- Email: [email protected]
Medical Record Retention and Maintenance for Private Practices
practice applications
BUSINESS OF DIETETICS
Medical Record Retention and Maintenance for Private Practices
I
n today’s health care environment, a patient might leave one physician or other health care practitioner in favor of another for a host of reasons. For example, the practitioner may switch to a concierge practice, refuse to work with specific insurance companies, or be unable to compete with offices that can see the patient sooner. Or, the patient may move, become frustrated with the office staff, or find that his or her insurance coverage has been changed (1). This patient shifting, coupled with the volume of appointments a health practice might book in a given week, underscores the various challenges a practitioner can face in maintaining accurate medical records for each patient for an appropriate period of time. The medical record “provides documentation of pertinent clinical and laboratory findings, diagnosis, therapeutic actions taken, patient progress and response to therapy, and instructions to the patient regarding physical activity, medication, diet, and follow-up care” (2). Thus, meticulous record-keeping in the health care practice is essential because it enhances the health care practitioner’s ability to assess and monitor patient care and ensures accurate transmission of information from one practitioner to another across the continuum of care (3). Furthermore, if ever there is a dispute related to care, this
This article was written by Karen Stein, MFA, a freelance writer in Querétaro, México. Stein is a former editor of the Journal and has also taught English and composition at the academic level. She currently runs a center for teaching English in México. Mary H. Hager, PhD, RD, FADA, director of Regulatory Affairs in ADA’s Washington, DC, office, contributed to the article. doi: 10.1016/j.jada.2009.09.014
1838
information becomes legal evidence, for practitioner and patient alike (2,4). RETENTION CHALLENGES Storage space constraints and long patient lifespan can make retention of hard copies of medical records a challenge. The recent push toward electronic medical record (EMR) systems is one approach to addressing this concern, but the systems are expensive and have not been universally adopted. In addition, there are various laws, regulations, and standards which define how records are to be managed, and these can vary by the types of settings in which the care is given, who pays for the care, and the state where the practice is located. Although some federal laws and regulations address medical record management—particularly the Health Insurance Portability and Accountability Act (HIPAA) and the Medicare Conditions of Participation and Conditions for Payment for various facility types—it is the states that determine requirements for medical record retention. Furthermore, several medical associations and accreditation organizations have issued best practice guidelines and standards, which can be voluntarily adopted by individual practitioners. These various factors will be reviewed to help you, the practitioner, determine the parameters affecting how you manage the medical records you keep. HOW LONG SHOULD RECORDS BE KEPT? When determining how long to keep medical records, health care practitioners are recommended to consider the following: state laws and regulations; Medicare and other federal regulations; and other third-party payer requirements, accreditation standards, and applicable statutes of limitations (5). Federal, state, and local governments are responsible for safeguard-
Journal of the AMERICAN DIETETIC ASSOCIATION
ing the public health and welfare. Federal laws and regulations are applicable nationally, and set a baseline upon which states are permitted to add higher or more stringent requirements. State Laws State laws related to medical records vary in content, with rules for designated subsets, retention times, types of data, and type of facility differing across jurisdictions (6). The basic protections of a person’s medical records are universally recognized by the states; the records are personal and private. In Arizona, for example, the laws specify the length of time records must be kept in the following types of institutions: assisted living facilities, abortion clinics, hospitals, sleep disorder facilities, hospices, nursing facilities, rehabilitation centers, end-stage renal disease treatment and transplant centers, ambulatory surgical centers, and birthing centers. In Wyoming, on the other hand, the laws address the retention periods for the type of record to be kept, such as hospital administrative and discharge records, diagnoses, operative reports, pathology reports, record summaries, and nursing histories (7). A good example of state counsel to practitioners and for the public is available in a report titled “Patient Access to Medical Records” published by the Connecticut state government (8). Whereas some states only require retention of as few as 3 years of certain types of medical records in certain types of facilities, other groups generally advise that health/medical records for adult patients be kept at least 10 years after the most recent patient visit. For minors, the recommendation is to keep the records until the patient reaches the age of majority (that is, 18 to 21 years, depending on state law). There is also the applicable length of time for the statute of limitations for suing a health care
© 2009 by the American Dietetic Association
BUSINESS OF DIETETICS ● It is suggested that RDs follow federal and state regulations for medical record retention. RDs working in hospitals and other health care facilities can view the federal regulations included in the Centers for Medicare and Medicaid Services’ State Operations Manual Appendixes at http://cms.hhs.gov/manuals/Downloads/som107. ● Dietitians working in private practice can access official online statutes (laws) in all 50 states and the District of Columbia by using http://law.findlaw.com/state-laws/statecodes.html and http://law.findlaw.com/state-laws/health-care-law/. ● RDs should confer with the physicians who refer patients to them and consider their medical record retention and documentation on the physician offices’ medical record retention and documentation policies and procedures. Figure. Resources for registered dietitians (RDs) to verify federal and state laws and regulations for retention of medical records. provider (9), which varies state to state but is typically 1 to 5 years following the injury (10). For patients who receive experimental treatment, longer retention periods are recommended for possible future medical research. And for patients who are incompetent, it is recommended that the record be retained permanently (9). Voluntary Standards In the interest of patient safety and provider protection, medical associa-
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November 2009 Volume 109 Number 11
tions and accrediting organizations have issued their own retention standards, which may be longer than the federal and some states’ regulations. Federal and state regulations are a minimum legal requirement, whereas the medical associations and accrediting organizations are aiming for a higher level of quality care. One explanation for this discrepancy was offered by Corn (6): “If the [rationalization] of storage is benefit to health care rather than the requirements of litigation law, the ideal retention period will almost surely be seen as longer than the relatively few years now mandated for retention of most patient records.” Some medical associations advocate for retention periods in office practices as long as 25 years as a safeguard in the eventuality of litigation. Others recommend longer retention periods as a matter of practicality— that is, in case a patient returns after a long absence (2). The American Medical Association has issued recommendations for medical record retention that may pertain to a variety of health care practitioners and can be viewed at www.ama-assn.org/ama/pub/ physician-resources/medical-ethics/ code-medical-ethics/opinion705.shtml. While registered dietitians (RDs) in facilities can rely upon medical records departments to verify hospital policies for retaining records, RDs in their own private practices should review state laws and regulations and other resources to establish procedures for record retention in their own practice. The American Health Information Management Association’s chart on “State Laws or Regulations Pertaining to Retention of Health Information” may be helpful to RDs. Because state laws are con-
stantly changing, RDs are advised to see legal counsel or to conduct their own legal research to verify the state laws and regulations. Web sites for verifying state laws are provided in the Figure. In addition to advising on the length of time certain types of records should be kept, the American Health Information Management Association has issued recommendations for practitioners, including the development of “a retention schedule for patient health information that meets the needs of its patients, physicians, researchers, and other legitimate users, and complies with legal, regulatory, and accreditation requirements.” That retention schedule “should include guidelines that specify what information should be kept, the time period for which it should be kept, and the storage medium (paper, microfilm, optical disk, magnetic tape, or other)” (9). Unless state law requires it—which is not typical—retention of a hard copy of medical records is not compulsory. If the records are easy to retrieve, many jurisdictions allow electronic or microfilm storage and have established attendant data retention policies (6,10). Such allowances will likely be more widespread as EMRs become more readily adopted. Purging Records Once it is legally (and ethically) acceptable to purge patient and client records from the system, practitioners must be mindful of the statutes regarding disposal—specifically, HIPAA requirements for protecting patient privacy and any state regulations, such as burning or shredding (5). In addition to regulations for how to dispose of records, almost every state mandates that practitioners document how the records were destroyed. Furthermore, if a practice contracts with a private, third-party entity to destroy the records, that firm must acknowledge state laws regarding confidentiality and provide certification of the file disposal method (10). CONTENTS OF THE MEDICAL RECORD It may seem cumbersome to the practitioner to maintain lengthy records for each and every patient. “The true extent to which access to past clinical information facilitates quotidian clinical
BUSINESS OF DIETETICS care is not known. Previous medical records can be life-saving in certain dramatic scenarios [but] for many medical problems . . . the clinician might need little past medical information other than current medications and active diagnoses/problems, information that most patients could provide” (6). On the other hand, cherry picking what is worthwhile for the medical record “would be a clumsy process,” which makes a strong case for the benefits of retaining everything (6). According to Tittle Cross, The Joint Commission and the American Hospital Association issued standards in the 1980s for nutrition-related entries in hospital medical records. These requirements included the following (2): ● ●
●
●
summary of dietary history and/or nutrition assessment; type of diet given, including number of kilocalories or specific nutrients; description or copy of the diet information/instructions given to the patient; and timely and periodic assessments of the patient’s nutrient intake and tolerance to the prescribed diet modifications.
Since then, the role of the RD in health care has expanded, and more detailed guidelines for what goes in the medical record—and that more accurately reflect current RD responsibilities and practice— have since been published by the American Dietetic Association (ADA) (11): ●
●
●
●
Nutrition-related assessment data, including pertinent food and nutrition history, biochemical data, medical tests and procedures, anthropometric measurements, nutritionfocused physical exam findings, and client history. The assessment may also include standard measurements for comparison. A clear, concise statement of nutrition diagnoses written in the general format. A description of the nutrition intervention to further the patient’s or client’s progress toward the nutrition prescription. A description of the nutrition monitoring and evaluation to identify patient/client outcomes relevant to the nutrition diagnosis and inter-
vention plans and goals, possibly with the change in specific nutrition outcome indicators measured and compared to previous status, nutrition intervention goals, or reference standards. While no specific standards for recording outpatient/private practice dietary encounters have been established, RDs in private practice can apply ADA’s Nutrition Care Process guidelines to their medical records. Of course, items to emphasize in the record depends on the disease/condition and the service being provided. For example, for RDs specializing in diabetes care, one step in the nutrition practice guidelines process is to maintain clear documentation of patient care— including clinical and behavioral goals— in the medical record, such as “nutrition prescriptions, meal-planning approaches, and educational topics covered,” beginning with the first patient encounter. At follow-up visits, the RD should record “clients’ acceptance and understanding, behavioral changes made, and plans for on-going care to their primary care providers (usually the referral source) and other team members” (12). ESTABLISHING GOOD PRACTICE Nutrition care has been documented in medical records by food and nutrition professionals since guidelines were jointly issued by ADA and American Heart Association in 1966 (11), and the nutrition information contained within the medical record has evolved along with advancements in practice. RDs should expect the information to evolve further as EMRs eventually become the standard, which the federal government has expressed as its goal. (For a comprehensive discussion of EMRs in the dietetics profession, see “Electronic Health Record: Where Does Nutrition Fit In?” in the October 2006 issue of the Journal.) To be on the safe side, practitioners should consider following the suggestions for longer retention periods and robust record-keeping as a matter of optimizing patient care and safety and of personal protection in the event of litigation.
2. 3.
4.
5.
6. 7.
8.
9.
10. 11.
12.
Medical Association Web site. http://www. ama-assn.org/amednews/2006/12/04/bisa1204. htm. Published December 4, 2006. Accessed July 31, 2009. Tittle Cross A. Legal requirement of private practice medical records. J Am Diet Assoc. 1988;88:1272-1274. New York University Medical Center. Importance of accurate medical documentation. New York University Medical Center Web site. http://www.med.nyu.edu/fgpcompliance/ coding/docs.html. Accessed August 10, 2009. Dixon L. Medical record retention. San Diego County Medical Society Web site. http:// www.sdcms.org/january-2009-san-diegophysician/medical-record-retention. Accessed July 11, 2009. Waller Landsen Dortch & Davis LLP. Retaining medical records—How long is long enough? FindLaw Web site. http://library. findlaw.com/1998/Jan/1/127216.html. Accessed July 15, 2009. Corn M. Arching the phenome: Clinical records deserve long-term preservation. J Am Med Inform Assoc. 2009;16:1-6. American Health Information Management Association. Practice brief: Retention of health information (updated): State laws or regulations pertaining to retention of health information. American Health Information Management Association Web site. http:// library.ahima.org/xpedio/groups/public/ documents/ahima/bok1_012547.pdf. Accessed August 17, 2009. Kasprack J. Patient Access to Medical Records. Connecticut Office of Legislative Research Web site. http://www.cga.ct.gov/2006/ rpt/2006-R-0599.htm. Accessed September 3, 2009. American Health Information Management Association. Practice brief: Retention of health information (updated). American Health Information Management Association Web site. http://library.ahima.org/xpedio/groups/public/ documents/ahima/bok1_012545.hcsp?dDoc Name⫽bok1_012545. Accessed August 10, 2009. American Dietetic Association. How long is long enough to keep medical records? Medicare MNT Provider. November 2005. Bueche J, Charney P, Pavlinac J, Skipper A, Myers E; Writing Group of the Nutrition Care Process/Standardized Language Committee. Nutrition Care Process Part II: Using the international dietetics and nutrition terminology to document the Nutrition Care Process. J Am Diet Assoc. 2008;108:12871293. Geil PB, Leontos C. Nutrition practice guideline care improves diabetes outcomes. Diabetes Spectrum. 2004;17:83-86.
References 1. Dolan PL. What makes patients loyal? It may take more than you think. American
November 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1841
BUSINESS OF DIETETICS
Medical Record Retention and Maintenance for Private Practices
I
n today’s health care environment, a patient might leave one physician or other health care practitioner in favor of another for a host of reasons. For example, the practitioner may switch to a concierge practice, refuse to work with specific insurance companies, or be unable to compete with offices that can see the patient sooner. Or, the patient may move, become frustrated with the office staff, or find that his or her insurance coverage has been changed (1). This patient shifting, coupled with the volume of appointments a health practice might book in a given week, underscores the various challenges a practitioner can face in maintaining accurate medical records for each patient for an appropriate period of time. The medical record “provides documentation of pertinent clinical and laboratory findings, diagnosis, therapeutic actions taken, patient progress and response to therapy, and instructions to the patient regarding physical activity, medication, diet, and follow-up care” (2). Thus, meticulous record-keeping in the health care practice is essential because it enhances the health care practitioner’s ability to assess and monitor patient care and ensures accurate transmission of information from one practitioner to another across the continuum of care (3). Furthermore, if ever there is a dispute related to care, this
This article was written by Karen Stein, MFA, a freelance writer in Querétaro, México. Stein is a former editor of the Journal and has also taught English and composition at the academic level. She currently runs a center for teaching English in México. Mary H. Hager, PhD, RD, FADA, director of Regulatory Affairs in ADA’s Washington, DC, office, contributed to the article. doi: 10.1016/j.jada.2009.09.014
1838
information becomes legal evidence, for practitioner and patient alike (2,4). RETENTION CHALLENGES Storage space constraints and long patient lifespan can make retention of hard copies of medical records a challenge. The recent push toward electronic medical record (EMR) systems is one approach to addressing this concern, but the systems are expensive and have not been universally adopted. In addition, there are various laws, regulations, and standards which define how records are to be managed, and these can vary by the types of settings in which the care is given, who pays for the care, and the state where the practice is located. Although some federal laws and regulations address medical record management—particularly the Health Insurance Portability and Accountability Act (HIPAA) and the Medicare Conditions of Participation and Conditions for Payment for various facility types—it is the states that determine requirements for medical record retention. Furthermore, several medical associations and accreditation organizations have issued best practice guidelines and standards, which can be voluntarily adopted by individual practitioners. These various factors will be reviewed to help you, the practitioner, determine the parameters affecting how you manage the medical records you keep. HOW LONG SHOULD RECORDS BE KEPT? When determining how long to keep medical records, health care practitioners are recommended to consider the following: state laws and regulations; Medicare and other federal regulations; and other third-party payer requirements, accreditation standards, and applicable statutes of limitations (5). Federal, state, and local governments are responsible for safeguard-
Journal of the AMERICAN DIETETIC ASSOCIATION
ing the public health and welfare. Federal laws and regulations are applicable nationally, and set a baseline upon which states are permitted to add higher or more stringent requirements. State Laws State laws related to medical records vary in content, with rules for designated subsets, retention times, types of data, and type of facility differing across jurisdictions (6). The basic protections of a person’s medical records are universally recognized by the states; the records are personal and private. In Arizona, for example, the laws specify the length of time records must be kept in the following types of institutions: assisted living facilities, abortion clinics, hospitals, sleep disorder facilities, hospices, nursing facilities, rehabilitation centers, end-stage renal disease treatment and transplant centers, ambulatory surgical centers, and birthing centers. In Wyoming, on the other hand, the laws address the retention periods for the type of record to be kept, such as hospital administrative and discharge records, diagnoses, operative reports, pathology reports, record summaries, and nursing histories (7). A good example of state counsel to practitioners and for the public is available in a report titled “Patient Access to Medical Records” published by the Connecticut state government (8). Whereas some states only require retention of as few as 3 years of certain types of medical records in certain types of facilities, other groups generally advise that health/medical records for adult patients be kept at least 10 years after the most recent patient visit. For minors, the recommendation is to keep the records until the patient reaches the age of majority (that is, 18 to 21 years, depending on state law). There is also the applicable length of time for the statute of limitations for suing a health care
© 2009 by the American Dietetic Association
BUSINESS OF DIETETICS ● It is suggested that RDs follow federal and state regulations for medical record retention. RDs working in hospitals and other health care facilities can view the federal regulations included in the Centers for Medicare and Medicaid Services’ State Operations Manual Appendixes at http://cms.hhs.gov/manuals/Downloads/som107. ● Dietitians working in private practice can access official online statutes (laws) in all 50 states and the District of Columbia by using http://law.findlaw.com/state-laws/statecodes.html and http://law.findlaw.com/state-laws/health-care-law/. ● RDs should confer with the physicians who refer patients to them and consider their medical record retention and documentation on the physician offices’ medical record retention and documentation policies and procedures. Figure. Resources for registered dietitians (RDs) to verify federal and state laws and regulations for retention of medical records. provider (9), which varies state to state but is typically 1 to 5 years following the injury (10). For patients who receive experimental treatment, longer retention periods are recommended for possible future medical research. And for patients who are incompetent, it is recommended that the record be retained permanently (9). Voluntary Standards In the interest of patient safety and provider protection, medical associa-
1840
November 2009 Volume 109 Number 11
tions and accrediting organizations have issued their own retention standards, which may be longer than the federal and some states’ regulations. Federal and state regulations are a minimum legal requirement, whereas the medical associations and accrediting organizations are aiming for a higher level of quality care. One explanation for this discrepancy was offered by Corn (6): “If the [rationalization] of storage is benefit to health care rather than the requirements of litigation law, the ideal retention period will almost surely be seen as longer than the relatively few years now mandated for retention of most patient records.” Some medical associations advocate for retention periods in office practices as long as 25 years as a safeguard in the eventuality of litigation. Others recommend longer retention periods as a matter of practicality— that is, in case a patient returns after a long absence (2). The American Medical Association has issued recommendations for medical record retention that may pertain to a variety of health care practitioners and can be viewed at www.ama-assn.org/ama/pub/ physician-resources/medical-ethics/ code-medical-ethics/opinion705.shtml. While registered dietitians (RDs) in facilities can rely upon medical records departments to verify hospital policies for retaining records, RDs in their own private practices should review state laws and regulations and other resources to establish procedures for record retention in their own practice. The American Health Information Management Association’s chart on “State Laws or Regulations Pertaining to Retention of Health Information” may be helpful to RDs. Because state laws are con-
stantly changing, RDs are advised to see legal counsel or to conduct their own legal research to verify the state laws and regulations. Web sites for verifying state laws are provided in the Figure. In addition to advising on the length of time certain types of records should be kept, the American Health Information Management Association has issued recommendations for practitioners, including the development of “a retention schedule for patient health information that meets the needs of its patients, physicians, researchers, and other legitimate users, and complies with legal, regulatory, and accreditation requirements.” That retention schedule “should include guidelines that specify what information should be kept, the time period for which it should be kept, and the storage medium (paper, microfilm, optical disk, magnetic tape, or other)” (9). Unless state law requires it—which is not typical—retention of a hard copy of medical records is not compulsory. If the records are easy to retrieve, many jurisdictions allow electronic or microfilm storage and have established attendant data retention policies (6,10). Such allowances will likely be more widespread as EMRs become more readily adopted. Purging Records Once it is legally (and ethically) acceptable to purge patient and client records from the system, practitioners must be mindful of the statutes regarding disposal—specifically, HIPAA requirements for protecting patient privacy and any state regulations, such as burning or shredding (5). In addition to regulations for how to dispose of records, almost every state mandates that practitioners document how the records were destroyed. Furthermore, if a practice contracts with a private, third-party entity to destroy the records, that firm must acknowledge state laws regarding confidentiality and provide certification of the file disposal method (10). CONTENTS OF THE MEDICAL RECORD It may seem cumbersome to the practitioner to maintain lengthy records for each and every patient. “The true extent to which access to past clinical information facilitates quotidian clinical
BUSINESS OF DIETETICS care is not known. Previous medical records can be life-saving in certain dramatic scenarios [but] for many medical problems . . . the clinician might need little past medical information other than current medications and active diagnoses/problems, information that most patients could provide” (6). On the other hand, cherry picking what is worthwhile for the medical record “would be a clumsy process,” which makes a strong case for the benefits of retaining everything (6). According to Tittle Cross, The Joint Commission and the American Hospital Association issued standards in the 1980s for nutrition-related entries in hospital medical records. These requirements included the following (2): ● ●
●
●
summary of dietary history and/or nutrition assessment; type of diet given, including number of kilocalories or specific nutrients; description or copy of the diet information/instructions given to the patient; and timely and periodic assessments of the patient’s nutrient intake and tolerance to the prescribed diet modifications.
Since then, the role of the RD in health care has expanded, and more detailed guidelines for what goes in the medical record—and that more accurately reflect current RD responsibilities and practice— have since been published by the American Dietetic Association (ADA) (11): ●
●
●
●
Nutrition-related assessment data, including pertinent food and nutrition history, biochemical data, medical tests and procedures, anthropometric measurements, nutritionfocused physical exam findings, and client history. The assessment may also include standard measurements for comparison. A clear, concise statement of nutrition diagnoses written in the general format. A description of the nutrition intervention to further the patient’s or client’s progress toward the nutrition prescription. A description of the nutrition monitoring and evaluation to identify patient/client outcomes relevant to the nutrition diagnosis and inter-
vention plans and goals, possibly with the change in specific nutrition outcome indicators measured and compared to previous status, nutrition intervention goals, or reference standards. While no specific standards for recording outpatient/private practice dietary encounters have been established, RDs in private practice can apply ADA’s Nutrition Care Process guidelines to their medical records. Of course, items to emphasize in the record depends on the disease/condition and the service being provided. For example, for RDs specializing in diabetes care, one step in the nutrition practice guidelines process is to maintain clear documentation of patient care— including clinical and behavioral goals— in the medical record, such as “nutrition prescriptions, meal-planning approaches, and educational topics covered,” beginning with the first patient encounter. At follow-up visits, the RD should record “clients’ acceptance and understanding, behavioral changes made, and plans for on-going care to their primary care providers (usually the referral source) and other team members” (12). ESTABLISHING GOOD PRACTICE Nutrition care has been documented in medical records by food and nutrition professionals since guidelines were jointly issued by ADA and American Heart Association in 1966 (11), and the nutrition information contained within the medical record has evolved along with advancements in practice. RDs should expect the information to evolve further as EMRs eventually become the standard, which the federal government has expressed as its goal. (For a comprehensive discussion of EMRs in the dietetics profession, see “Electronic Health Record: Where Does Nutrition Fit In?” in the October 2006 issue of the Journal.) To be on the safe side, practitioners should consider following the suggestions for longer retention periods and robust record-keeping as a matter of optimizing patient care and safety and of personal protection in the event of litigation.
2. 3.
4.
5.
6. 7.
8.
9.
10. 11.
12.
Medical Association Web site. http://www. ama-assn.org/amednews/2006/12/04/bisa1204. htm. Published December 4, 2006. Accessed July 31, 2009. Tittle Cross A. Legal requirement of private practice medical records. J Am Diet Assoc. 1988;88:1272-1274. New York University Medical Center. Importance of accurate medical documentation. New York University Medical Center Web site. http://www.med.nyu.edu/fgpcompliance/ coding/docs.html. Accessed August 10, 2009. Dixon L. Medical record retention. San Diego County Medical Society Web site. http:// www.sdcms.org/january-2009-san-diegophysician/medical-record-retention. Accessed July 11, 2009. Waller Landsen Dortch & Davis LLP. Retaining medical records—How long is long enough? FindLaw Web site. http://library. findlaw.com/1998/Jan/1/127216.html. Accessed July 15, 2009. Corn M. Arching the phenome: Clinical records deserve long-term preservation. J Am Med Inform Assoc. 2009;16:1-6. American Health Information Management Association. Practice brief: Retention of health information (updated): State laws or regulations pertaining to retention of health information. American Health Information Management Association Web site. http:// library.ahima.org/xpedio/groups/public/ documents/ahima/bok1_012547.pdf. Accessed August 17, 2009. Kasprack J. Patient Access to Medical Records. Connecticut Office of Legislative Research Web site. http://www.cga.ct.gov/2006/ rpt/2006-R-0599.htm. Accessed September 3, 2009. American Health Information Management Association. Practice brief: Retention of health information (updated). American Health Information Management Association Web site. http://library.ahima.org/xpedio/groups/public/ documents/ahima/bok1_012545.hcsp?dDoc Name⫽bok1_012545. Accessed August 10, 2009. American Dietetic Association. How long is long enough to keep medical records? Medicare MNT Provider. November 2005. Bueche J, Charney P, Pavlinac J, Skipper A, Myers E; Writing Group of the Nutrition Care Process/Standardized Language Committee. Nutrition Care Process Part II: Using the international dietetics and nutrition terminology to document the Nutrition Care Process. J Am Diet Assoc. 2008;108:12871293. Geil PB, Leontos C. Nutrition practice guideline care improves diabetes outcomes. Diabetes Spectrum. 2004;17:83-86.
References 1. Dolan PL. What makes patients loyal? It may take more than you think. American
November 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1841