Relias Training: Basics of Effective
Documentation Exam Questions And Answers
Latest 2025
When working with one person, when should another person's
identifying information such as their name be included in the chart?
---
correct answer ✅The other person's information should never be
included
True or False: It is acceptable to go back into the medical record
and REMOVE mistakes in a previously submitted note. - - -
correct answer ✅FALSE
Which is the best example of how to document if you suspect a
person was under the influence of alcohol when you saw them? - - -
correct answer ✅There was a strong smell of alcohol and six
empty bottles on the table.
Which of the following is an example of objective information? - - -
correct answer ✅Ken was able to recall five of seven items
correctly.
What does the Golden Thread mean with regard to
documentation? - - -
Documentation Exam Questions And Answers
Latest 2025
When working with one person, when should another person's
identifying information such as their name be included in the chart?
---
correct answer ✅The other person's information should never be
included
True or False: It is acceptable to go back into the medical record
and REMOVE mistakes in a previously submitted note. - - -
correct answer ✅FALSE
Which is the best example of how to document if you suspect a
person was under the influence of alcohol when you saw them? - - -
correct answer ✅There was a strong smell of alcohol and six
empty bottles on the table.
Which of the following is an example of objective information? - - -
correct answer ✅Ken was able to recall five of seven items
correctly.
What does the Golden Thread mean with regard to
documentation? - - -
