©THESTAR 2024/2025 ALL RIGHTS RESERVED 11:04PM.
RHIA Practice Exam 1 Domain 1 Questions
And Answers 2025 Update.
The data elements in a patient's automated laboratory result are examples of:
a. Unstructured data
b. Free-text data
c. Financial data
d. Structured data - Answer✔d. Structured data
What type of information makes it easy for hospitals to compare and combine the contents of
multiple patient health records?
a. Administrative information
b. Demographic information
c. Progress notes
d. Uniform data sets - Answer✔d. Uniform data sets
According to Joint Commission Accreditation Standards, which document must be placed in the
patient's record before a surgical procedure may be performed?
a. Admission record
b. Physician's order
c. Report of history and physical examination
d. Discharge summary - Answer✔c. Report of history and physical examination
Which of the following materials are required elements in an emergency care record?
a. Patient's instructions at discharge and a complete medical history
b. Time and means of the patient's arrival, treatment rendered, and instructions at discharge
c. Time and means of the patient's arrival, patient's complete medical history, and instructions
at discharge
1
, ©THESTAR 2024/2025 ALL RIGHTS RESERVED 11:04PM.
d. Treatment rendered, instructions at discharge, and the patient's complete medical history -
Answer✔b. Time and means of the patient's arrival, treatment rendered, and instructions at
discharge
A patient is admitted with right diabetic cataract, and extracapsular cataract extraction with
simultaneous insertion of intraocular lens.
a. H25.9, E11.36, 08DJ3ZZ
b. E11.36, 08RJ3JZ
c. E11.9, E11.36, H26.9, 08DJ3ZZ
d. E25.9, E11.9, 08RJ3JZ - Answer✔b. E11.36, 08RJ3JZ
Dr. Collins admitted Mr. Smith to University Hospital. Blue Cross Insurance will pay Mr. Smith's
hospital bill. Upon discharge from the hospital, who owns the health record of Mr. Smith?
a. Mr. Smith
b. Blue Cross
c. University Hospital
d. Dr. Collins - Answer✔c. University Hospital
What is the principal function of health records?
a. Determine appropriate resource allocation
b. Serve as the repository of clinical documentation relevant to the care of individual patients
c. Provide information for performance improvement activities
d. Support billing and reimbursement processes - Answer✔b. Serve as the repository of clinical
documentation relevant to the care of individual patients
All documentation entered in the health record relating to the patient's diagnosis and
treatment are considered this type of data:
a. Clinical
b. Financial
c. Identification
d. Secondary - Answer✔a. Clinical
When defining the legal health record in a healthcare entity, it is best practice to establish a
policy statement of the legal health record as well as a:
a. Case mix index
b. Master patient index
2
RHIA Practice Exam 1 Domain 1 Questions
And Answers 2025 Update.
The data elements in a patient's automated laboratory result are examples of:
a. Unstructured data
b. Free-text data
c. Financial data
d. Structured data - Answer✔d. Structured data
What type of information makes it easy for hospitals to compare and combine the contents of
multiple patient health records?
a. Administrative information
b. Demographic information
c. Progress notes
d. Uniform data sets - Answer✔d. Uniform data sets
According to Joint Commission Accreditation Standards, which document must be placed in the
patient's record before a surgical procedure may be performed?
a. Admission record
b. Physician's order
c. Report of history and physical examination
d. Discharge summary - Answer✔c. Report of history and physical examination
Which of the following materials are required elements in an emergency care record?
a. Patient's instructions at discharge and a complete medical history
b. Time and means of the patient's arrival, treatment rendered, and instructions at discharge
c. Time and means of the patient's arrival, patient's complete medical history, and instructions
at discharge
1
, ©THESTAR 2024/2025 ALL RIGHTS RESERVED 11:04PM.
d. Treatment rendered, instructions at discharge, and the patient's complete medical history -
Answer✔b. Time and means of the patient's arrival, treatment rendered, and instructions at
discharge
A patient is admitted with right diabetic cataract, and extracapsular cataract extraction with
simultaneous insertion of intraocular lens.
a. H25.9, E11.36, 08DJ3ZZ
b. E11.36, 08RJ3JZ
c. E11.9, E11.36, H26.9, 08DJ3ZZ
d. E25.9, E11.9, 08RJ3JZ - Answer✔b. E11.36, 08RJ3JZ
Dr. Collins admitted Mr. Smith to University Hospital. Blue Cross Insurance will pay Mr. Smith's
hospital bill. Upon discharge from the hospital, who owns the health record of Mr. Smith?
a. Mr. Smith
b. Blue Cross
c. University Hospital
d. Dr. Collins - Answer✔c. University Hospital
What is the principal function of health records?
a. Determine appropriate resource allocation
b. Serve as the repository of clinical documentation relevant to the care of individual patients
c. Provide information for performance improvement activities
d. Support billing and reimbursement processes - Answer✔b. Serve as the repository of clinical
documentation relevant to the care of individual patients
All documentation entered in the health record relating to the patient's diagnosis and
treatment are considered this type of data:
a. Clinical
b. Financial
c. Identification
d. Secondary - Answer✔a. Clinical
When defining the legal health record in a healthcare entity, it is best practice to establish a
policy statement of the legal health record as well as a:
a. Case mix index
b. Master patient index
2
