We have two EMR's...one that records the authors name on the record itself and one that does not. Recently, I noticed that the HPI (on a couple of records) was recorded by the ancillary staff. I knew this because the name of the nurse was recorded not the provider. So to answer your question...If it pertains to the HPI, it needs to have the providers name listed. Ancillary staff can record the ROS and PFSH but not the HPI.
Now...our other EMR doesn't print the name of the individual recording the information (example-who records the HPI). However, there is an internal audit trail that I can view to authenticate who actually recorded the HPI. Either way...it needs to have the provider's name attached to this information since it is a requirement for the provider to record the HPI.
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