Health Information Management

Ask these questions to define your legal health record

Medical Records Briefing, July 1, 2008

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Unlike clothing, “one size fits all” is not an option when defining a legal health record (LHR). Federal, state, and some local laws provide the initial framework for an LHR, but fine-tuning the definition is ultimately the organization’s responsibility.

AHIMA defines the legal health record as “generated at or for a healthcare organization as its business record and is the record that would be released upon request.”

“What we’re really talking about is what are you going to hand out upon subpoena or other legal request,” says Kelly McLendon, RHIA, president of Health Information Xperts, LLC, in Titusville, FL.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Medical Records Briefing.

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