chapter 11 written correspondence

tile line (10)

A business or professional title associated with the person who has written the letter is keyed on the line below the signature line or immediately after the signature and preceded by a comma.

transcription templates

As stated previously, a template in an EMR is a predesigned format, used as a starting point to input documentation so it does not have to be recreated every time. The software company can customize it for the physician or medical specialty. Typically, it has a sequence of basic headings for content to help with creation of a document. The writer uses the template as a guide for the report elements that are needed. A template is often used for electronically captured information. In a computer system, it is a keystroke saver and speeds generating a document.

complementary close (8)

At the end of a letter, one to three complimentary words are typed a double line space below the last line of the body of the letter, indicating that the sender has concluded the message; only the first letter is capitalized. The closing line is followed by a comma if a colon has been used after the salutation in keeping with the mixed punctuation format; in open punctuation, no punctuation follows the closing.

text editing features

Automatic format features may also indicate a certain style, setup, or format. Inadvertent use of the above-mentioned features may result in a printout containing an incorrect format or an inappropriate word, phrase, or entire paragraph, so proofreading is always necessary. Word processing software also has the capability to convert partial words to complete words; however, when this occurs, the word should always be checked for correctness.

types of letters

Basic types of letters used in medical offices include multipage letters, form letters, and interoffice memorandums

word processing

Communications system using computerized and text-editing equipment to produce printed letters, reports, and other office documents; includes memory

MEMOS

Confidential matters should never be written in memos, because those messages are circulated throughout the office and may be part of permanent or temporary records

cut and paste

Cut-and-paste features allow the operator to remove words or sections of text and rearrange by putting the removed (cut) item in another place. When using this editing feature, it is easy to make mistakes while inserting or rearranging words or paragraphs. Particular care must be taken whenever these procedures are performed.

Types of memos include the

(1)informative, which provides facts with explanations; (2)directive, which gives brief instructions; and (3)administrative, which states policy or judgment on a specific topic

defaults for top and bottom margins

Defaults are also in place for top and bottom margins, usually set at 1 inch but they may be adjusted according to the letter size and side margins. If there is a second page to the letter, the bottom margin of the first page can be increased up to 2 inches (12 lines) so that lines can be better spaced on the additional page.

letter template

Document formatted with each component of a letter (i.e., letterhead, date line, inside address) used to eliminate setting up various components of a letter, saving time and keystrokes

composing letters

+A medical assistant who can independently compose letters for the physician possesses a skill that is an asset to the practice. Letters written over the assistant's signature will deal with patient appointments, insurance, and routine business matters.+Letters written by the assistant for the physician's signature will usually concern medical matters, for example, abstraction of medical data from patients' charts in reply to requests for information. Such letters should emulate as much as possible the physician's usual degree of formality and professional style.

Letterhead (1)

Letterhead lines are designed in an attractive format and are positioned in the upper 2 inches of a sheet of bond paper. They may include a specially designed practice logo and generally contain the medical practice name, physician's name and title, address, telephone number, fax number, and possibly email address (Example 11-1). The return address on the envelope may match the letterhead format in miniature

parts of a letter

Letterhead, dateline, inside address, subject line, attention line, salutation, body, complimentary close, typed signature, reference initials, enclosure notations, carbon copy notations, second page headings,

carful proofreading

Locating and marking the corrections as needed while reading a document.Proofreading on-screen is more difficult than scanning the printed page because errors can be easily overlooked. Errors that are not corrected might seriously affect a medical case or research information, so take extra care to find and correct errors when they appear on-screen.

Margins

Right and left margins may be changed according to whether a letter is short or long. Most of the time the default (preset) feature of the word processing program is used to keep side margins of letters consistent in dimension. This default is usually set at 1 or 1.25 inches and is ideal for long- or medium-length letters. Side margins for short letters might be increased in width and set at 2 inches

body (7)

The body is the main part of the letter and contains the message to be conveyed to the recipient; it should begin two lines below the salutation or two lines after the reference or subject line if there is one. In block style, all paragraphs begin at the left margin. Paragraphs are single-spaced internally, with double-spacing separating the paragraphs. Extremely short letters can be double-spaced with indented paragraphs.

Date line (2)

The date line is keyed 13 or 14 line spaces from the top of the paper or 3 spaces below the letterhead, depending somewhat on the size and position of the letterhead. Do not abbreviate the month or show the date in numbers only (e.g., 1/28/XX). Example 11-2 shows acceptable date line formats

modified block format

Typed communication with a balanced appearance, formatted with date, closing, and writer's information aligned starting at the center; all other lines are flush with the left margin

Full block style

Typed communication, also known as block style, formatted with all lines flush with the left margin

reference materials

Useful references for letter writing include an English grammar reference book for punctuation and correct use of grammar, a medical dictionary for spelling and definitions, a secretarial manual for style and format, and a thesaurus.

transcription confidentially

Quality assurance, security, and confidentiality measures need to be taken into consideration because the HIPAA does not prevail outside the United States. The HIPAA privacy rule does not prohibit the use of tapes for dictation, nor outsourcing of transcription. However, it requires that specific language addressing confidentiality be inserted in contracts with business associates (outside vendors).

word processing log

Record of incoming and outgoing word processing documents used for accessing written communications quickly and easily

thesaurus

Reference book of alphabetized words with their synonyms and antonyms; also found in word processing software

most common letter styles

full block modified block simplified letter

grammar checks allow six writing styles

general, business, technical, fiction, informal, and custom.

photocopy machine

is one of the most important pieces of equipment in the medical office. Documents can be reproduced on ordinary paper stock, specially coated paper, copying paper, letterhead, preprinted forms, and colored stock. The copies resemble the original, the equipment is easy to operate, and paper and toner are the only supplies necessary. Some models can reduce or enlarge copy size, collate, and staple multiple documents. Although the cost of making one copy is small, employees should be discouraged from duplicating items unnecessarily. Both sides of an insurance card can be copied using the same piece of paper and running it through a second time. Caution should be taken because certain copyrighted material cannot be legally copied without permission.

photocopy

means any process using light or photography to reproduce multiple copies of original (graphic) material, also known as reprographics. Medical offices are experiencing the need to make more copies of patient records, medical reports, correspondence, insurance claim forms, bills, memos, and other documents. A computer can send electronic medical records or print multiple copies, and the fax machine may also have reproduction capabilities; however, the most popular machine to reproduce documents is the photocopier.

Letter Punctuation styles

open and mixed punctuation

common photocopy machine problems

paper jam remove or install ink cartridges misfeeding wrinkling jamming smoking unreadable

edits

Any editing done to letters or medical records should not change the content or meaning of the physician's dictation. If questions arise, ask the physician prior to making changes. changes an correction

envelope enclosures

A letter's first impression is made by the envelope in which it is enclosed; much the same way that the first impression of a book is determined by its cover. The envelope should always have a professional appearance and follow accepted business style. See Chapter 12 for envelope guidelines.When a letter goes to the physician to be signed, it is paper-clipped under the flap of the envelope so the physician sees both together (Figure 11-7). The envelope size depends on the type of communication and the number of enclosures. Attachments are stapled to the back of the letter. When the letter has been signed and is ready to mail, it is folded and inserted into the envelope so that it will be in reading position when it is removed

multifunction devices

A multifunction device (MFD) is linked to a computer system and provides a printer, scanner, copier, and often a fax in a single unit. It comes in small sizes, just larger than a printer, which saves desktop space, and in large sizes that offer all the functions of a deluxe photocopy machine.

Transcriptionist

A person who converts recorded dictation to hard copy. (MT) or medical language specialist (MLS) may be a certified medical assistant (CMA [AAMA]), registered medical assistant (RMA), certified medical transcriptionist (CMT), or other health care professional. MTs may work in the physician's office, in a health care facility, or at home.

postscript (14)

A postscript is an afterthought or a statement repeated (reiterated) for emphasis (Example 11-14). It is keyed a double line space below the last keyed line and may be preceded by "P.S.," if desired.

photocopy machine

Always place the machine away from file cabinets or walls to prevent overheating. Keep the area surrounding the machine neat and clean, and recycle used photocopy paper. Schedule lengthy copy projects for times when the machine is least busy. Study the operating manual for specific instructions and place it in a prominent place for reference.To make a photocopy, the original material is either fed into the machine or placed facedown on the platen glass. After machine adjustments are made according to size, darkness, and quantity, copies may be produced in seconds from paper stored in cassettes. The "print" button is pressed to activate the copy machine.

Computer Equipment and Supplies Used for Written Correspondence

Forms that used to require the use of typewriters may now be scanned into the computer system to be filled in and manipulated using word processing software. Electronic letters may be created using templates, signed electronically, and printed in hard copy or sent via email or fax. The electronic letter must be able to include different types of communication in a variety of formats. Letters should be printed on 20- or 24-pound bond paper that has a crisp surface and is receptive to both ink and printed copy. Plain or printed bond paper is used for continuation sheets (i.e., the second, third, or additional pages of a letter). Both large (No. 10) and small (No. 6 3/4) envelopes are used for business correspondence and patient statements.

physicians preference of letter

In the simplified format, reference initials and notations are keyed in lowercase, two lines below the signature line, as in other styles. The simplified style is rarely used by physicians, because it is too impersonal. It is used in situations in which form letters are sent in the corporate setting. The physician's preference determines the letter style used in a particular office.

Justification

In word processing, the spacing of words on each line of text so that the text is centered or the ends of the lines are flush at the right and left margins.

characteristics of a letter

It creates a favorable impression by arousing the reader's interest with the first sentence. It appeals to the reader's point of view and avoids the use of the pronoun "I." It is correct in every grammatical detail. It is courteous, friendly, and sincere—promoting goodwill. It is accurate, clear, concise, and complete. It flows smoothly from paragraph to paragraph and concludes by telling the reader how to respond. It avoids jargon and stilted phrases such as "please be advised," "as per," "under separate cover," and "attached hereto." It also avoids sexism by deleting the role use of "he" or "she." It concludes on a positive note, emphasizing a pleasant closing thought

letter standards, styles and components

Margins on all four sides should be as equal as possible, with spacing adjustments made between various components of the letter. Material placed too high or too low upsets the symmetry of the page and causes an imbalance. Mailability standards for a keyed communication require a perfect letter with balanced margins (Figure 11-2) and without grammatical or keyed errors. An unmailable letter is one that has any of the following: Misspelled word Keyed error or a poorly corrected error Unbalanced margins; any of the four Special lines omitted, such as a date line or a signature line City name abbreviated, such as LA for Los Angeles or NY for New York City

folding envelopes enclosures

No/10 +envelope, place the letter flat on the desk in reading position. First fold from the bottom to a point a little less than one-third of the page and crease. Next, fold downward from the top to within one-half inch of the first fold and crease. The last crease is inserted into the envelope first so that the top of the letter is at the top of the envelope +(No. 63/4) envelope, the letter is placed flat on the desk in reading position. First, fold from the bottom up to within one-half inch of the top and crease. Next, fold from the right a third of the way over to the left and crease; then fold from the left over to about one-half inch of the previous crease on the right. The last creased edge is inserted into the envelope first

mail merge

Software program used to create, address, sort, and print letters; typically used for form letters with the same text but may have different greetings sent to patients at various addresses

speech recognition

Some physicians use speech or voice recognition software to generate documents. While the dictator speaks into a microphone, the dialogue appears on the computer monitor. The dictator is able to verbally order the record to be electronically signed when it is completed. The document is instantly available as hard copy or can become part of the patient's EMR. However, all speech engines must be initially trained and the dictator must practice speaking into the machine so that his or her voice, style, syntax (way in which words are put together), and vocabulary allow the software to work at its optimum. Dictation must be distinct, clear, and unhurried. It may be time consuming because physicians are used to dictating rapidly.

form letters

Standardized communication that may be personalized by the insertion of variable information +are often used when the physician communicates repetitious information, such as notifying the health department of an individual who has contracted a contagious disease or notifying the Department of Motor Vehicles that an individual has developed epilepsy. Additionally, form letters are mailed to patients who fail to keep appointments, who do not follow the medical advice given to them, or who need to be advised, with written documentation, of the physician's withdrawal from a case. HOSPITAL STAYS

mixed punctuation

Style of letter punctuation in which a colon or a comma is placed after the salutation and complimentary close

open punctuation

Style of letter punctuation in which no punctuation mark is placed after the salutation or complimentary close.

Enclosure or Attachment notation (12)

The enclosure notation is a courtesy to the correspondent to affirm that separate material is enclosed with the letter. The word "enclosure" or an abbreviation is keyed either a single or double line space below the identification initials. It is appropriate to list the enclosures or particular attachments when several items are included. When an enclosure is large or bulky, it may be best to indicate that the enclosure will be sent separately

identification initials (11)

The fact that a letter is dictated or written by someone other than the person who signs it is indicated by the writer's name or initials followed by the typist's initials (rather than the signer's and the typist's).

Introduction, body, and closing

The first paragraph of a letter (i.e., introduction) should be positive in tone and deal immediately with the subject matter in a friendly and courteous manner. It should include a personal comment and an expression of interest in the patient or his or her health problem. Thoughts are presented in logical order in the body of the letter with sentences averaging no more than 20 words. A concise and courteous closing statement includes some reference to an action to be taken by the recipient. Thanks are expressed if a service has been rendered or a response expected; otherwise, the assistant waits until the request has been fulfilled before following up with an acknowledgment. All correspondence should be answered promptly—within 24 hours if possible. If there is a delay, the letter, when it is written, should include a tactful explanation.

inside address (3)

The inside address consists of the name and address of the individual, the firm, or the medical facility that the letter is being sent to, and may include the correspondent's title, position, department, or office. It is keyed exactly as it appears on the recipient's letterhead or return address, beginning four to eight line spaces below the date line. The first line includes the name of the addressee. Never use "Dr." before the name of a physician; instead use "MD" or "DO" after the name. The position and firm or institution name follow; then the post office box number or street number and name; and last, the city (always spelled in full), state (using two-letter standard abbreviations), and five- or nine-digit ZIP code. If the letter is being sent to a foreign country, the name of that country is keyed in all capital letters as the last line of the address. The inside address of a letter and the envelope address usually match in style and format.

Reference or Subject Line (6)

The reference or subject line draws the reader's attention to a subject or, in medical correspondence, to a patient's name or account number. It is customarily positioned a double line space after the salutation. In block style, it is always positioned at the left margin.In modified block style, it may be centered or, for special emphasis, aligned with the left edge of the date line. Another placement variation is to type the subject line between the last line of the inside address and the salutation, in the same style and position as the attention line. An attention line and a subject line can be keyed in the same style if both appear in a letter

Salutation (5)

The salutation, or greeting, is placed a double line space below the last line of the inside address or a double line space below the attention line. It typically begins with "Dear" and reflects the name of the person to whom the letter is addressed. In open punctuation, there is no punctuation after the salutation. In mixed punctuation, the salutation is followed by a colon. "Ms." is used when a woman's title is not known or as a substitute for "Miss" or "Mrs." The best clue is what the letter writer uses to identify herself. "Dear Sir or Madam" is used when it is not known whether the addressee is a man or a woman.

signature line (9)

The signature line includes the first and last names of the person responsible for writing the letter and his or her credential (e.g., MD). It is keyed three to five line spaces below the complimentary close to allow space for the handwritten signature. The space may be reduced or increased to improve letter placement. The signature line uses complete names rather than initials, so the reader can determine the title to use in response.

outline and tone

The trend when writing business letters is to use a personalized approach. Eliminate the use of formal words or artificially worded phrases, and keep the number of words to a minimum, which increases clearness and avoids the possibility of overwhelming the reader. Simplicity, clarity, and conciseness are basic standards for every medical communication.Use gender-neutral terms instead of "he/she" or "him/her" to avoid offending the recipient. Careful proofreading prevents the embarrassment of discovering an error in the letter's text or a misspelling of the recipient's name after the original letter has left the office. Medical correspondence deals primarily with routine matters, and letters of two or three paragraphs cover most subjects

multiage letter

When more than one page is needed for written correspondence, a simplified heading is placed at the top of each continuation sheet, using a horizontal or vertical format. Continuation pages are keyed on plain bond paper or preprinted second sheets. The heading for all continuation sheets begins on line seven, which leaves a 1-inch top margin. The letter is continued on the third line space after the heading. It is best to conclude a paragraph at the bottom of each page, but if this is not possible, carry at least two lines of a paragraph to the continuation sheet. Never use a second page to key only the complimentary close. There must be at least a 1-inch bottom margin.

copy notations (13)

When several copies have been mailed to people other than the person whose name appears on the inside address, a copy notation is keyed at the bottom of the letter a single or double line space below the enclosure notation. "Copy," "CC," or "C" indicates that courtesy copies have been mailed or made for distribution to the named people; names or initials are given in alphabetical order (see Example 11-13). Never key a copy notation without a name following it.The notation "bcc," "bc," or "BCC" is used for blind copies, when the writer sends a copy of the correspondence to a third party without the knowledge of the person receiving the original letter. For blind copies, do not make a copy notation on the original, but make a "bcc" notation on the file copy with the name of the recipient following it

Print Preview

When you are proofreading on the computer screen, the display can be deceptive as to how the format of a document may appear when printed. Most software programs offer a "print preview," allowing the proofreader to view the document on the screen as it will appear when printed. Always view the document using "print preview." Proofread work on-screen and train your eyes to spot the smallest of errors. Then print out and proofread the document again to see if anything slipped by unnoticed. This skill will improve with experience

visual guide for letters

Word processing margins set to 1 inch (dark gray) for long letters, 1.25 inches (medium gray) for medium letters, and 2 inches (light gray) for short letters. 400-500 1 inch margin 350 1.25 margin 250 2 margin

Simplified letter style

Written communication typed without a salutation or complimentary close

interoffice memorandum

Written informal communication circulated within an organization or office

Attention Line (4)

directs your document to a certain person or department within a company