bethuel best

Step One: Imagine that you are the HIM Supervisor over the record completion area in a multi-facility healthcare system. The HIM Director has asked you to provide information about the documentation requirements for various record types (Acute, Outpatient, LTC, Rehab, and Behavioral health) for the History and Physical (H&P). You must research The Joint Commission, the CMS Conditions of Participations (COPs), CARF, and your state's law. Complete the table below that compares the H&P requirements for all record types.

Acute Care

Outpatient

Long term care

Rehab

Behavior Health