1. Today's Medical Assistant
Chapter 44
Written Communications

2. Introduction to Written Communication
In the past, written communication was usually sent through the mail
Today, written communication is also sent electronically
Can be viewed or printed after transmission
Must adhere to professional standards
If written communication contains protected health information, a consent for its release must be obtained from the patient
If a patient sees a nephrologist for a consultation, how does the patient consent to have a consultation report sent to his or her primary care provider? (See Figure 37-4 first and last paragraphs.)
Would you expect a consultation report to be sent by mail or by ? Why?

3. Business Letters
Letters must be formatted correctly to maintain a professional image
May be dictated by the physician and prepared by the medical assistant (MA)
May be composed by the MA
Form letters or letters based on templates may be used for routine correspondence
What are examples of letters that might be dictated by the physician in a medical office?
What are examples of letters that the medical assistant might compose?
What are examples of form letters that might be used in the medical office?

4. Equipment and Supplies
A computer and printer are usually used to create a letter
Word processing software facilitates formatting and corrections
Letterhead stationery is used with matching envelopes
Letters are usually photocopied for the medical record and if copies are sent to other recipients
Why are letters usually created on a computer instead of a typewriter? Which do you prefer and why?
What is letterhead stationery? Why is it used?
Why do offices usually purchase envelopes with a preprinted return address that matches their letterhead?

5. Heading
Return address is placed at the top of the letter, or letterhead stationery is used
Date line on second line below return address or two to three spaces below letterhead
Month is written out in full
Written as month, day, and year (e.g., January 5, 2009)
When is it necessary to key a return address for a letter?
Where should the date line be placed?
In what form should the month be written on a letter and with what punctuation?

6. Inside Address
Includes the name and address of the party to whom the letter is being sent
Located just above the salutation
Placed on the paper so that the body of the letter is centered top to bottom
Inside address is single-spaced
If the letter will require 2 pages, inside address begins on the second or third line below the date line
What is the inside address?
Where is the inside address positioned in a business letter?
Is the inside address single spaced or double spaced?

7. Salutation or Greeting
Formal greeting uses “Dear” plus a title with the recipient’s surname
Use of the first name is informal and should be avoided
Not correct to use credentials
Example: Dear Dr. Taylor:
In a business letter, the salutation is punctuated with a colon
Salutation is followed by one blank line
What is an appropriate salutation for a physician named Gordon Taylor?
What is the appropriate salutation for a patient named Janet Winston?
How should the salutation of a business letter be punctuated? Is this the same as or different from a personal letter?

8. Body of the Letter Contains the substance of the letter
Each paragraph is single-spaced with a double space between paragraphs
What information is contained in the body of a letter?
What spacing is used for the body of a letter?

9. Complimentary Closing
Placed on the second line below the body of the letter
First word is capitalized and closing is followed by a comma
The standard complimentary close is “Sincerely,” or “Sincerely yours,”
More formal closing is “Yours truly,” or “Very truly yours,”
Example: “Sincerely yours,”
What would be an acceptable complimentary close for a business letter?
How should the medical assistant decide which complimentary close to use for letters from a medical office?
What is the most formal complimentary close for a business letter?

10. Signature, Printed Signature, and Title
Four to five spaces are left after the closing for the handwritten signature
The printed signature includes the full name of the individual sending the letter, including credentials
Why is a printed signature included under the handwritten signature of a business letter?
Is a printed signature included in a personal letter? Why or why not?
Where are an individual’s credentials placed relative to the printed signature?

11. Signature, Printed Signature, and Title
A title may be entered on the line below the printed signature
If the MA composes the letter, he or she usually also signs the letter
If the physician dictates the letter, the physician will proofread and sign the letter
Where is an individual’s title (e.g., Practice Manager) placed relative to the printed signature?
Who signs a business letter in the medical office?

12. End Notations
The order of information given below the signature may vary according to office policy
End notations include enclosures, copies, and initials of the individual who prepared the letter
The initials of the individual who dictated the letter are entered in upper case followed by a slash or colon and the initials of the individual who prepared the letter in lower case
What are examples of end notations?
In what order are end notations placed on the business letter?
Is it necessary to include all end notations for each business letter? Why or why not?

13. End Notations
End notations include enclosures, copies, and initials of the individual who prepared the letter
Enclosure(s) may be written out or abbreviated “Enc.”
The number of enclosures is given so that the recipient can be sure everything was actually included with the letter
The copy notation indicates recipients of copies of the letter. The copy retained by the office is not included in the copy notation
What is the reason for indicating the number of enclosures in a letter?
Why is the recipient of a letter notified of other individuals who have received copies of the letter?

14. Business Letters
What is the spacing between the letterhead and the date line?
What is the spacing between the date line and the inside address?
What is the spacing between the inside address and the salutation?
What is the spacing between the salutation and the body of the letter?
How is the body of the letter spaced?
What is the spacing between the complimentary close and the typed signature?
How are the end notations spaced?

15. Setting Up a Letter Margins
Top margin should accommodate the letterhead
Side margins may be 1-2 inches
A short letter usually has wider side margins
Body of the letter should be centered top to bottom on the page
How does the medical assistant know how large the top margin should be for a business letter?
When are side margins of 1 inch appropriate? 1½ inches? 2 inches?
How should the body of the letter be positioned on the letter? Why?

16. Setting Up a Letter Font
Generally accepted font for business letters is Times or Times New Roman
Entire letter (except for letterhead) should be in the same font
A header should be placed at the top of a 2-page letter including recipient, page number, and date
What font is recommended for business letters?
What font is used in the template for a letter in your version of Microsoft Word? Is the font legible and businesslike? Would you change the size or style of the font? Why?

17. Letter Styles Full block style
All lines are left-justified, but letterhead may be centered
Left-justified means that the line begins at the left margin
A double space is used between the paragraphs of the body of the letter
What distinguishes the full block letter style from other letter styles?
Why is the full block style considered the easiest letter style to use?

18. Letter Styles Full block style
What end notations are included in this letter?
Where are the end notations placed?
Which parts of this letter are left-justified?
Is the letterhead usually left-justified? Why or why not?

19. Letter Styles Modified block style
All lines in the inside address, salutation, and body of the letter are left-justified
Date line, complimentary close, and printed signature are right-justified or set on a tab at the center or to the right of the center
Right-justified means ending at the right margin
A double space is used between the paragraphs of the body of the letter
Which lines of the modified block style are not left-justified?
What is the advantage of setting the date line on a tab at the center (or to the right of center) in the modified letter style?
What is the advantage of right-justifying the date line in the modified letter style?

20. Letter Styles Modified block style
Which lines of this letter are left-justified?
Which lines of this letter are not left-justified?
What additional end notations might be found on a letter?

21. Letter Styles Semiblock style
All lines in the inside address, salutation, and body of the letter are left-justified
Date line, complimentary close, and printed signature are right-justified or set on a tab at the center or to the right of the center
All paragraphs are indented and a double space is used between paragraphs
What is another name for the semiblock letter style? (Modified block with indented paragraphs.)
Which lines are left-justified?
Which lines are indented?

22. Letter Styles Semiblock style
How many lines of this letter are indented?
How many paragraphs are there in the body of the letter?
Which lines are left-justified?
Which lines are not left-justified?

23. Letter Styles Simplified style
All parts of the letter (except the letterhead) must be left-justified
The salutation is replaced by a subject line in all upper case letters
The complimentary close is not used, and the printed signature line is in all uppercase letters five lines below the written signature
A double space is used between the paragraphs of the body of the letter
Which lines of the simplified letter style are left-justified?
What replaces the salutation in the simplified letter style?
What replaces the complimentary close in the simplified letter style?
How common is the simplified letter style?

24. Letter Styles Simplified style Which line replaces the salutation?
Which line is completely eliminated in this letter style?
Which lines are left-justified?
Which lines are not left-justified?

25. Composing a Business Letter
Collect information and jot down important points
Be sure information is in logical order
Review old letters for wording
Enter the letter into the word processor and format
Have a draft letter proofread by the office manager and/or physician if necessary
Proofread for accuracy, grammar, and spelling
What points might you want to make in a letter notifying a patient that his bill is overdue? What is a logical order?
What points might you want to make in a letter notifying a vendor that part of an order was not delivered? What is a logical order?
Why is it important that every letter sent by the medical office has been proofread carefully for accuracy, grammar, and spelling?

26. Responding to Written Communication
MA usually responds to correspondence or s related to office management
Supply orders
Billing or insurance questions
Requests for information about the practice
When is an an appropriate way for the medical assistant to initiate or answer correspondence related to the medical office?
What format should be used for s to individuals outside the medical practice?

27. Responding to Written Communication
Correspondence related to patient care is referred to the physician
If paper-based medical records are used, MA attaches letter to medical record
If physician dictates a reply to a letter related to patient care, MA transcribes the dictation
What type of correspondence should always be referred to the physician? Why?

28. Grammar and Punctuation
Grammar is a term meaning the accepted rules to create meaningful sentences
MA must always use correct grammar and spelling
Parts of speech are categories that describe how words are used
Why is it important for the medical assistant to master the rules of grammar and sentence structure?

29. Parts of Speech Nouns A noun is the name of a person, place, or thing
Common nouns refer to general things or categories
Proper nouns refer to specific individuals or places and begin with an upper case letter
Examples of common nouns: baseball, rabbit, medical assistant
Examples of proper nouns: Dean Johnson, Bugs Bunny, New Orleans
What are examples of common nouns? Proper nouns?
Which type of nouns are capitalized?

30. Parts of Speech Pronouns A pronoun is used in place of a noun
Possessive pronouns show ownership
Examples of pronouns: he, she, you, I, them
Examples of possessive pronouns: mine, his, their, theirs
What are examples of pronouns?
How do pronouns change to show possession?
What are examples of pronouns with their respective possessive pronouns?

31. Parts of Speech Verbs A verb either shows action or a state of being
A verb that shows a state of being may also be called a linking verb
A sentence requires a subject (noun or pronoun) and a verb to be complete
Examples of action verbs: run, sing, dance
Examples of verbs that show a state of being: is, are, seems
What are examples of action verbs?
What are examples of verbs that show a state of being (linking verbs)?
Which types of verbs can be followed by a direct object?

32. Parts of Speech Adjectives and articles An adjective modifies a noun
Two or more words used together as one modifier may be joined by a hyphen (e.g., 20-year-old)
English has three articles: a, an, the
What are examples of adjectives modifying a noun?
Why are articles usually grouped with adjectives?

33. Parts of Speech Adverbs Prepositions
An adverb modifies a verb, adjective, or other adverb
Words that end in -ly are usually adverbs
Question words are also adverbs (e.g., who? where? why?)
Prepositions
A preposition shows the connection of a noun to some other word
Prepositions often show relationships of space, time, or possession
Examples of prepositions: to, on, above, of, in
What are examples of adverbs modifying a verb? An adjective?
What are examples of question words?
What are examples of prepositions used in prepositional phrases?

34. Parts of Speech Conjunctions Interjections
A conjunction joins words, phrases, or clauses in a sentence
Examples of conjunctions: and, but, or, because
Interjections
An interjection is a word that expresses feelings
Examples of interjections: oh! yeah! ouch!
What are examples of conjunctions?
How are conjunctions used?
What are examples of interjections?
Are interjections commonly used in business correspondence? Formal s? Informal s?

35. Sentence Structure Simple sentence Compound sentence
A simple sentence is composed of one independent clause
Example: The dog was very hungry.
Compound sentence
A compound sentence is composed of two independent clauses
A comma separates the two independent clauses in a compound sentence
Example: The dog returned from its walk, and it drank all the water in its bowl.
What is the difference between a simple sentence and a compound sentence?
What punctuation is necessary before the conjunction in a compound sentence?
What is an example of a simple sentence? A compound sentence?

36. Sentence Structure Complex sentence
A complex sentence consists of one independent clause and one or more dependent clauses
A dependent clause cannot stand alone
If a dependent clause begins a sentence, it is followed by a comma
If a dependent clause follows an independent clause, a comma is not used
Examples:
When it returned from its walk, the dog drank all the water in its bowl.
The dog drank all the water in its bowl when it returned from its walk.
What is the difference between a complex sentence and a compound sentence?
What is an example of a complex sentence?
When and where is a comma required in a complex sentence?

37. Sentence Errors Sentence fragment
A dependent clause is used to stand alone as a sentence
An additional independent clause is necessary for meaning
Example: When I arrive for my appointment.
What is a sentence fragment?
How can a medical assistant determine if a sentence is complete or a fragment?

38. Sentence Errors Run-on sentence Comma splice
It is a sentence in which two or more independent clauses are used without a conjunction
My appointment is on Thursday I will bring my insurance card.
Comma splice
It is the incorrect use of a comma to separate two sentences
Example: My appointment is on Thursday, I will bring my appointment card.
What is a run-on sentence?
What can be added to a run-on sentence to make it complete?
What is a comma splice? What is required to correct it?

39. Comma Rules When to Use a Comma
To separate the elements in a series of three or more things
Example: The patient complained of abdominal pain, difficulty breathing, and headache.
Before a conjunction that joins an independent clause
Example: The patient called an ambulance, and the ambulance brought her to Memorial Hospital.
What is an example of a comma used to separate the elements in a series of three or more things?
Is a comma required in a list of two items? Why or why not?
What is an example of a comma used to separate two independent clauses?

40. Comma Rules When to Use a Comma
To set off introductory elements like prepositional phrases or dependent clauses
Example: After the upper GI, the patient continued to experience abdominal pain.
To set off information that could be omitted or placed in parentheses without changing the meaning of the sentence
Example: The patient, who was referred by Dr. Johnson, had an appointment today.
What is an example of a comma used to set off an introductory dependent clause? An introductory prepositional phrase?
What are examples of commas used to set off information that could be omitted without changing the meaning of a sentence?
How many commas must be used to set off information that could be omitted without changing the meaning of the sentence?

41. Comma Rules When to Use a Comma
Before quotation marks that open a quotation
Example: The patient said, “My incision burns like fire.”
To avoid confusion
Example: For most, the academic year is already finished.
What is a direct quotation?
What is the rule for using a comma with quotation marks?
How can a comma avoid confusion in a sentence?

42. Comma Rules When to Use a Comma
Between the city and state, the day of the month and the year, a name and the title
Example: June 17, 1987 BUT June 1987
With terms like not, however, and but to express contrast
Example: The wound was large, but it was healing well.
Where is a comma used when identifying a town and state?
Where is a comma used in dates?
How is a comma used to express contrast?

43. Comma Rules When to Use a Comma
To separate appositives, nouns of direct address, titles that follow a person’s name, and introductory words from the rest of the sentence
Example: We will make an appointment with Dr. Cannon, a gynecologist.
To separate parenthetical expressions from the rest of the sentence
Example: The report, I hope, will give you more specific information
What is an appositive?
How is a comma used to separate titles that follow a person’s name?
How is a comma used to separate expressions that could be put in parentheses?

44. Spelling Proofread all documents for spelling
Spell check is helpful but cannot verify that a word is correct in context
Keep a list of difficult words and try to learn them
A medical dictionary and computer program can be helpful
Give examples of spelling mistakes that would not be caught by the spell check feature of a word processing program.
How can the medical assistant get better at spelling, especially difficult words?
What are sayings that you may know to help spell certain words?
(Examples: The sentence Neither foreign financier seized either species of weird leisure” contains many words that do not follow the rule: “I” before “e” except after “c” or when sounded like “ay” in neighbor and weigh.)

45. Proofreading Look up any unfamiliar words to verify spelling
Write out abbreviations for medical conditions, but use standard abbreviations for medication times, measurements, and vital signs
What is proofreading?
When should a medical assistant perform proofreading in the medical office?
In medical reports, what are general guidelines for the use of abbreviations?

46. Proofreading
Personalize the spell check program by adding commonly used words
Leave a space if there was an unintelligible word so that the physician can fill it in before signing
How can the medical assistant use the computer to check the spelling of medical terminology?
What should the medical assistant do if there is a word in a dictation that he or she simply cannot understand?

47. Preparing Memoranda A memo is used to communicate within a business
Memo headings include the names of the individuals to whom it is sent, the name of the person sending the memo, the date, and the subject
The message is informative and succinct
The memo may be sent in hard copy or as an attachment to an
What format is used for a memorandum?
What are examples of topics that might be communicated to medical office staff in a memorandum?
Why might a memo be sent as attachments?

48. Electronic Transmission and Photocopying Documents
Lesson 42.3
Electronic Transmission and Photocopying Documents
Compare the use and style of business letters and electronic communication, such as or clinical messages.
Explain how to use and attachments for business communication.
Explain how to transmit information using a fax machine.
Describe how to make copies of multiple-page documents.

49.
A method of exchanging information between individuals using a computer
Usually uses a format like a letter, but less formal
Usually not used with patients
Should contain a subject line
Use correct grammar and spelling
Subsequent s usually created as a reply so that previous communication is included
How does compare to written correspondence in terms of formality?
How does compare to written correspondence in terms of format?
Why is it helpful to create subsequent s related to the same topic as a reply?

50.
Abbreviations, humor, and negative comments should be avoided in s to business contacts
Assume that s are not private and do not include confidential information
Be sure that s are sent to the correct recipient
Print s that contain information related to orders or other business transactions
What are disadvantages of trying to use humor in s?
Which s should be printed and filed? Why?

51. Attachments
Documents, images, and other types of files can be sent as attachments
Attachments may transmit viruses, so open them only if from a trusted source
Attachment must be opened with a compatible program
Save documents as text file if you do not use a standard word processing program
Files can also usually be saved as web pages
What is an attachment?
When should the medical assistant avoid opening an attachment?
How does the medical assistant open an attachment?

52. Fax Transmissions
Fax is sent with a cover sheet to identify the sender
Medical office usually uses a confidentiality statement on the fax cover sheet
Cover sheet often printed on office letterhead
Fax transmissions are not considered secure and should be avoided for patient information unless there is a need for rapid transmission of information
When are fax transmissions used in the medical office?
How can a medical assistant facilitate patient confidentiality if the fax must be used to send PHI?

53. Photocopying Learn how to use the features of the photocopy machine
Remove staples and arrange documents before copying
Most machines will collate pages (arrange in order) and staple
If collating manually, pay attention to retain correct order of pages
Many machines will produce two-sided copies
How does a photocopier collate documents?
Why does it save time to copy multiple page documents using a photocopier that has a collate function?
When is it helpful to use a photocopier that can read and/or produce two-sided documents?

54. Photocopying
Be sure patient has signed a release before copying patient information
After copying, be sure no originals are left at the machine
Shred any spoiled copies containing patient information
What patient information is photocopied using a photocopier?
How is patient confidentiality protected if patient information must be photocopied?