Friedman, Schuman, Applebaum and Nemeroff, P.C.Attorneys at Law • A Professional Corporation
Related Areas

Medical documentation and your health

You expect the information on your medical records to be accurate. However, the more doctors you see and the more conditions, illnesses or injuries you have, the greater the possibility of a breakdown in keeping your records up to date.

The accuracy of medical record documentation is a subject for continuing discussion between the medical and legal communities, as malpractice cases are often an effective means of holding negligent providers accountable.

Patient input

When you visit the doctor, a nurse or assistant usually sits with you to take down basic information. This includes listing the medications you take and any allergies you have. Problems may develop when more than one health care professional treats you. Although it is a good idea to always bring a current list of your prescriptions and allergies, each provider should ensure that he or she has records from visits made to others. These should show past and current treatments with medications and allergic reactions included. If someone does not update this information correctly, a doctor could inadvertently prescribe you a medication or treatment that causes you harm.

Beyond accuracy

Even though your records may have accurate information in them, poor legibility or organization could render them difficult to interpret and lead to medical errors. Other aspects of record keeping that may affect your health include timely updates and thorough entries. If your doctor does not enter notes from your visit right away, for example, he or she may forget important details that led to the decisions made for your care. If your health problem gets worse, the doctor may not be able to show the pertinent reasons behind the treatment or medication, which could indicate negligence.

Your next step

If you suffer an adverse event such as a medication error, a missed diagnosis or an illness that gets worse instead of better, it is important to report the circumstances to the provider or facility where you received care. Most hospitals have a reporting system already in place and can guide you in the information you need to provide. When the incident costs you in the form of unnecessary pain and suffering, medical bills and lost quality of life, it may be a good idea to speak to an attorney about addressing the issue through the legal system.

 

No Comments

Leave a comment
Comment Information

Contact Friedman Schuman

Fill Out The Form To Schedule A Consultation

Work with our experienced team of lawyers. Call 215-635-7200 or email us today to schedule a consultation.

View Office Locations

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close

Privacy Policy

Email Us For A Response

Main Office
101 Greenwood Avenue, Fifth Floor
Jenkintown, PA 19046

Phone: 215-635-7200
Fax: 215-635-7212
Jenkintown Law Office Map

Bucks County Office
196 West Ashland Street
Doylestown, PA 18901

Phone: 267-794-0200
Fax: 215-635-7212
Map & Directions

New Jersey Office
1040 North Kings Highway
Suite 200
Cherry Hill, NJ 08034

Phone: 856-616-8818
Fax: 215-635-7212
Map & Directions