Medical Records Department otherwise known as the shop window of the hospital is the first point of call or contact of every patient to the healthcare facility or hospital where the documents that explains all the details about the patient's history, climical/diagnostic findinds, medical labortory results, pre and post operative care, patient;s progress and medication which will support the doctors about the correctness of treatment. It also portaits the image of the hospital.
The Medical Department are made up of fourteen (14) Units which are listed below with its functionalities
The registration unit of the medical records department is the first point of call of every patient attending the hospital where documentation of all identification data entry takes place for both the present and future treatments.
In medical records, the retrieval unit is where all the patients folders filed in the filing shelves at the libray unit of the department are retrieved for the continuoys assessment and treatment of the patients or for education and research purposes.
This is a unit in medical records department where every patient medical history in the case note that visits the hospital are arranged and filed back at the shelves at the end of every clinic day.
Coding Unit is where medical information about a patient who have been on admission in the hospiatl ward are assigned and represented with a code number which is universally acceptable according to the international classification of disease and (ICD) Volume1, 2, 3 and all operative procedures according to the classification for surgical operation (CSO).
Coding Unit is where medical information about a patient who have been on admission in the hospiatl ward are assigned and represented with a code number which is universally acceptable according to the international classification of disease and (ICD) Volume1, 2, 3 and all operative procedures according to the classification for surgical operation (CSO).
Indexing is listing of the medical records is where diseases conditions and operation are listed in an index card according to the specialty, physician, age, sex, diagnosis, hospital number, disposal and result of treatment using a universally accepted code numbers.
The Unit is where patients on admission are documented according to their name, age, sex, address, physician diagnosis, treatment and disposal.
Statistics unit of the medical records is where hospital statistics otherwise known as hospital data are collected, collated, complied, analysed and interpreted giving the imprerative facts used for good decision making and planning.
This unit houses medical/health information gathered from all health clinical / sectors on epidemics and pandemic of disease occurrence and information gathering are used for planning, research, statistics, mointoring and evaluation of health care practices.
Medical records unit in A.N.C is in charge with the booking, registration and documentation as well as filing, retrieval and storing of case notes of pregnant women that visit the hospital for medical attention.
The medical records unit in accident & emergency is shouldered with the responsibility of taking information / registration and documentation of all patient need emergency treatment / urgent attention in the hospital.
Mointoring And Evaluation (M & E) is a unit in medical records in charge of mointoring And evaluation of every medical practice done by the doctors and other health / paramedical personal in the hospital.
GHAIN or Heart to Heart unit is where the medical records oficers attach to the unit carry out professional work of registration, documentation, filing, retrieval and storages of information and treatment of all the HIV/AIDS patients attending the hospital.
Is a unit in medical records where information compiled on patients from medical points of view are stored for education, reserach and training of the medical students as well as other para medical students.
The O & G unit is a unit embedded with the medical treatment of women / men with health issues affecting their reproduction organs and medical records in that unit takes the registration and documentation as well as the storage of all these information for future use.