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EHR 1

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An EHR specialist is generating patient statements. Which of the following types of information will be included? a. Date of service b. Marital status c. Prescriptions d. Chief complaint Date of service An EHR specialist is explaining to a new provider the process for entering a new prescription for a patient discharge. In which of the following EHR locations should the EHR specialist direct the provider to enter the information? a. Progress note b. Clinical results reporting c. E-prescribing d. Medication E-prescribing Which of the following is an EHR documentation tool that a provider can use to add comments for increasing the specificity of a physical examination finding? a. General consent b. Lists c. Action buttons d. Free-text box Free-text box Which of the following features of the clinical decision support system presents a provider with standard plans of therapy for a documented diagnosis or condition? a. Drug formulary b. Protocols c. The task list system d. Medical references Protocols An EHR specialist is assisting a certified coder with providing an in-service about the purpose of Current Procedural Terminology (CPT) codes for a group of staff members. Which of the following staff members statements indicates an understanding of the teaching? a. "CPT codes are used to classify services provided to patients." b. "CPT codes group patients using demographic information." c. "CPT codes are used to classify patient diagnoses." d. CPT codes are different from one facility to the next." "CPT codes are used to classify services provided to patients." Which of the following information recorded by a provider during a patient's visit is required during electronic transmission of an order to an outside laboratory? a. Assessment b. Diagnosis code c. Chief complaint d. Treatment plan Diagnosis code Which of the following reporting tools is commonly used in EHRs to aggregate data for monitoring milestones during well-child visits? a. Early screening b. Quality measures c. Growth chart d. Immunization schedule Growth chart An EHR specialist is reviewing the record of a petient who is in a coma. Which of the following entries documented in the record signals a data discrepancy? a. "The patient's head is elevated." b. "The patient's partner is present." c. "The patient reports a headache." d. "The patient's heart rate is regular." "The patient reports a headache." A neighbor of an EHR specialist is admitted to the facility where the EHR specialist works. Which of the following HIPAA standards monitors control for accessing the neighbor's PHI without purpose for treatment, payment, and health care operation? a. Administrative safeguards b. Physical safeguards c. Technical safeguards d. Permitted disclosures Technical safeguards A patient arrives at an initial health care visit for an occupied injury covered under workers' compensation plans. An administrative professional collects proof of identity and demographic information. Which of the following additional documentation should the administrative professional request? a. A consent to release form b. A medical service order c. A Doctor's First Report of Occupational Injury or Illness d. A progress report A medical service order A provider requests that an EHR specialist enter a comorbidity of depression into the EHR to allow the provider to complete a medication order for the clinic visit. A comorbidity should be entered into which of the following sections of the record? a. Primary diagnosis b. Secondary diagnosis c. Probable diagnosis d. Admission diagnosis Secondary diagnosis When recording information in a patient's health record, an EHR specialists should understand that the consent forms represent which category of data in t


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