demanded a change in the medical record information, etc, this paper discusses the countermeasures to solve the problem. For the patient to use case in the various problems were analyzed, and find out the cause of the problems. RESULTS：To improve patient admission doctor-patient communication, medical care patients in hospital accreditation system, implement the system and to strengthen the hospital medical record writing and quality control, modification and management in accordance with the measures of medical record. By strengthening the medical staff medical institution to a recognition of the importance of, improve medical record writing and medical record management system, to ensure that patients can get timely and accurate medical service, so as to improve the satisfaction of patients.