scholarly journals Perilaku Merokok Pengunjung dalam Mematuhi Peraturan Kawasan Tanpa Rokok (KTR) di Lingkungan RSUD S. K. Lerik Kota Kupang

2019 ◽  
Vol 1 (1) ◽  
pp. 8-14
Author(s):  
Imelda Fitryani Dam ◽  
Honey I. Ndoen ◽  
Indriati A. Tedjuhinga
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Family Environment ◽  
Statistical Tests ◽  
Smoking Behavior ◽  
Health Care Facilities ◽  
Hospital Environment ◽  
Cross Sectional ◽  
Care Facilities ◽  
Level Of Knowledge

Non-smoking area is a room or area that is otherwise prohibited to activities of production, sales, advertising, promotion and use of cigarettes. Regional regulation Kupang City No. 3A year 2014 about non-smoking area explain that health care facilities, including hospitals is a place or non-smoking area. S. K. Lerik Municipality General Hopital is government owned health care facilities in Kupang and non-smoking area but still a lot of casual visitors who smoke in the hospital environment. The purpose of this research was to determine the relationship between the level of knowledge, education and family environment with the behavior of visitor to comply with regulation of non-smoking area at S. K. Lerik Kupang Municipality General Hospital 2016. The method of this research was analytical surveys using the cross-sectional design. The population in this research were all those at S. K. Lerik Kupang Municipality General Hospital environment with a total sample of 384 respondents. Statistical tests were used for data analysis in this research is Chi-Square with a degree of confidence α= 0.05. The results showed that there was correlation between the level of knowledge and education with smoking behavior of the visitor at S. K. Lerik Kupang Municipality General Hospital. There was no correlation between family environment with smoking behavior of the visitors at S. K. Lerik Kupang Municipality General Hospital.

FIRST AID AND TREATMENT FOR CHILDREN ACCIDENT INJURY IN BUON MA THUOT CITY, DAK LAK PROVINCE 2014

2017 ◽  
pp. 69-74
Author(s):  
Van Hung Nguyen ◽  
Van Thang Vo
Keyword(s):  
Health Care ◽  
Intervention Program ◽  
First Aid ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Health Staff ◽  
Cross Sectional ◽  
Care Facilities ◽  
Accident Injuries ◽  
Accident Injury

Background: Accident injuries caused has been serious heatlth problem in developing coutries. Children is vulnerable group with accident injury beucase of lacking knowlegde and exposing with risk factors in eviromental household. The treatment outcome for accident injury of children usually has more serious than other groups. The aims of this study to describle some characteristics of first aid and the outcome of treatment for children accident in Buon Ma Thuot, Dak Lak provice in 2014. Methodology: A cross-sectional study was conducted total 2,273 household which was 4,505 children aged under 16 in 8 communes, Buon Ma Thuot city, Daklak province. Interview technique with structural questionnaire and household observation methods were used for data collection. Results: The propotion of first aid was 75.9%; not received any first aid (23.8%); mortality at accident place (0.3%). At the time accident: The highest personal involving first aid was pedestrians 54.1%; 25% of health staff, self- first aid was 14.5%. Two main of first aid methods were hemostasis and bandeged with 45.5%; 28% respectiviely. After first aid, there was 80% delivering to health care facilities. The transport methods were motocycle (91.8%), car (5.6%) and ambulance (0.4%). The rate of approach health care facilities around early 6 hours were 86.7%. The characteristics of damages: sub-damages (scratches, dislocations, sprains...) were 36.9 %, deep damages (fractures, open wounds) accounted for 44.6%. Inpatient treatment was 23.9%; 91.5% medical therapy, surgery of 8.2%. The outcome of treatment were good (97.2%), sequelae/disability 2.6%. Conclusion: First aid activities for children at time and properly right were demonstrated effectively for prevented seriously outcome. There should be an intervention program for children with the appropriate models to reduce accident injuries in children; improvement first aid to communities and health care worker. Key words: accident injury, first aid, capacity first care, children under 16 years old

Assessing the Preparedness of Healthcare Facilities for Disasters and Emergencies in Damghan, Iran

2021 ◽  
pp. 1-7
Author(s):  
Behrad Pourmohammadi ◽  
Ahad Heydari ◽  
Farin Fatemi ◽  
Ali Modarresi
Keyword(s):  
Health Care ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Mitigation Measures ◽  
Health Staff ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Wide Range ◽  
Care Facilities ◽  
The Impact

Abstract Objectives: Iran is exposed to a wide range of natural and man-made hazards. Health-care facilities can play a significant role in providing life-saving measures in the minutes and hours immediately following the impact or exposure. The aim of this study was to determine the preparedness of health-care facilities in disasters and emergencies. Methods: This cross-sectional study was conducted in Damghan, Semnan Province, in 2019. The samples consisted of all the 11 health-care facilities located in Damghan County. A developed checklist was used to collect the data, including 272 questions in 4 sections: understanding threatening hazards, functional, structural, and nonstructural vulnerability of health-care facilities. The data were analyzed using SPSS 21. Results: The results revealed that the health-care facilities were exposed to 22 different natural and man-made hazards throughout the county. The total level of preparedness of the health-care centers under assessment was 45.8%. The average functional, structural, and nonstructural vulnerability was assessed at 49.3%, 31.6%, and 56.4%, respectively. Conclusions: Conducting mitigation measures is necessary for promoting the functional and structural preparedness. Disaster educational programs and exercises are recommended among the health staff in health-care facilities.

scholarly journals TINGKAT KECEMASAN IBU HAMIL TERHADAP KUNJUNGAN ANTENATAL CARE DI MASA PANDEMI COVID-19

2021 ◽  
Vol 13 (01) ◽  
pp. 96
Author(s):  
Nining Sulistyowati ◽  
Yeti Trisnawati
Keyword(s):  
Health Care ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Personality Inventory ◽  
Health Care Facilities ◽  
Chi Square ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
Pregnancy Anxiety ◽  
Care Facilities

ABSTRAKLatar belakang: Pandemi Covid-19 menyebabkan banyak pembatasan hampir ke semua layanan rutin termasuk pelayanan kesehatan maternal dan neonatal. Ibu hamil menjadi enggan ke puskesmas atau fasiltas pelayanan kesehatan karena takut tertular, adanya anjuran menunda pemeriksaan kehamilan dan kelas ibu hamil Kurangnya kunjungan ANC ini bisa menyebabkan bahaya bagi ibu maupun janin seperti terjadinya perdarahan saat masa kehamilan karena tidak terdeteksinya tanda bahaya. Tujuan penelitian: Untuk menganalisis kecemasan ibu hamil terhadap kunjungan antenatal care di masa pandemic covid-19. Metode: Penelitian analitik dengan rancangan cross sectional. Penelitian dilakukan di Praktik Mandiri Bidan di Kota Tanjungpinang dari bulan Januari – Februari 2021. Populasi seluruh ibu hamil TM III yang terdata di Praktik Mandiri Bidan di Kota Tanjungpinang dengan sampel sebanyak 32 responden. Teknik purposive sampling dengan kriteria antara lain ibu hamil dengan usia kehamilan trimester III, mampu mengungkapkan perasaan dan kecemasannya, mempunyai handphone dan nomor whatsapp, memiliki Buku KIA serta skor L-MMPI (Lie-Score Minnesota Multiphase Personality Inventory) <10. Hasil penelitian: Hasil uji statistik chi square diperoleh nilai p 0,016 (p<0,05) disimpulkan ada hubungan antara tingkat kecemasan ibu hamil dengan kunjungan antenatal care ke fasilitas pelayanan kesehatan di masa pandemi Covid-19. Simpulan: Hasil penelitian menunjukkan bahwa kunjungan ANC ibu hamil ke fasilitas pelayanan kesehatan pada masa pandemi covid-19 sebagian besar melakukan kunjungan ANC teratur 22 ibu hamil (68,8%), ibu hamil tidak mengalami kecemasan 9 (28,1%). Ibu hamil yang mengalami kecemasan dan tidak teratur melakukan kunjungan ANC sebanyak 12 ibu hamil (37,5%). Ibu hamil yang tidak mengalami cemas seluruhnya melakukan kunjungan ANC secara teratur yaitu 9 responden.Kata kunci: umur, Pendidikan, pekerjaan, kehamilan, kecemasan, frekuensi antenatal carePREGNANT MOTHER'S ANXIETY LEVELS ON ANTENATAL CARE VISITS DURING THE COVID-19 PANDEMICABSTRACTBackground: The Covid-19 pandemic has caused many restrictions on almost all routine services, including maternal and neonatal health services. Pregnant women are reluctant to go to the puskesmas or health service facilities for fear of contracting it, there are recommendations to postpone pregnancy checks and classes for pregnant women. This lack of ANC visits can cause danger to the mother and fetus, such as bleeding during pregnancy because no danger signs are detected. The purpose of the study: To analyze the anxiety of pregnant women regarding antenatal care visits during the covid-19 pandemic. Methods: Analytical research with cross sectional design. The study was conducted at the Independent Midwife Practice in Tanjungpinang City from January - February 2021. The population of all TM III pregnant women recorded at the Midwife Independent Practice in Tanjungpinang City with a sample of 32 respondents. Purposive sampling technique with criteria including pregnant women with the third trimester of pregnancy, being able to express their feelings and anxieties, having a cellphone and whatsapp number, having a KIA Book and an L-MMPI (Lie-Score Minnesota Multiphase Personality Inventory) score <10. Research results: The results of the chi square statistical test obtained a p value of 0.016 (p <0.05) it was concluded that there was a relationship between the level of anxiety of pregnant women and antenatal care visits to health care facilities during the Covid-19 pandemic. Conclusion: The results showed that ANC visits of pregnant women to health care facilities during the covid-19 pandemic mostly carried out regular ANC visits 22 pregnant women (68.8%), pregnant women did not experience anxiety 9 (28.1%). Pregnant women who experience anxiety and do not regularly visit ANC as many as 12 pregnant women (37.5%). Pregnant women who do not experience anxiety all make regular ANC visits, namely 9 respondents.Keywords: age, education, occupation, pregnancy, anxiety, antenatal care frequency.

FAIRNESS OF UTILIZING HEALTH CARE FACILITIES AND OUT-OF-POCKET PAYMENT BURDEN: EVIDENCE FROM CAMBODIA

2012 ◽  
Vol 45 (3) ◽  
pp. 345-357 ◽  
Author(s):  
KOUSTUV DALAL ◽  
OLATUNDE AREMU
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Cross Sectional ◽  
Middle Income ◽  
Distinct Level ◽  
Out Of Pocket Payments ◽  
Care Facilities ◽  
Low And Middle Income

SummaryCatastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable.

scholarly journals Identifikasi Praktik Kefarmasian Yang Sesuai Dengan Kebutuhan Pasien Dan Fasilitas Pelayanan Kesehatan

2019 ◽  
Vol 22 (2) ◽  
pp. 126-136
Author(s):  
Selma Siahaan ◽  
Rini Sasanti Handayani
Keyword(s):  
Health Care ◽  
Health Care Facilities ◽  
Exit Interview ◽  
Lead Times ◽  
Cross Sectional ◽  
Planning Strategy ◽  
Medicines Information ◽  
Central Java ◽  
Care Facilities ◽  
Study Sites

The study of pharmaceutical practices in health care facilities was conducted in 2016. It aimed to identify pharmaceutical practices needed by patients and health care facilities. The study sites were in Central Java, Bali, South Kalimantan, and South Sulawesi. In each provinces, the study was conducted in one urban and one rural district areas. The sample locations were both government and private hospitals, health centers and pharmacies. The study design study was cross sectional. Data collection was carried out by in-depth interview to responsible pharmacists who did medicines management, and exit interview to patients after they received medicines services from government hospitals and primary health cares. The results showed that pharmaceutical practices needed by the health care facilities were good medicines planning andprocurement that can maintain the continuity of the availability of medicine stocks needed for patients, and the ability in managing medicines effi ciently and eff ectively. Moreover, the pharmaceutical practices needed by the communities were medicines completeness, quick services, as well as simple and complete medicines information. It is recommended that pharmacists should be trained on comprehensive medicines planning, strategy to anticipate the emptiness of medicines including lead times, and communication skills to the patients. In addition, IT supports for pharmacy services development is also needed. Abstrak Telah dilakukan studi mengenai praktik kefarmasian di fasilitas pelayanan kesehatan yang bertujuan mengidentifikasi pelayanan kefarmasian yang dibutuhkan pasien dan fasilitas pelayanan kesehatan. Kegiatan studi dilaksanakan di Jawa Tengah, Bali, Kalimantan Selatan, Sulawesi Selatan. Dari masing-masing propinsi di atas dipilih satu kota dan satu kabupaten. Studi dilakukan pada tahun 2016. Lokasi penelitian adalah rumah sakit pemerintah, rumah sakit swasta, puskesmas dan apotek dengan desain potong lintang. Pengumpulan data dilakukan melalui wawancara mendalam terhadap apoteker penanggung jawab/pengelola obat, dan exit interview terhadap pasien rumah sakit pemerintah dan puskesmas yang baru selesai menerima pelayanan obat. Hasil penelitian menunjukkan praktik kefarmasian yang dibutuhkan oleh fasilitas pelayanan kesehatan adalah perencanaan dan pengadaan obat yang baik yang dapat menjaga kesinambungan ketersediaan stok obat yang diperlukan bagi pelayanan ke pasien serta pengelolaan obat yang efektif dan efi sien. Praktikkefarmasian yang dibutuhkan masyarakat adalah tersedianya obat lengkap, kecepatan pelayanan, dan informasi obat yang singkat padat. Disarankan perlunya pelatihan perencanaan obat yang lebih komprehensif, kiat-kiat mengantisipasi kekosongan obat dan lamanya pengiriman, serta pelatihan cara berkomunikasi yang baik kepada pasien secara menyeluruh. Selain itu, dukungan teknologi informasi bagi pengembangan pelayanan farmasi juga dibutuhkan.  

scholarly journals MEDICAL GRADUATES?

2015 ◽  
Vol 22 (02) ◽  
pp. 153-158
Author(s):  
Fatima Mukhtar ◽  
Abuzar Aziz ◽  
Shayan Rashid Khawaja ◽  
Akasha Amjad ◽  
Alina Haider
Keyword(s):  
Health Care ◽  
Prolonged Exposure ◽  
Medical Profession ◽  
Health Planning ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Cross Sectional ◽  
Medical Graduates ◽  
Care Facilities

A universal challenge faced by developing countries these days is the inequitabledistribution of health professionals, which compromises the capacity of the health system todeliver efficient and effective health care. Availability of reliable data on medical graduatesis important for health planning and development of policies and plans dealing with healthworkforce labour market. Objectives: To determine the proportion of medical graduates whoremained affiliated with the profession three to six years after graduation from a private medicalschool, To find out the specialty selection and practice location of these graduates, and todetermine the association between their gender and affiliation with the profession. Methods:A cross-sectional study was undertaken at the Lahore Medical & Dental College from March toMay 2014 selecting graduates through convenience sampling. The graduates were contactedthrough e-mail, Facebook and telephone. After obtaining voluntary informed consent fromthe respondents, a pre-tested structured questionnaire was used to collect information.Thedata was recorded and analysed using the statistical package for social sciences version 16.0.Chi-square test is used to test statistical significance between respondent’s gender and theiraffiliation with the medical profession at p < 0.05. Results: A large proportion 98(88%) ofmedical graduates remained affiliated with the profession. Those who didn’t pursue it were allfemales (p < 0.05). Majority 86(88%) were located in Pakistan. A greater proportion worked inthe tertiary health care facilities 65(94%). The popular specialty being pursued was medicine24(24%). Conclusion: Female medical graduates should be provided opportunities for parttime work.Medical schools should provide early and prolonged exposure of students to primaryhealth care facilities, in order to increase their uptake of rural postings.

scholarly journals Leadership and motivation among employees in health-care facilities in Serbia

2018 ◽  
Vol 24 (1) ◽  
pp. 33 ◽  
Author(s):  
Miroslava Krstic ◽  
Vladimir Obradovic ◽  
Zorica Terzic-Supic ◽  
Dejana Stanisavljevic ◽  
Jovana Todorovic
Keyword(s):  
Health Care ◽  
Job Security ◽  
Health Care Facilities ◽  
Motivational Factors ◽  
Team Work ◽  
Motivational Factor ◽  
Cross Sectional ◽  
Patient’S Satisfaction ◽  
Health Care Institutions ◽  
Care Facilities

Reserarch question: This paper investigates whether motivational factors have influence on the work of employees in health care organizations of Serbia and what factors affect employees. Motivation: Motivation and job satisfaction among different groups of workers in health care facilities in Serbia are an important issue. This study’s purpose is to assist health managers in their efforts to fulfill individual and organizational targets by highlighting the most preferred motivational factors among the employees. With good leadership and with the building of good motivational system the organization can increase its value and competitiveness. It has been shown that employees are more motivated and work under less stress if there is a support from their leader or manager (Jensen, 2010). Idea: The  core  idea  of  this  paper  is to  evaluate  the  relationship  between motivational factors and work of employees in health care institutions in Serbia. The central hypothesis of this study is what the managers within health care institutions have to do to improve motivation as well as their abilities for the fulfillment of both individual’s and organization’s needs. Data: The cross-sectional study included 217 physicians, nurses, technicians, health associates and non-medical staff in 21 facilities of primary, secondary and tertiary levels in Pozarevac, Belgrade, Nis, Pirot, Novi Sad, Zrenjanin, Krusevac, Varvarin and Novi Pazar. Tools: The research instrument was a questionnaire with questions regarding socio-demographic characteristics, participants’ characteristics and motivational factors. The data were analyzed using descriptive and analytical statistics. Findings: The most important motivational factors are: salary, good interpersonal relationships and team work, contribution to population’s health and patient’s satisfaction. Around 10% of the participants thought that work could be done well even without motivational factors’ presence. Employees from the areas outside Belgrade rated job security higher in comparison with employees from Belgrade. A study conducted at the University of llorin Teaching Hospital in 2011 showed that salary was the most important motivational factor, followed by job security (Ojokuku& Salami, 2011). Contribution: Salary is an important motivational factor for employees in health care facilities in Serbia. Managers should work on the improvement of motivational factors through acknowledgement of needs of individual employees as well as through involving employees into decision making. 

scholarly journals Risk factors threatening health care facilities in disasters and emergencies

2020 ◽  
Author(s):  
Behrad Pourmohammadi ◽  
Ahad Heydari ◽  
Farin Fatemi ◽  
Ali Modarresi
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Mitigation Measures ◽  
Health Staff ◽  
Structural Vulnerability ◽  
Cross Sectional ◽  
Care Facilities ◽  
Health Care Centers

Abstract Background: Iran is exposed to a wide variety of natural and man-made hazards. Health care facilities can play a significant role in providing lifesaving measures in the minutes and hours immediately following impact or exposure. The aim of this study was to determine the risk factors threatening the preparedness of health care facilities in disasters and emergencies. Methods: This cross-sectional study was conducted in Damghan, Semnan province in 2019. The samples consist of all the eleven health care facilities which are located in Damghan County. A developed checklist including 272 questions in four sections; understanding threatening hazards, functional, structural and non-structural vulnerability of health care facilities was used to collect the data. The data were analyzed using STATA 11 software. The risk factors were determined and prioritized based on mean and total vulnerability score. Results: The results showed that the health care facilities were exposed to 22 different natural and man-made hazards throughout the county. The overall preparedness of the health care centers was 45%. The average functional, structural, and nonstructural vulnerability was assessed at 40.58%, 45.12%, and 50%, respectively. Conclusion: The findings of this study showed an average preparedness of the health care facilities in the studied area. Conducting the mitigation measures is necessary for reducing the structural and non-structural vulnerability. Disaster educational programs and exercises are recommended among the health staff in order to increase the functional capacity and enhance the preparedness in the HCFs at time of emergencies and disasters.

scholarly journals TINJAUAN PELAKSANAAN NILAI GUNA REKAM MEDIS BAGI PASIEN DI RUMAH SAKIT UMUM IMELDA PEKERJA INDONESIA (RSU IPI) MEDAN TAHUN 2018

2020 ◽  
Vol 5 (1) ◽  
pp. 80-84
Author(s):  
Johanna Christy ◽  
Afni Efani Putri S
Keyword(s):  
Health Care ◽  
Medical Care ◽  
General Hospital ◽  
Medical Record ◽  
Medical Records ◽  
Health Care Facilities ◽  
Use Value ◽  
Care Facilities ◽  
Conducting Research

ABSTRAK Rekam medis adalah berkas yang berisi catatan dan dokumen tentang identitas pasien, pemeriksaan, pengobatan, tindakan dan pelayanan lain kepada pasien pada sarana pelayanan kesehatan. Tujuan penelitian ini adalah untuk mengetahui bagaimana pelaksanan nilai guna rekam medis bagi pasien. Jenis penelitian ini adalah deskriptif bertujuan menggambarkan secara sistematis fakta dan karakteristik objek dan subjek secara tepat. Waktu penelitian ini dilakukan pada bulan Juli di Rumah Sakit Umum Pekerja Indonesia Medan (RSU IPI) Tahun 2018. Populasi dalam penelitian adalah 440 berkas rekam medis. Dalam melakukan penelitian, peneliti mengambil sampel sebanyak 81 berkas rekam medis. Berdasarkan hasil penelitian yang dilakukan di RSU IPI pelaksanaan nilai guna rekam medis sudah terlaksana dengan baik, dilihat dari tersedianya ringkasan masuk dan keluar, resume, lembar operasi, identifikasi bayi, lembar persetujuan tindakan, lembar kematian pada setiapberkas pasien pulang meninggal, asuhan keperawatan didalam berkas rekam medis. Tetapi dalam pengisian berkas rekam medis petugas rekam medis belum mengimplementasikan nilai guna rekam medis dengan baik. Kesimpulannya pelaksanaan nilai guna rekam medis sudah baik namun dalam pengisian berkas rekam medis lebih di perhatikan sesuai Permenkes 269 Tahun 2008 Tentang rekam Medis sehingga pelaksaaan nilai guna rekam medis dan pengisisan berkas rekam medis berjalan lebih baik.   Kata Kunci: Rekam Medis, Nilai Guna Rekam Medis, Berkas Rekam Medis                                             ABSTRACT   Medical record is a document that contains records and documents about patient identity, examination, treatment, care and other services for patients in health care facilities. The purpose of this study was to study how the implementation of the use of medical records for patients. This type of research is descriptive which addresses the systematic problem and the appropriate characteristics of objects and subjects. When this study was conducted in July at the Medan Indonesian Workers General Hospital (RSU IPI) in 2018. The population in this study was 440 medical record documents. In conducting research, researchers took 81 samples of medical records. Based on the results of research conducted at the IPI General Hospital, the implementation of the use value of medical records has been carried out well, seen from the availability of incoming and outgoing assessments, proceeding, surgery sheets, accessing infants, action approval sheets, consent sheets on each patient's return documents, medical care care. However, in applying medical records, medical record officers have not applied the use value of medical records properly. Conclusion the reclamation of the value of the medical record has been better in the reclamation of the medical record is better with the approval in accordance with Minister of Health Regulation 269 of 2008 About the Medical Record requires the implementation of the value of the medical record and the filling of the medical record better.

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