• PR: Hospitals Must Design Systems to Ensure Accurate and Complete Medical Records (PDF/QV) [REF: IM, MD, RN] Perspectives September 2014, Vol 35, #9, Pg 8 JCp1509_B2

RC.01.01.01 is the 4th most frequently cited hospital standard.  this short article indirectly suggests that findings of incompleteness may frequently result from providers that leave blanks when they believe the information called for is not applicable or needed for the patient’s care.
Tip1: Advise staff (physicians and nurses in particular) not to leave blank form fields, but rather to indicate non-applicability in some manner (e.g., N/A or ‘Does Not Apply’)
Tip 2: Use practitioner input to design forms that include options for indicating non-applicability.