This book is an essential tool for all healthcare professionals. An understanding of the law and the way in which it impacts upon roles, responsibilities and care is a vital component in everyday healthcare. Written in a clear and concise style, Health Records in Court provides practical legal advice by highlighting real-life healthcare case studies and workplace examples. It offers much-needed, clearly explained guidance for navigating the complexities and intricacies of medico-legal processes, practices and obligations - vital for every health professional who creates, adds to or maintains health records.

chapter 1|4 pages

Introduction to health records

chapter 2|14 pages

Health records and the law

chapter 3|14 pages


chapter 5|20 pages

Good practice for health records

chapter 6|12 pages

The detail

chapter 7|18 pages

How do we record?

chapter 8|6 pages

Fact, assumption, professional opinion

chapter 9|4 pages

Amending the records

chapter 10|8 pages

What to leave out

chapter 11|6 pages

Common errors in the records

chapter 12|8 pages

Sharing information

chapter 13|10 pages

Access to health records by the patient

chapter 14|8 pages

Systems of record keeping

chapter 15|6 pages

Further considerations

chapter 16|6 pages

Who owns the health records?

chapter 18|6 pages

Health records used as evidence

chapter 19|2 pages

Defensive writing

chapter 20|2 pages

Assessment criteria for health records