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HIM-M 325 Healthcare Information Requirements and Standards I

3 credits

  • Prerequisites: None
  • Delivery: On-Campus, Online
  • This course outlines the documents and data content required legally to maintain health records using paper and electronic media. It examines federal, state, and local law; accreditation standards; regulatory requirements for maintaining patient data; and documentation in acute care, psychiatric, and other healthcare settings.

    Learning Outcomes

    1. Verify that documentation in the health record supports the diagnosis and reflects the patient’s progress, clinical findings, and discharge status.
    2. Compile organization-wide record documentation guidelines.
    3. Interpret health information standards.
    4. Manage clinical indices, databases, and registries.
    5. Appraise current laws and standards related to health information initiatives.
    6. Identify departmental and organizational survey readiness for accreditation, licensing, and certification processes.
    7. Comply with ethical standards of practice.
    8. Differentiate the roles and responsibilities of various providers and disciplines to support documentation requirements throughout the continuum of health care.