Medical Law Test Questions

Question 1
1. According to the OIG, the use of copy and paste functions to clone information in EHRs creates:
I. Difficulty for coding and billing staff members to tell which activities were competed in the current visit, possibly leading to inappropriate charges
II. An easy way for unethical providers and/or unethical staff members to use “cloned” information to create fraudulent records or claims.
III. A clear picture of services provided during the patient’s stay
IV. Accurate and complete documentation

I and II

III and IV

I and IV

All of the above are correct
1 points
Question 2
1. Assuming a Medicare patient remains in the skilled nursing facility for the full 100 days of his or her benefit, which of the following represent the correct required MDS assessment cycle?

5 -day, 14-day, 30-day, 60-day

7 -day, 14-day, 30-day, 60-day, 90-day

14-day, 30-day, 60-day, 90-day

5-day, 30-day, 60-day, 90-day
1 points
Question 3
1. A living will and a designation of durable power of attorney is an example of what type of form in the medical record?

Acknowledgement of Patient Rights

Consent to Special Procedures

Advance Directives

Patient Care Plan
1 points
Question 4
1. A principal procedure is a type of procedure that is performed for the following purposes:
I. Definitive treatment
II. Diagnostic purposes
III. Exploratory purposes
IV. Custodial

I only

I and III

I, II, and III

I, II, III, and IV
1 points
Question 5
1. Cancers derived from connective tissues such as bone, cartilage, muscle or hematopeietic tissues are classified as which of the following:

Adenoma

Lipoma

Sarcoma

Carcinoma
1 points
Question 6
1. What is Natural Language Processing (NLP)?
I. A method of tape recorder dictation
II. A method of voice recognition
III. Product used in CAC

I and II

II and III

I and III

I, II, and III
1 points
Question 7
1. CAC works with which of the following for data abstraction?
I. CPT®
II. ICD-9-CM
III. SNOWMED-CT
IV. LOINC
V. RxNorm
VI. Transcription
VII. Dictation

I, II, VI, and VII

III, IV, V, VI, and VII

I, II, and III

I, II, III, IV, V, VI, and VII
1 points
Question 8
1. Which of the following are valid POA indicators?

Y, N, O, A, 1

U, W, N, 1, Y

A, N, W, Y, 0

N, W, Z, P, O
1 points
Question 9
1. A coder in a hospital is using a grouper to calculate MS-DRG assignment. The coder notices that there are multiple MS-DRGs that could be assigned, the coder should:

Choose the MS-DRG with the highest relative weight

Choose the MS-DRG with the highest ALOS (Average Length of Stay)

Choose the MS-DRG with the lowest relative weight

Choose the MS-DRG related to the primary diagnosis code assigned for the case
1 points
Question 10
1. Ideally, the chargemaster should not be the responsibility of a single person. Which of the following people/departments should be involved with annual chargemaster reviews?
I. HIM/Coding
II. Finance
III. Pharmacy
IV. Lab and/or Radiology

I only

II only

III and IV

I, II, III, and IV
1 points
Question 11
1. Who is responsible for requesting the pre-certification for an elective or planned hospital admission?

Patient

Primary Care or Attending Physician

Admitting office

Policyholder
1 points
Question 12
1. In what hospital setting does Medicare’s 3-day payment window become 1-day window instead?

Acute care hospital

Hospital day surgery unit

Psychiatric hospitals

Observation unit
1 points
Question 13
1. Type of bill ( TOB) code 0121 indicates:

Skilled nursing, Oupatient, Interim-first claim

Hospital, inpatient, non- payment zero claims

Hospital, inpatient (Medicare Part B only) Admit through discharge claim

Hospital, outpatient, admit through discharge, first claim
1 points
Question 14
1. Under APCs, payment status indicator S indicates?

Ancillary service

Clinic or emergency department visit

Significant procedure, discounted

Significant procedure, non-discounted.
1 points
Question 15
1. Electronic Health Records (EHR) help with CDI due to the following:
I. It can prompt physicians for additional information
II. Natural language processing can allow for more effective documentation in less time
III. Computer interfaces can provide physicians with decision support tools improving patient care

I only

II only

I and II

I, II and III
1 points
Question 16
1. A coder should consider using a provider query when:
I. Documentation is illegible
II. Documentation is unclear or incomplete
III. Documentation provides a diagnosis without clinical validation, or vice versa
IV. Documentation does not include the precertification number

I and II

I and III

I, II, and III

I, II, III, and IV
1 points
Question 17
1. NCD Blood Transfusions.pdf
Use the link above for the PDF for this question.
According to the NCD for Blood Transfusions under Hospital Part A Coverage and Payment which of the following statements is false in regards to Hospital Coverage and Payment.

Non-physician services furnished to hospital patients are covered and paid for as hospital services.

Medically necessary blood transfusions, regardless of type, are covered under Medicare Part A and B.

The DRG payment does not cover the blood and blood services, and these are services are paid separately under Medicare Part A.

In a situation where the hospital operates its own blood collection activities, rather than using an independent blood supplier, the costs incurred to collect autologous or donor-directed blood are recorded in the whole blood and packed red blood cells cost center.
1 points
Question 18
1. A Medicare patient presents to a hospital for a Screening Colonoscopy. This preventative service would be covered under:

Medicare Part A

Medicare Part B

Medicare Part C

Medicare Part D
1 points
Question 19
1. Which of the following could represent an example of fraud & abuse?
I. A facility selects the principal diagnoses based on the most complicated illness the patient suffers from during an admission for higher MS-DRG
II. A coder does not fully understand the coding guidelines and inadvertently selects an inaccurate code for a procedure.
III. A coder omits one of the procedure codes for a complicated cardiac catheterization case

I only

II only

III only

I, II, and III
1 points
Question 20
1. All of the following are within the OIG’s scope of legal activities in healthcare EXCEPT:

Excluding individuals from participating in Medicare and Medicaid programs

Negotiating and Monitoring Corporate Integrity Agreements

Suing facilities for malpractice

Assessing civil monetary penalties
1 points
Question 21
1. GENERAL HOSPITAL USA
DISCHARGE SUMMARY John Smith
DOB: 5/15/1958
DOS: 6/24/20XX Discharge Summary
PRINCIPAL DIAGNOSIS: Bilateral lower lobe pulmonary embolism with pleuritic chest pain.
SECONDARY DIAGNOSES:
1-Weight lost program with stimulant medication Phendimetrazine, held for now.
2-History of renal calculi, no recurrence or nephrolithiasis.
3-Left erythematous flank lesion, resolved.
4-Mild renal insufficiency with dehydration. Creatinine 1.5 on admit, now 1.0 after hydration.
5-History of allergy to penicillin.
6-Low protein C resistance. Recommend follow up with Hematology and factor V Leiden screen is pending.
PROCEDURES: Chest x-ray, which showed mild basilar atelectasis. Followup chest x-ray did show some worsening consolidative densities in bilateral bases. Creatinine was 1.5 on admission, now it is 1.0. Aspartate transaminase of 75 on admission, now is 27. D-dimer was elevated at 1.55. Computerized tomography angiogram of the chest showed bilateral lower lobe segmental and subsegmental pulmonary embolism and atelectasis. Hypercoagulation panel showed a normal antithrombin 3 level, lupus anticoagulant is pending. Protein C resistance was low at 2, There is a factor V Leiden genetic screen pending. Inflammatory C-reactive protein of 58.8 on admission, now 78.8, peaked at 80.8. Thyroid-stimulating hormone is 3.2, prostate-specific antigen 1.04. The patient did have a wound swab that was negative for herpes simplex virus polymerase chain reaction. Urinalysis showed 5 to 10 red blood cells, trace leukocytes, +1 crystals, calcium oxalate. A urine culture is pending. Total cholesterol was 182, high density lipoprotein was 66 with low-density lipoprotein of 104. Doppler ultrasound of lower extremities did not show any obvious deep vein thrombosis. There was some sluggish flow in the right leg without compressibility in the right Peroneal vein that showed to have some old clot.
Computerized tomography of the abdomen and pelvis did not show any specific abnormality. Echocardiogram showed aortic sclerosis with increased cardiac outputs, normal diastolic function. No obvious pulmonary hypertension with the ejection fraction of 60%. International normalized ratio was 1.0 on admission, currently 1.7. On admission, the patient received Lovenox 1 mg/kg every 12 hours here, started on Coumadin, had gently intravenous fluid hydration, pain management. The patient is generally doing well. No issues overnight. His room air saturation ranged between 85-89%.
DISPOSITION: He will be discharged home in improved condition today.
DISCHARGE MEDICATIONS: He will go home on Lovenox 90 mg every 12 hours. He is going to follow up in the emergency room tonight for Lovenox injection. He will take 10 mg of Coumadin tonight and then follow up in the Coumadin Clinic tomorrow for an international normalized ration to adjust. Go home on Percocet 5/325 one to two tablets every 6 hours as needed for pain and home oxygen 1 L/minute by nasal cannula continuously until follow up with Dr. Andrews. Recommend he hold his Phendimetrazine for weight loss until follow up with his primary care doctor. DISCHARGE INSTRUCTIONS: Recommend that he stay up-to-date on all of his routine cancer screening tests. Consider Hematology consult with Dr. Thomas if positive for Factor V Leiden or other clotting predisposition when laboratories return.
Recommend he avoid any activity that would be prone to head trauma while on the anticoagulant. He should call or return to emergency room for worsening chest pain, flank pain, temperature over 101, cough, shortness of breath, abdominal pain, vomiting, bleeding, particularly nosebleeds lasting greater than 15 minutes, black tarry stools, blood in the stool or other problems. He can have a regular diet, stay well-hydrated. No strenuous activity or travel to higher altitude uncleared by his primary doctor.
Followup Labs: The factor V Leiden panel and the rest of the Hypercoagulation panel is pending. Urine culture is pending. He will follow up in the Coumadin Clinic tomorrow 02/05 for recheck. He is going to establish with Dr. Andrews locally here. He should follow up this week and Coumadin Clinic tomorrow for an international normalized ration check and adjustment of his Coumadin. Recommend considering Hematology consult with Dr. Thomas, call 555-555-5555 to schedule. Kendall Kramer, MD
Electronically signed by KENDALL KRAMER, MD 6/24/20XX GENERAL HOSPITAL USA
HISTORY AND PHYSICAL EXAMINATION John Smith
DOB: 5/15/1958 ADMITTING DIAGNOSES: This is the second General Hospital USA admission for this delightful, 54-year-old male, complaining of a 48-hour history of pleuritic left flank, left lower posterior chest pain, radiating to the left shoulder. HISTORY OF PRESENT ILLNESS: The patient has enjoyed good health. He is physically active on a regular basis. He has had no history of recent trauma. He has been seeing Dr. Jones for the past month and has been engaged in a supervised weight loss program, in which he has been taking Phendimetrazine. He has also been watching his diet. He admits that he may be a bit dehydrated. He has lost approximately 15 pounds over the last several months. Again, this has been completely volitional. He works out regularly, does P90X 3 times a week at home. Did extensive core work last weekend. Again, sustained no trauma. He also went skiing last weekend. Forty-eight hours ago while attempting to go to sleep, he noticed difficulty lying flat due to pleuritic chest pain. This seems to start in the shoulder. He had no associated cough, no associated hemoptysis. He has also noted some hesitancy with urination. Has not had any hematuria, frequency, or urgency. He does have a remote history of kidney stones. PAST MEDICAL HISTORY: Normal childhood illnesses. No surgeries. He was hospitalized 20 years ago for concussion related to a sports injury. He has had a kidney stone. He is unaware of hypertension, hyperlipidemia, diabetes. MEDICATIONS: Phendimetrazine. He takes aspirin every other night. ALLERGIES: PENICILLIN SOCIAL HISTORY: He works from home, doing 3 dimensional computer rendering for construction companies. He is quite physically active. He is a nonsmoker. He has about 2 glasses of wine at night. FAMILY HISTORY: Father died at 75 of COPD, mother died of uterine cancer. A brother died at 58 of lung cancer, he was a smoker. A sister is alive and well. A 25-year-old daughter is alive and well. He is unaware of any hypercoagulability in the family. REVIEW OF SYMPTOMS: It is noteworthy for his supervised weight loss and some difficulty with urination. It is otherwise negative. PHYSICAL EXAMINATION:
General: Reveals an alert and oriented male, in obvious distress. He is seated upright and leaning forward due to the pain. Skin: He has an erythematous lesion in the left flank area. He has 3 right punctate, raised central areas, it looks somewhat like an insect bite. It does not look like herpes zoster. HEENT: Negative. He wears glasses. Neck: Supple. Chest: Clear, but breathing is shallow. Cardiac: Sinus. Abdomen: Benign. Extremities: Negative Homans. LABORATORY DATA: Sodium 138, potassium 4.2, chloride 101, C02 of 26, glucose 113, BUN 26, creatinine 52. Liver function study tests normal. White count 10,000 with left shift, hemoglobin 16.2, hematocrit 48. D-dimer positive at 1.55. Urinalysis: Negative for blood. Chest x-ray: Mild bibasilar atelectasis. CT scan of the chest via PE protocol shows bilateral Lower lobe segmental and subsegmental pulmonary emboli, patchy bilateral lower Lobe atelectasis. Upper abdominal images are unremarkable. IMPRESSION:
1 - Bilateral Lower Lobe pulmonary emboli.
2 - Stimulant weight loss medication, isolated reports found in more literature.
3 - History of kidney stones.
4 - Left flank erythematous lesion, ?bite, ?early presentation of Herpes zoster. DISCUSSION: The patient has no obvious precipitating factors for pulmonary embolism. There are isolated rare reports of Phendimetrazine related pulmonary emboli.
PLAN: The patient will be admitted to the intensive care unit. He has been started on Lovenox 1 mg/kg subcu q. 12 hours. He has also been started on Coumadin 7.5 mg daily, Hypercoagulation panel has been ordered. We will also do a CAT scan of his abdomen. Echocardiogram has been ordered to assess for pulmonary hypertension and bilateral lower extremity Dopplers have been ordered. CODE STATUS: The patient is a full code. PRIMARY CARE PHYSICIAN: Dr. Andrews
He has been seeing Dr. Jones for weight loss. ADDENDUM: The lesion in the patient’s left flank area has now developed some central blistering, and there are some satellite lesions in a dermatome distribution that definitely are consistent with herpes zoster. A zoster PCR has been sent. Kendall Kramer, MD
Electronically signed by KENDALL KRAMER, MD 6/24/20XX GENERAL HOSPITAL USA
PROGRESS NOTES John Smith
DOB: 5/15/1958 Patient clinically stable. Afebrile.
CT abd negative for malig. c/o nausea, anoxia chest: improved breath sounds today rales LLL cardio: normal abdomen: negative Imp: bilateral PE
? thrombosis Plan: ambulate
Zofran foo nausea
IS
d/c Foley Medicine Hospitalist NP
Chart reviewed, patient seen
S: Stable “better than yesterday”, low pain L flank, no shortness of breath, no cough or fever, mild nausea from yesterday resolved
Vitals: BP 126/66 HR: 59 RR: 20 O2 96% T: 98°
A/P:
1 - Bilat lower love PE
On Lovenox and Coumadin
Cont Lovenox until therapeutic INR, then just Coumadin, f/u Coumadin Clinic
2 - Pleuritic pain.
Managing with Percocet PO - improving Medicine Hospitalist
Patient seen and examined, agree with resident note for f/u at Coumadin Clinic f/u Hematology
Kendall Kramer, MD
Electronically signed by KENDALL KRAMER, MD 6/24/20XX Diagnosis 1:

1 points
Question 22
1. Diagnosis 2:

1 points
Question 23
1. Diagnosis 3:

1 points
Question 24
1. Diagnosis 4

1 points
Question 25
1. Diagnosis 5

1 points
Question 26
1. Diagnosis 6:

1 points
Question 27
1. Diagnosis 7:

1 points
Question 28
1. General Hospital USA
PATIENT: Lucy Smith
DOB: 6/21/1957
DOS: 7/10/20XX
SURGEON: Donald Kramer, MD
ATTENDING PHYSICIAN: Donald Kramer, MD
PROCEDURE PERFORMED: PTCA and stenting of right coronary artery stenosis with Xience Drug eluting stent.
INDICATION: CAD w unstable angina
DESCRIPTION OF PROCEDURE: Please see the computer report. Please note that we started first by dilating the ostium using a 2.5 × 15 mm cutting balloon. We then deployed a 3.0 × 8 mm Xience DES stent. The stent was then post-dilated using a 3.225 × 8 mm PowerSail up to 24 atmospheres.
COMPLICATIONS: None
RESULTS: Successful angioplasty/stent of 70% ostial right coronary artery stenosis with no residual stenosis at the end of the procedure.
Donald Kramer, MD
Electronically signed by DONALD KRAMER, MD 7/10/20XX Diagnosis 1:

1 points
Question 29
1. Diagnosis 2:

1 points
Question 30
1. Procedure 1:

1 points
Question 31
1. Procedure 2:

1 points
Question 32
1. Procedure 3:

1 points
Question 33
1. Procedure 4:

1 points
Question 34
1. Joyce Smith
DOB: 1/10/1983
Provider: Jamie Thompson, MD
Admit Date: 07/12/20XX History and Physical
ADMITTING DIAGNOSIS: A 30-year-old with vaginal bleeding.
HISTORY OF PRESENT ILLNESS: The patient had D and C for retained placenta on 07/11/20XX, with significant tissue and difficulty removing tissue. At home, she had acceleration of bleeding and was instructed to come to the ER. In the ER, she passed 2 clots. She had an ultrasound showing a small nidus of hypoechoic area in the cervix. The patient was admitted overnight for observation and side effects.
PAST MEDICAL/SURGICAL HISTORY: Significant for term delivery 8 weeks ago and above D and C. Delivery was by C-section.
ALLERGIES: No known drug allergies.
MEDICATIONS: Vicodin.
SOCIAL HISTORY: The patient denies tobacco, alcohol, or recreational drug use.
REVIEW OF SYSTEMS: Remarkable for above vaginal bleeding. She denies any cramping.
OBJECTIVE: Vital Signs: Stable. Blood Pressure: 133/74, heart rate 80. HEENT: Normocephalic, atraumatic. Neck: Supple. Heart: RRR. Lungs: Clear.
IMAGING: Ultrasound showing a 1 cm hyperechoic area in the cervix and clot in the endometrium normal ovaries bilaterally.
ASSESSMENT: This is a 30-year-old with retained products.
PLAN:
1-Additional course of Cytotec.
2-Probably return to D and C. Operative Report PROCEDURE DATE: 07/12/20XX
SURGEON: John Kramer, MD
ANESTHESIA: General.
PREOPERATIVE DIAGNOSIS: Retained placenta, vaginal bleeding.
POSTOPERATIVE DIAGNOSIS: Retained placenta, vaginal bleeding.
PROCEDURE PERFORMED: Suction and a sharp dilation and curettage and bleeding control measure including packed red blood cell infusion.
COMPLICATIONS: Bleeding.
FLUID: 1000 cc of crystalloid, 1 unit of packed RBCs.
ESTIMATED BLOOD LOSS: 1000.
URINE OUTPUT: 800.
INDICATION FOR PROCEDURE: The patient is a 30-year-old, who approximately 8 weeks postpartum was seen on 07/11/20XX with continued postpartum bleeding. Ultrasound demonstrated a 2 cm hyperechoic area with vascular flow. She underwent a D and C on 07/11/20XX with difficulty removing a large amount of tissue. The patient was stable upon end of procedure and recovery. On 07/12/20XX, she called reporting heavier bleeding and was instructed to come to the ER. The patient has a stable hematocrit of 34. Ultrasound demonstrated normal-appearing endometrial lining with clot only present and a small 1 cm hyperechoic area in the cervix. The patient was managed conservatively in the hospital overnight including Cytotec. Repeat ultrasound at 0700 on 07/12/20XX showed persistence of calcified area. The patient had no significant vaginal bleeding at that time but counseled on need for repeat D and C for abnormal placentation and continued vaginal bleeding. The patient was counseled extensively on risks, benefits, alternatives to procedure including possible need for laparotomy and even hysterectomy and signed consent.
PROCEDURE: The patient was taken to the operating room where general anesthesia was found to be adequate. She was prepped and draped in normal sterile fashion. The bladder was cleared of 200 cc of urine. Legs were placed in Allen stirrups. A weighted speculum was inserted vaginally and the anterior lip of the cervix grasped with a tenaculum. Ring forceps was used to remove the calcified area which was in the cervix. Upon doing so, increased vaginal bleeding started a suction D and C and sharp D and C were then performed. The patient had continuing vaginal bleeding. At approximately 300 cc of blood loss, the patient was given 400 mcg of Cytotec rectally. Pitocin was started through the IV and blood products were called for. The patient received 0.25 of Hemabate and 0.2 of Methergine both IM. At approximately 800 cc of blood loss, the bleeding was minimized. An intraoperative ultrasound was performed showing only clear endometrial cavity and areas from recent D and C in the cervix. No continued hyperechoic masses were noted. The patient’s bleeding continued to minimize. All instrumentation was then removed from the vaginal canal. All vital signs remained stable. The unit of packed red blood cells was started intraoperatively and continued postoperatively. The patient was also ordered to have 1 unit of FFP. In addition, a DIC panel was ordered intraoperatively. All sponge, lap, and needle counts were correct x2, and the patient was transferred to recovery room in stable condition. Ultrasound Echography Transvaginal TRANSVAGINAL PELVIC ULTRASOUND
EXAM DATE: 07/12/20XX
INDICATION: C-section 05/05/20XX, patient presents with bleeding.
TECHNIQUE: Transvaginal gray-scale sonography of the pelvis was performed. Supplemental color Doppler vascular flow imaging was performed to identify vascular structures as needed.
COMPARISON: None.
FINDINGS: (left blank)
UTERUS: The uterus appears normal. The uterus measures 7.8 x 4.5 s 5.4 cm in size. The endometrial stripe measures 21 mm. Color Doppler signal is noted within the endometrium. A lobulated hyperechoic and mildly heterogeneous structure seen within the cervix, measuring 15 mm. There is associated shadowing.
RIGHT OVARY: Right ovary appears normal. The right ovary measures 3.5 x 1.7 x 3.4 cm in size.
LEFT OVARY: Left ovary appears normal. The left ovary measure 3.0 x 1.4 x 3.1 cm in size.
PELVIS: No free fluid present. IMPRESSION:
1 - Thickened and hyperemic endometrium.
2 - Indeterminate hyperechoic shadowing structure within the cervix, measuring 15 mm. Pathology Report COLLECTED: 07/12/20XX
RECEIVED: 07/13/20XX DIAGNOSIS: Retained placental tissue: degenerated chorionic villi with associated blood, fibrin, and mixed inflammation.
GROSS DESCRIPTION: Received in a container labeled with the patient’s name, designated “retained placenta” and consisting of multiple fragments of purple tan tissue and blood clot, 8.0 x 6.5 x 3.5 cm and 74 g in aggregate. A 1.8 cm fragment of gray-tan tissue suggestive of placental tissue is noted. This is sectioned and submitted entirely as A and B. additional representative portions of the specimen are submitted as C through F.
MICROSCOPIC EXAMINATION: Sections demonstrate fragments of retained placental tissue, consisting of degenerated chorionic villi with associated blood, fibrin, acute and chronic inflammation, and calcifications. Focal detached myometrial smooth muscle is present. Placenta accrete is not demonstrated. Previous pathology reports are reviewed. Progress Notes 07/12/20XX 0730. Patient has had minimal bleeding today. Pain 0. 07/12/20XX 1400. Patient doing well with minimal vaginal bleeding. No pain or cramping. 07/13/20XX 1010. Doing well this morning. No recall or anesthesia complications.
Discharge Summary
DISCHARGE DATE: 07/13/20XX
ADMITTING DIAGNOSIS: A 30-year-old with vaginal bleeding, retained placenta.
DISCHARGE DIAGNOSIS: Same. PROCEDURES PERFORMED: Initial observation followed by repeat dilation and curettage, transfusion of 2 units of packed red blood cells and 1 unit of fresh frozen plasma. INDICATIONS FOR ADMISSION: The patient is a 30-year-old, who underwent a dilation and curettage on 07/11/20XX for retained products 6-8 weeks postpartum. She did well until at home began having accelerated bleeding and was instructed to come back to the emergency department. HOSPITAL COURSE: The patient was seen in the emergency department and on ultrasound noted to have a clear endometrial lining but small 1 cm area within the cervix of hypoechoic clot or retained products. She was admitted for initial conservative management due to decreased bleeding. She received 2 doses of Cytotec. A repeat ultrasound before noon on 07/12/20XX demonstrated continued area of hypoechoic in the cervix. Decision was made to proceed for repeat dilation and curettage. Repeat dilation and curettage was performed on 07/12/20XX. At that point, the patient had accelerated bleeding again losing approximately 1000 cc in the operating room. The patient was given 1 unit of blood starting in the operating room and a second one postoperatively. Bleeding was controlled using Cytotec per rectum as well as a dose of Hemabate and dose of Methergine intraoperatively. Postoperatively, the patient was transferred back to Obstetrics. The patient’s vital signs remained stable throughout the night. She was ambulating. Foley catheter was continued for strict input and output management. On examination on 07/12/20XX, blood pressure was 117/76, heart rate was 54. Inputs and outputs were 7450 in, 6350 out. The patient was ambulating, tolerating regular diet. Postoperative day #1, the patient was ultimately discharged on antibiotics which were initially started postoperatively. She was discharged on Keflex 500 orally every 6 hours for 5 days. She was given strict instructions in terms of vaginal bleeding and follow-up in 1 week. John Kramer, MD Electronically signed by JOHN KRAMER, MD 7/12/20XX Diagnosis 1:

1 points
Question 35
1. Procedure 1:

1 points
Question 36
1. Procedure 2:

1 points
Question 37
1. Procedure 3:

1 points
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