This past week on Tuesday June 22nd and Thursday June 25th I helped to pull medical records that were going to be audited. The Brevard County Health Department was preparing for an audit that would take place on Friday June 26th. There were two long lists of patients whose medical records were needed for the audit on Friday. I had to go through and find the patient’s medical records and mark down the ones that I was unable to find in the files. Then I had to check on the computer record system to make sure that the patient didn’t have any appointments coming up soon. Those that did have an appointment I had to put a note on them stating the date and time of the appointment. This way the file would be made available for the patient’s appointment. Most of the patients with appointments with in the time of the audit were maternity appointments this is because the maternity patients are seen very frequently in the clinic. When I left on Thursday the records that were needed for the audit were all organized and ready except for a few patients who had appointments on Thursday.

HSA Internship

On Tuesday June 2nd the third week of the summer semester I started learning the lab posting process. After the patients have received testing at the clinic it takes a few days for the lab to find out the results. The lab results are then sent in paper form up to the front of the clinic to the medical records department. The results have to first be seen an approved by the patients doctor. Once the doctor signs off on the lab results they are then handed over to the nurses. The nurses have to notify the patients and set up follow up appointments if needed. Once the patient has been notified and the nurse has signed off on the lab results they are then ready to be posted in the medical records.

The lab results are then put into the filing folder in alphabetical order. This allows you to pull the files much easier and a lot quicker. Once you have found all the patients files that have lab results you can begin posting them in the records on the lab results chart. You write out each of the test, the date it was collected and the results that were found. This allows the doctor to be able to look back at the patient’s record to see if there is any history of a problem with the patient. The paper form of the lab results that was signed off by both the doctor and the nurse is also kept in the medical record incase there are any mistakes made on the lab results chart. Then you have to check to see if the patient had anymore lab testing done. If the patient only had the one test and you posted the results to that test then their record can be refilled. However most of the patients have more than one lab test done and many times they don’t get all the results all at the same time.

HSA Internship

On Tuesday may 26th already the second week of the summer semester I completed six hours of volunteer work at the Brevard County Health Department clinic in Melbourne. This was the first day that I was able to start working on the computer based medical records. The computer system holds medical records for any person who has ever had an appointment with any of the Brevard County Health Department clinics even when they missed their appointment. This allows the medical records department to retrieve a patient’s medical information even if they didn’t go to that specific clinic location.

This also helps the medical records department when they are trying to locate a patient’s chart. When I am looking for a patients chart and I can’t locate it with in the files I can then look it up on the computer based medical records. This allows me to see if they were ever a patient at our clinic, when their last visit was and of great importance what they have been seen for at the clinic. If the patient was only seen at the clinic for vaccinations they would most likely not have a medical record on file. The date of the patient’s last visit is also important because the files of patients who haven’t been seen in the clinic since 2007 are stored in the back filing room. The computer based medical records system allows you to wither the patient should have a record on file and where to find it if they do.

Brevard County Health Department Internship

I am participating in an internship this summer at the Brevard County Health Department Clinic in Melbourne. My preceptor is Tammy Massingill who is the operations manager at the Melbourne clinic. When I found out about the internship position I went in to talk to Tammy about the position. She took me on a tour of the clinic and showed me the medical records department and explained that this would be where I would be assigned.
I began my internship at the Brevard County Health Department clinic on Monday May 18th the first day of the summer semester. Before I could begin working with and handling the medical records I had to do a HIPPA security training program. This program was available to take online and consisted of readings about the rules and policies of HIPPA followed by assessments on the readings. After the security training I meet with Jennifer and Lisa who work in the medical records department. They then instructed me on how to create new medical record charts which they always need to have prepared before a new patient comes in. I then learned how the medical records here filled and was able to pull files when they were needed.