MTR 120 - Medical Transcription I

1. Recognize the role the medical transcriptionist plays in providing quality patient care.
   1. Identify the background and importance of medical records.
   2. Describe the chain of communication in dictation/transcription.
   3. Differentiate between machine transcription and medical transcription.
   4. Discuss the knowledge, skills, and abilities of a competent medical transcriptionist.
   5. Compare different medical transcription environments.
   6. Differentiate between medical typing and medical transcription.
2. Operate designated equipment for medical transcription.
   1. Compare typewriting and word processing equipment.
   2. Compare different types of dictation equipment.
   3. Compare different types of transcription equipment.
   4. Define vocabulary terms related to office equipment.
   5. Identify ergonomic factors that affect the transcriptionist’s work environment.
3. Demonstrate the ability to listen
   1. Practice listening discrimination activities
   2. Clarify dictation which is unclear of incomplete.
4. Demonstrate the ability to use reference materials
   1. Locate the most common and helpful references for the medical transcriptionist
   2. Use the designated references appropriately and efficiently.
5. Apply English, grammar, spelling, and punctuation rules as they pertain to medical reports.
6. Prepare material containing numbers, symbols, and abbreviations.
   1. Explain when a number should be transcribed as a figure, transcribed in spelled-out form, or transcribed as a Roman numeral
   2. Demonstrate proper transcribing of medical and business symbols and abbreviations
7. Identify types/formats of medical reports
   1. Describe the various mechanical formats for history and physical examinations
   2. Describe the type of information that appears in histories, physicals, discharge summaries, consultations, radiology reports, operative reports, and pathology reports
8. Transcribe histories, physical examination, and miscellaneous medical reports.
   1. Verify patient information for accuracy and completeness.
   2. Format reports according to established guidelines
   3. Interpret inconsistencies and/or discrepancies in medical dictation
9. Proofread transcribed documents
   1. Discuss general rules for proofreading
   2. Utilize informal proofreader’s symbols
   3. Revise corrected and marked documents
10. Demonstrate an understanding of the medico legal implications and responsibilities related to the transcription of patient records
    1. Define privileged and non-privileged information
    2. Enumerate guidelines for the release of information
    3. Explain patient confidentiality
    4. Discuss the American Association of Medical Transcription (AAMT) Code of Ethics