RHIA Practice Exam Domain 1 | Questions with 100% Correct Answers | Verified | Latest Update 2024

A method of documenting nurses' progress notes by recording only abnormal or unusual findings or deviations from the prescribed plan of care is called: a. Problem-oriented progress notes b. Charting by exception c. Consultative notations d. Open charting - Charting by exception Mrs. Smith's admitting data indicates that her birth date is March 21, 1948. On the discharge summary, Mrs. Smith's birth date is recorded as July 21, 1948. Which quality element is missing from Mrs. Smith's health record? a. Data accuracy b. Data consistency c. Data accessibility d. Data comprehensiveness - Data consistency Data that have been grouped into meaningful categories according to a classification system are referred to as this type of data: a. Research b. Reference c. Coded d. Demographic - Coded