Activity ID



June 30, 2020

Format Type


CME Credit



CME Provider

Medical Risk Management, Inc.


Most physicians can remember reading medical records and seeing entries that are questionable or don’t make sense. On occasion these entries have been made in error (i.e., the event or treatment occurred but was documented in the wrong patient’s chart). Sometimes these entries are vague or ambiguous, and sometimes they have even been made in a deliberate attempt to falsify the record. Good documentation is essential to good patient care, and that’s why this course has been developed.

Diplomate Engagement

Correct answers to the post-test

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NOTE: If a Member Board has not deemed this activity for MOC approval as an accredited CME activity, this activity may count toward an ABMS Member Board’s general CME requirement. Please refer directly to your Member Board’s MOC Part II Lifelong Learning and Self-Assessment Program Requirements.

Educational Objectives

Know what should be documented in the medical record
Know how errors in the chart should be corrected
Understand when and how should late entries be made
Know what steps should be taken to protect the integrity of the medical record when there are multiple providers


Risk Management, EHR, Medical Record


Systems-based Practice

CME Credit Type

AMA PRA Category 1 Credit

Practice Setting

Inpatient, Outpatient, Rural, Urban

National Quality Strategies and/or Quadruple Aim Care Processes


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