影响患者使用病案的问题与对策

针对病案复印后因患者个人信息与有效证件不符造成患者不能报销、保险理赔以及暴露患者个人隐私而患者要求修改病案信息等问题,探讨解决问题的对策;提出完善患者入院知情同意签字制度、实行实名制入院以及病历书写方面的奖惩规定等病案管理制度,加强对医务人员病历书写规范的培训,加强医护人员和病案管理人员法律法规的培训等措施,依法管理病案,确保为患者及时准确的使用病案提供服务,从而提高了患者的满意度。

The Influences of Patients Using Medical Record and Its Countermeasures

To discuss the problems such us the patients can not get settlement of insurance claim by personal information is not conform to effective certificate and patients’ personal privacy are exposed after medical record copying to found solutions.Some medical record management systems such us improving the admission in patients with informed consent signature system,implementation of real-name system for admission and reward and punishment provisions of the medical records,and some measures such us strengthening the medical writing standard training,strengthening the training of the laws and regulations,and manage medical records according to law should be put forward to ensure patients can copy medical record timely and accurately,and improve patient’ satisfaction.