Maintenance includes
- creating records that contain data formatted according to standard practices
- keeping accurate, complete, and formatted records, as evidenced in the student data log
- assuring that files, bench notes, and other collected data are organized
- maintaining both manual and electronic files, including computer databases
- correcting an error in a document to meet the legal requirements (e.g., current Good Manufacturing Practice [cGMP])
- understanding the legal implications of documentation (i.e., inspection, patents, research, lawsuits).
Process/Skill Questions:
- Why is it important to keep accurate and standardized records in the field of medicine?
- What data comprises medical record keeping?
- What are the possible effects of lack of documentation in the field of medicine?
- What resources and tools are available to manage medical information?
- What data is maintained through medical recordkeeping?