AprilSueMadison
Expert
It has come to my attention that sometimes our providers will see a patient for severe bleeding (a day after surgery) or to remove a deep suture that has worked it way out....without checking the patient in and without creating a medical record entry.
I'm looking, but can someone provide me with links to a rule or guideline that says we need to have an entry for every visit...not matter how small they feel it is? Thank you!
I'm looking, but can someone provide me with links to a rule or guideline that says we need to have an entry for every visit...not matter how small they feel it is? Thank you!