Book of Style & Standards for CLINICAL DOCUMENTATION 4th Edition. Documentation Integrity (AHDI) will be available in print and an online version. This widely acclaimed industry standards manual has long been the trusted resource for data capture and documentation standards in healthcare.
Posted By: XanaX on 2007-07-09In Reply to:do this report in BOS form?? - debbie
Subject: AAMT 'Book of Style'? (nm)
Complete Discussion Below: marks the location of current message within thread
- do this report in BOS form?? - debbie
- AAMT 'Book of Style'? (nm) - XanaX
- That would be the 'rule book' of how to do transcription if you - haven't been exposed to it yet. Book II is the
- newest one, but already a few years old. If you get a used one, make sure you get - the 2nd Edition. New it's around $85. nm
- That would be the 'rule book' of how to do transcription if you - haven't been exposed to it yet. Book II is the
- AAMT 'Book of Style'? (nm) - XanaX
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AAMT Style
Subject: AAMT Style
Anyone have any good web links to sum up AAMT BOS Second Edition - Don't have book yet..Thanks
AAMT style question..smcan someone please tell me what the rule is on numbers 1-10? I read they were wanting to change it to all numerals, but has that happened or do you still spell out numbers 1-10 except for clarity purposes? Have gotten myself all confused now..Thanks. I need opinion on something from AAMT regarding style..
I know the latest from AAMT regarding using numbers is to use 2, 3, 4, etc instead of two, three, four in the body of a report. I just think it looks tacky to say 'on postoperative day 2' or 'after 3 days', etc. I hate doing it. It's not so bad when referring to meds or technical stuff. Does everyone follow this AAMT 'law' now? Just wondering what everyone else does??? AAMT follows AMA's style guide on this issue
Subject: AAMT follows AMA's style guide on this issue
x style
Subject: style
stay home for the next two days or 2 days? or does it depend on account specifics? Thanks in advance. style
Subject: style
Use numbers unless 2 numbers in a row or beginning a sentence. Zoloft 50 mg 1 daily versus Zoloft 50 one daily.
If you don't have AAMT Book of Style, this is a good website. http://www.mtdaily.com/style.html Which style do you use for PRN/p.r.n.? How about the same for PC/p.c.? -sm
Subject: Which style do you use for PRN/p.r.n.? How about the same for PC/p.c.? -sm
http://www.ismp.org/tools/errorproneabbreviations.pdf
Because this site re: medical abbreviations that should never be used in reports doesn't list PC/p.c., then your choice is based on your style guide, isn't it. Which style guide do you follow for tx'ing 'as needed'..PRN or p.r.n.? Go with it for PC/p.c. (There's an AAMT Style Guide that some medical tx companies require MTs to follow. Does it require small letters and periods for Latin-word abbreviations?)
Resource: Abbreviations Web site,
http://www.medilexicon.com/medicalabbreviations.php?keywords=PC&search=abbreviation
[After Meals(post cibum)] Need help on style board..nm..TIA
Subject: Need help on style board..nm..TIA
. Maybe McGhan style 133
Subject: Maybe McGhan style 133
xx style question
Subject: style question
Is it correct to put 'May 10th' or 'May 10' - this is just a general question. I don't know if the 'th' is supposed to be there after a date. TIA. Have a style question here!!
Subject: Have a style question here!!
Working for a new company -- they say all meds in a paragraph be separated by semi-colons as well as semi-colon use in parts of the PE. They seem to imply that I am some kind of incompetent fool for not doing this automatically. I've been an MT for 25+ years, and a few of my accounts were for some of the most prestigious medical facilities in the U.S. and have never routinely done this. Is this a new AAMT style rule? I wouldn't be questioning this if it was a hospital preference, but it's the whole little smarmy company...
Sorry so cranky.
per the Book of StyleSubject: per the Book of Style
Per Book of Style 2 edition page 150:
'When the generic name and brand name of a medication sound alike, use the generic spelling unless it is certain that the brand name is being referenced to.'
Therefore, I would use the generic spelling levothyroxine.
Book of Style
Subject: Book of Style
x Style question, sm..
Subject: Style question, sm..
The provider is dicating HPV DNA in the ASSESSMENT. Normally, we never abbreviate in the assessment, but for some reason I'm wondering if an exception to this could be for DNA. Should I type it 'human papilloma virus deoxyribonucleic acid' or 'human human papilloma virus DNA'?
TIA for your advice,
Vertically Challenged Book of Style sm.
Subject: Book of Style sm.
It is the former AAMT's way of trying to standardize what each MT is doing. Many companies expect you to strictly adhere to what the BOS says for quality and if you do not it affects your QA scores. but then CDC Journal Style Guide says..
Subject: but then CDC Journal Style Guide says..
Gram stain, gram-negative, gram-positive Book of Style 2nd edition..
Subject: Book of Style 2nd edition..
I don't know if you guys follow BOS rules but..
per BOS page 150 'When generic name and brand name of a medication sound alike, use the generic spelling unless it is certain that the brand name is being referenced.' (Therefore, use KCl.)
Also per BOS p 461 Dangerous Abbreviations 'Use complete spelling for drug names.' (Therefore, use potassium chloride!) ? Style question: If using the term SM
Subject: Style question: If using the term SM
'history of present illness' within the report, such as 'see history of present illness above', do you capitalize the letters such as 'see History of Present Illness above'? Also, such as 'see Review of Systems below'? Do we keep them lower case or upper case when they are used within the report?
Thank you. I'm confused and I hope this question makes sense.
s/l *Chang style syringette*????
Subject: s/l *Chang style syringette*????
lol, I love your style and wisdom! Nm
Subject: lol, I love your style and wisdom! Nm
nm Looked but can't find anything in AMA style guide. sm
Subject: Looked but can't find anything in AMA style guide. sm
I think your doc is confusing 'more so' with 'moreover.' 'Moreso' is not even in the English dictionary.
Abbreviations per book of style question - sm
Do you abbreviate mg, ml, 02 etc if the account instructions say to spell out abbreviations as per book of style?
Have ordered book, not here yet. Thanks in advance for help.
Megan style tissue expander?Subject: Megan style tissue expander?
OP note - he says Megan-style 133 500 cc full volume tissue expander. Cannot find Megan or Megann.
client preference and BOS (book of style)Subject: client preference and BOS (book of style)
really, we cannot tell you the answer, albeit for 20 years, Webster's Merriam dictionary has it with no hypen (same with most re- words)..but it's really up to your client(s) and also the Book Of Style by the AAMT really spells it out...somewhere in the huge nearly 600 page book....
good luck :)
BOS is 'Book of Style', what has crepitus to do in there? We all know what 'crepitus' iSubject: BOS is 'Book of Style', what has crepitus to do in there? We all know what 'crepitus' is
It all comes down to style as stated in the begining of a lot of reference books
Subject: It all comes down to style as stated in the begining of a lot of reference books
/ That's what I mean by 'ask your QA!' Account specifics dictate style, sm
Subject: That's what I mean by 'ask your QA!' Account specifics dictate style, sm
but the AAMT BOS dictates what is correct for the industry, getting its information from sources such as the Chicago Manual of Style, the American Medical Association book of style (which I own), etc. As the poster below states, Joint Commission goes by BOS and does not like 'same' or abbreviations for diagnoses, impressions, op titles, etc. They will randomly choose patient charts and go through them to check things like this! It's the Joint Commission which recommends or removes hospital accreditations--a very powerful entity.
So, ask your QA what the account wants. If they want 'same,' give them 'same.' For other accounts, do it the correct way. may I just add something about AAMT..sm
Subject: may I just add something about AAMT..sm
While I used to respect the AAMT, the AAMT is not the end-all, be-all, and, in fact, prior to the late 1990s, their book was 80 pages long..
But you have to know how to find them. So here’s how it works: SoundCloud is essentially a free streaming service. Then, it’s yours! But a lot of artists also allow free downloads as well. You have to search around, but you’ll see a free music download option if the artist has enabled it. Free download game house 2017.
just my 2 cents..
According to AAMT and .Subject: According to AAMT and .
the Pharmicist's association, q.d. is on the 'dangerous abbreviations' list. So if you did shorten it to the abbreviation, it can only be '1 daily' or '1 every day' And where did the AAMT
Subject: And where did the AAMT
get this information? AAMT
Subject: AAMT
In my most humble opinion, I would think the AAMT BOS rules are set by AAMT, as Joint Commision accredits hospitals. Some of the style guides that my account uses are actually requirements by Joint Commission, but not those specifically required by the BOS. Anyone else have an opinion? I mean q.6h. (per AAMT)
Subject: I mean q.6h. (per AAMT)
nm AAMT BOS
Subject: AAMT BOS
'I wrote him a prescription for 38 Tylox.' Am I supposed to type #38 or not?
Per AAMT
Subject: Per AAMT
Abbreviate units of measure, even if dictated in full, if they are accompanied by a numeral.
I would assume in your case since it is not accompanied by a number and has the word of between the two, then I would spell it out. # according to AAMT
Subject: # according to AAMT
I type for a hospital so # are not written out. I only have the first AAMT book. In the new book, is it now standard to not write out #. I am QAing a clinic where they told me to use my own judgement as half MT are writing them out and the other half are not. What is new standard rule? AAMT BOS
Subject: AAMT BOS
Use only with numerals. Use a lowercase x in expressions of area and volume, as a multiplication symbol, and when it takes the place of the word times.
A capital X is generally used to express magnification.
X30 magnification
x meaning by (dimensions)
Use a lowercase x to express by in dimensions.
Space before and after the x.
13 x 2 cmx meaning for
When the word 'times' is dictated and can be translated as for, it should be transcribed as for rather than using times or x.
Ahdi Book Of Style Online
D: The patient was given antibiotics to take times 2 weeks.
T: The patient was given antibiotics to take for 2 weeks.
x meaning times
When the word 'times' is dictated and means the number of times a thing was done, the letter x can be used.
To keep this expression together and easily read as a unit, do not place a space after the x.
D: Blood cultures were negative times 3.
T: Blood cultures were negative x3.
Use the symbol x meaning times only when the x precedes a numeral.
D: Demerol was administered 3 times.
T: Demerol was administered 3 times. not ..3x. Yes, BOS is from AAMT, but
Subject: Yes, BOS is from AAMT, but
what they base their decisions on I'll never know.
A new BOS is being written, and the new writers have some much better credentials than the former writers, so hopefully the new one will make actual sense. One can only hope. it is CT per AAMT
Subject: it is CT per AAMT
x AAMT BOS
Subject: AAMT BOS
affect, effect
These terms often sound alike when dictated, but their usage and meanings are not interchangeable. Affect is usually a verb, and effect is usually a noun. In medicine either of these terms may be a verb or noun, with a multitude of meanings, and their differences in usage and meaning should be learned.
affect
As a verb, affect (pronounced af-féct) means to influence or change.
She suffers from a neuropathy affecting her upper extremities.
The warm encouragement of the patient's wife positively affected his outcome.
As a noun, affect (pronounced áf-fect) means an expressed or observed emotion or feeling.
The patient displayed a flat affect.
Her affect did not change throughout the course of the interview.
effect
As a verb, effect means to bring about or cause to happen.
We plan to effect a decrease in the size of the tumor using adjunctive therapy.
The medication effected relief.
As a noun, effect means result.
The effect of the treatment was pronounced.
A mass effect was seen on x-ray.
Copyright (c) 2002 American Association for Medical
Transcription
It is confusing! I have been doing this for years and still have to stop and think at times. Good luck to you! You are getting into a great field of work! Hope you can get with a good company! x3 per AAMT
Subject: x3 per AAMT
According to AAMT BOS use
Subject: According to AAMT BOS use
arabic numerals (not roman numerals) in this case.
See AAMT-BOS (sm)Subject: See AAMT-BOS (sm)
Gleason tumor grade
Also known as Gleason score. The system scores or grades the prognosis for adenocarcinoma of the prostate, with a scale of 1 through 5 for each dominant and secondary pattern; these are then totaled for the score. The higher the score, the poorer the prognosis.
Lowercase grade or score, and use arabic numerals.
Diagnosis: Adenocarcinoma of prostate, Gleason score 8.
Gleason score 3 + 2 = 5.
Gleason 3 + 3 with a total score of 6. without the S per AAMT-BOS (sm)
Subject: without the S per AAMT-BOS (sm)
eponyms
Names of entities—e.g., diseases, anatomic structures, operations, or tests— derived from the names of persons or places.
Homans sign
Lyme disease
Down syndrome
capitalization
Capitalize eponyms but not the common nouns, adjectives, and prefixes that accompany them.
Do not capitalize words derived from eponyms.
ligament of Treitz
red Robinson catheter
non-Hodgkin lymphoma
Parkinson disease but parkinsonism
Cushing syndrome but cushingoid
plurals
Do not use an apostrophe in the plural forms of eponyms.
Babinskis were negative.
possessive form
AAMT first advocated dropping the possessive form of eponyms in 1990. We adopted this standard because it promotes consistency and clarity. More recently, The AMA Manual of Style (1998), Stedman's Medical Dictionary (2000), and Dorland's Illustrated Medical Dictionary (2000), have acknowledged the trend away from the possessive form.
It is important to note, however, that use of the possessive form remains an acceptable alternative if dictated and/or if indicated as the preference by employer or client.
Apgar score
Babinski sign
Down syndrome
Gram stain
Hodgkin lymphoma
In awkward constructions, such as when the noun following the eponym is omitted, the possessive form becomes preferred.
The patient's husband suffers from Alzheimer's. AAMT says..
Subject: AAMT says..
AAMT under cancer classifications has it as grade 1. AAMT says..
Subject: AAMT says..
AAMT under obstetrics has it as gravida 1 or G1 62 mL - according to AAMT - nm
Subject: 62 mL - according to AAMT - nm
From AAMT
Subject: From AAMT
fractions
Spell out or use numerals for common fractions. Use the dictation style as a guide.
An hour and a half before presentation, the patient slipped and fell.
or Approximately 1-1/2 hours before presentation.. (if dictated 'one and a half hours' or 'one and one-half hours')
The glass was two-thirds full. or The glass was 2/3 full.
7/8-inch wound
a half-inch incision or a 1/2-inch incision (since it was dictated precisely)
about a half inch below the sternal notch (the word about makes this an imprecise measurement)
He smokes a pack and a half of cigarettes per day.
or He smokes 11/2 packs of cigarettes per day.
or He smokes 1-1/2 packs of cigarettes per day.
Copyright (c) 2002 American Association for Medical Transcription
Per my AAMT BOS, gm is acceptable, smSubject: Per my AAMT BOS, gm is acceptable, sm
but g is the referred method (no period), which is the way I type it, i.e. Valtrex 1 g
Of course, my BOS is not the newest version, so things could have changed. FYI-AAMT BOS, edition 2
Subject: FYI-AAMT BOS, edition 2
Aamt
Just thought I would pass on some information recently sent to me.
AAMT BOS (Book of Style), 2nd edition
periods
Do not use periods within or at the end of most abbreviations, including acronyms, abbreviated units of measure, and brief forms. Use a period at the end of abbreviated English units of measure if they may be misread without the period. Better still, write out most English units of measure, thereby avoiding this use of a period at the end of an abbreviation.
wbc
WBC
mg
exam
prep
inch preferred to in. (Do not use in meaning inch without a period.)
However, use periods in lowercase drug-related abbreviations.
b.i.d.
q.4 h. = note it is 'q.4' and then a space before the 'h.'
p.o.
p.r.n.
If a sentence terminates with an abbreviation that requires a period, do not add another period.
He takes Valium 5 mg q.a.m.
not He takes Valium 5 mg q.a.m.
plurals
Use a lowercase s without an apostrophe to form the plural of capitalized abbreviations, acronyms, and brief forms.
EEGs
PVCs
CABGs
exams
Use 's to form the plural of lowercase abbreviations.
rbc's
Use 's to form the plural of single-letter abbreviations.
X's
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Hyphens and adjectives
15-year-old boy
The patient is a 33-year-old.
2-year 5-month-old child (note no comma in this)
5-1/2-year-old girl
1-month course
.38-caliber pistol - note no leading zero here - see below
two-thirds full
one-half normal saline
half-normal saline
She was panic-stricken
20-pack-year history
self-medicated
shell-like
For quantities less than 1, place a zero before the decimal point, except when the number could never equal 1 (e.g., in bullet calibers and in certain statistical expressions such as correlation coefficients and statistical probability).
0.75 mg
.22-caliber rifle
the new AAMT BOS says about numbers..sm
Subject: the new AAMT BOS says about numbers..sm
that you should use 4-5 and not spell out four to five...all numbers now, even 1 through 9, should be numerals and not spelling out four, five, etc. quote from AAMT BOS
Subject:
Aamt Book Of Style Free
quote from AAMT BOSeponyms
A name of a drug, disease, anatomic structure, operations, etc., derived from the name of the person or place. Do not use the possessive form.
Homans sign
Lyme disease
Parkinson disease
Cushing syndrome
ligament of Treitz