1. Managing Medical Records Lesson 2: Filing13
Managing Medical Records
Lesson 2:
Filing

2. Lesson Objectives
Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
Identify the three types of file storage units.
Name the “Rules for Filing.”
List and discuss five types of numerical filing systems. 2

3. Lesson Objectives
Lesson Objectives
Compare and contrast the alphabetic, numeric, and color-coded filing systems.
State an effective system used for cross-referencing.
Understand how to find a missing file.
Describe a tickler file. 3

4. Categories of Medical Records
Active records
Inactive records
Closed records 4

5. Active Records
Relate to patients who have been seen within the past three years and are currently being treated
Each medical practice may have its own policy regarding what constitutes an “active” file, but it is usually from three to five years

6. Inactive Records
Relate to patients who have not been seen within the past three years or another time period determined by office policy
Files are still maintained by the office but are generally kept in a separate storage file cabinet that may be off-site
Patients have not received a formal notification that the physician has terminated caring for them. They may return when a medical problem develops.

7. Closed Records
Records of patients who have actively terminated their contact with the physician
Files can be placed in storage boxes or converted and saved on a computer disk
Files are referred to as archives, since they are no longer needed but must be kept for legal reasons

8. Types of File Storage
Vertical
Lateral
Movable 8

9. Vertical File Cabinet
Set up with two to four stacked pullout drawers holding up to 100 files per drawer
Heavy and space-consuming

10. Lateral File Cabinet
Set up with shelves allowing for easy access to files by pulling them off the shelves
Uses a color-coded method for visual recognition of files

11. Movable File Cabinet
Set up with electrically powered or manually controlled file units that move on tracks in the floor
Type of open filing system
Space-saving since the file units can be moved close together when they are not needed
Useful for books and journals since the floor can be reinforced when the track is installed

12. Traditional Hard Copy Patient Record
Patient file typically has tabs on the top or side edge
These tabs are marked with identification labels
If files are stored with alternating tab cuts, it is easier to read the labels in the file drawer
Identification label is attached to the top tab in a vertical file cabinet or to the side edge of the file in a lateral file cabinet

13. Traditional Hard Copy Patient Record
May be placed within a separate tabbed folder that remains in the filing cabinet
File folders may be color-coded to indicate the primary care physician
Each physician may be assigned a folder color as well as special indicators
This helps keep files in order in large clinics

14. Divider Guides
Divides the files into subsections using a letter or by patient number

15. Out Guide
Placed in the file when a file is removed to indicate where the file should be returned
Can be used to indicate who has removed the file and when it was removed
Especially helpful in a large office when trying to locate charts
Usually a distinctive color, such as red, is used to indicate a file is missing

16. Purpose of Labels on File Folders
Main purpose is to identify what is in the file
Label can include a color-coding stripe that can be used for other purposes, such as identifying the primary care physician
Offices use special labels on charts to bring attention to patient allergies, required co-pays, and year of last visit
Special labels help the staff find pertinent information at a glance

17. Systems Used for Filing
Alphabetic system
Numeric system
Subject filing
Color-coding
Let’s take a closer look at each of these! 17

18. Rules for Alphabetic System
Name with only an initial first name is filed before a full name
Hyphenated names are treated as one unit
Apostrophes are disregarded
Titles and initials are disregarded, but placed in parentheses after the name
Married women are to be indexed using their legal name. Husband’s name can be cross-referenced. 18

19. Rules for Alphabetic System
Seniority units are filed numerically
Numeric seniority terms are filed before alphabetic terms 19

20. Numerical Filing or Patient Identification System
Used in hospitals and many larger clinics
Number is assigned to each patient’s medical record
Generally a six-digit number divided into three sections of two digits each 20

21. Types of Numerical Filing
Straight numerical filing
Terminal digit filing
Middle digit filing
Unit numbering
Serial numbering 21

22. Straight Numerical Filing
Simplest numerical method
Each record is filed sequentially based on its assigned number
Numbers used in this system begin at 01 and continue upward
File space becomes depleted rapidly as new files are added to one section requiring constant reshifting of files to make room for the new files

23. Terminal Digit Filing Based on the last digits of the ID number
Evenly distributes the files within the entire filing system, eliminating the need for frequent reshifting of files
Requires dividing the files into 100 primary sections, starting with 00 and ending with 99
Three sections of numbers assigned to each file are designated as tertiary, secondary, and primary sections respectively

24. Let’s review the steps for using the terminal digit filing system!
Find the file section matching the patient’s primary digits (21)
Within that section, match up the secondary digits (72)
File the record according to the tertiary digits (05)
Let’s review the steps for using the terminal digit filing system!

25. Steps for Using the Terminal Digit Filing System
Step 1: Locate medical record files or medical record room.
Step 2: Observe the numbers on the record to be filed.
Step 3: Locate the set of files with the same tertiary
numbers as the record to be filed.
Step 4: Within the set of records with the same
tertiary numbers, locate the row of records with the
same secondary numbers as the record to be filed.

26. Steps for Using the Terminal Digit Filing System
Step 7: If there is a marker or out guide in place of
the removed record, then remove the marker when
replacing the file.
Step 6: After placing the file in numerical order by
primary numbers, check once more to be sure the file
is properly placed.
Step 5: Within the set of records with the same tertiary
and secondary numbers as the record to be filed, place
the record to be filed in numerical order by primary
numbers.

27. Middle Digit Filing
Using the same six-digit numbering system as with the terminal digit system
Middle digit filing system places the middle digits as the primary numbers

28. Unit Numbering
Assigns a number to patients the first time they are seen or admitted to a hospital
All other hospitalizations or hospital visits use the same number
Requires that all the records be kept at the same location

29. Serial Numbering
With this system the patient receives a different medical record number for each hospital visit
The patient acquires multiple records that are stored at different locations
The assigned numbers are kept in an accession record in which numbers in sequential order (1, 2, 3, 4, 5, 6…) have a name placed next to them as each new name is entered
This record can also be maintained on the computer

30. Subject Matter Filing
Used for general files, such as invoices, correspondence, resumes, and personnel records
Method is adequate as long as the files are relatively small
If these files become large, then another method, alphabetic or numerical, will have to be devised

31. Color-Coding Systems Assigns a color for each number from 0-9
Color bars on files correspond with the medical record number
Typically only the three primary digits are color-coded
System allows for misfiles to be easily seen 31

32. Color-Coding Methods Numerical system Alphabetic system
Ames Color File system
Smead Manufacturing Company’s method
Alphabetic system
Alpha-Z system 32

33. Alpha-Z System
System is based on 13 colors using white letters on a colored background for the first one-half of the alphabet, and the addition of a white stripe on the colored background for the second half of the alphabet
Uses file labels to denote the patient’s name, and a color label with the letter of the alphabet to indicate the index unit

34. Alpha-Z System
Ideal for the large practice with many patients having the same surnames
Can be adapted to a particular office’s needs
In large practices with several physicians, each physician may have a color assigned to him or her

35. Critical Thinking Question
What would be some advantages of cross-referencing files?

36. Advantages of Cross-Referencing Files
Helps in busy offices that have large number of files processed and who may have confusion occur over surnames
Alerts the health care worker that a file may be found under another name
Useful tool for finding and avoiding “lost” records

37. Methods to Ensure Location of Records is Known
Write down the name of the removed file on a master file sheet
Use an out guide to indicate the removal of a record

38. Guidelines for Locating Missing Files
Look for a file with a “sound-alike” or “look-alike” name
For color-coded files, look for a folder with the same color-coding
For files filed numerically, look for transposed numbers.
Look for transposed letters
Look for different spellings 38

39. Guidelines for Locating Missing Files
Look at folders filed before and after missing record
Look in other areas throughout the office
For a video on locating lost files click here, go to MyHealthProfessionsKit.com, or insert the DVD-ROM found in the back of your book. 39

40. Tickler Files Reminders for future events Should be reviewed daily
Contents include:
Patient’s names
Telephone numbers
Dates when action or activities should occur
Action to be taken 40

41. Questions? 41