Medical Records Glossary
Help in Medical Terminology provided by Madalina who studies Medical Archives.
Hi, my name is Madalina. I have been studying Medical Archives for 2 years at Ahuntsic College. This Glossary will help students in Medical Archives. You will find here some help in understanding this profession, as well as some medical terms. Give it a try. Pleasant study!
- administrative officer
- administrative = adjective , officer = noun
- Administrative officers oversee and implement administrative procedures, establish work priorities and co-ordinate the acquisition of administrative services such as office space, supplies and security services.
- Example: Despite the relatively lax application requirements, the applicants for the position of administrative officer have to attend two written tests and two other interviews in order to be selected.
- en: agent administratif
- coding diseases (International Classification of Diseases)
- coding = adjective, diseases = noun
- The standard diagnostic tool for epidemiology, health management and clinical purposes.This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems.
- Example: Coding diseases is the main occupation of medical archivists.
- en: codage des maladies

- confidentiality
- noun
- A set of rules or a promise that limits access or places restrictions on certain types of information.
- Example: Parents were provided with contact numbers for any further advice, and confidentiality was maintained throughout including anonymity in reporting.
- en: confidentialité
- data collection
- data = adjective, collection = noun
- The process of gathering and measuring information on variables of interest, in an established systematic fashion that enables one to answer stated research questions, test hypotheses, and evaluate outcomes.
- Example: The technique crosschecks itself by, ideally, triangulating (i.e. using three) different data collection procedures in order to minimize the risk of misinterpretation via the extraction of a trend from one imperfect data collection method.
- en: collecte de données
- disclosure
- noun
- The release of information about a person or entity.
- Example: The defenses and the procedure for disclosure give rise to several practical and legal implications for practitioners. ibid, section 338 Having reported a suspicion, in order to avoid liability, practitioners must await consent from the SOCA before continuing with the transaction.
- en: divulgation
- file
- noun
- Folder, in paper or electronic format, that holds documents together for organization and protection.
- Example: Due to different programming techniques, databases are found in a few different file formats.
- en: dossier
- jurisprudence
- noun
- The study and theory of law.
- Example: However, she believed that the 'general tenor of [their] jurisprudence' was different to that of which was established by the majority.
- en: jurisprudence
- medical record
- medical = adjective, record = noun
- Documentation of patient health information that is created by a health care organization.
- Example: She exemplifies that if reading banks statement, private correspondence, and medical record is an encroachment of personal privacy then keeping reading of DNA profile should also be treated in the same manner.
- en: archive médicale
- medical terminology
- medical = adjective, terminology = noun
- Language used to precisely describe the human body including its components, processes, conditions affecting it, and procedures performed upon it.
- Example: The abbreviations in the evolution notes of a hospitalization episode of a patient are part of the medical terminology.
- en: terminologie médicale
- medicine
- noun
- Science and practice of establishing the diagnosis, prognosis, treatment, and prevention of disease.
- Example: For a long time it only offered vocational training for local students in medicine, law, and theology.
- en: médecine
- patient
- noun
- A person who is under medical care or treatment.
- Example: This is demonstrated by the image of Clostridium difficile (21.12.05) the bacteria linked to patient deaths in hospital from the front page.
- en: patient
- registry
- noun
- A place where data, records, or laboratory samples are kept and usually are made available for research or comparative study.
- Example: Search date 2001; primary sources Medline, Embase, Biological Abstracts, International Pharmaceutical Abstracts, Cochrane Controlled Trials Database, McMaster Cardiovascular Randomized Clinical Trial registry, and Science Citation Index.
- en: registre

- signature
- noun
- A person's name written in a distinctive way as a form of identification in authorizing a cheque or document or concluding a letter.
- Example: Finally, the names given in the right column, as well as the "P.S." and the sketch next to the signature adds to the letter's general purpose of persuasion.
- en: signature
- statistic
- noun
- Study of the collection, organization, analysis, interpretation and presentation of data.
- Example: From above statistic data may find there is a very good economic opportunity for Fantastic Fitness Club.
- en: statistique
- subpoena
- noun
- A writ issued by court authority to compel the attendance of a witness at a judicial proceeding; disobedience may be punishable as a contempt of court.
- Example: A court, Grand Jury, legislative body, or Administrative Agency uses a subpoena to compel an individual to appear before it at a specified time to give testimony.
- en: subpoena