Medical Records Technician Certificate Click here to request more info


Program Contacts

Program Director Nancy Bowers (928) 776-2252
Instructional Specialist Stephanie Kallam (928) 771-6122
Dean Scott Farnsworth (928) 776-2234

Quick Facts


About the Medical Records Technician Certificate

The Medical Records Technician certificate prepares students for employment in a physician's office, acute care setting and/or long-term care setting.

Program Outcomes

Upon successful completion of the Medical Records Technician Certificate program, the learner will be able to:

 

  1. Describe the Health Information Management (HIM) process including legal and ethical implications. (HIM 110, HIM 173)
  2. Define elements in the medical word building system. (AHS 130)
  3. Correctly spell and pronounce medical terms. (AHS 130)
  4. Apply basic computer skills. (CSA 126)
  5. Identify and describe the structure and function of major organs and body systems. (BIO 160, BIO 201 & BIO 202)
 

Program-Specific Requirements

Course Course Title Hours
AHS130 Medical Term for Patient Care

COURSE DESCRIPTION:
AHS 130. Medical Terminology for Patient Care Staff (3). Medical terminology used in direct patient care, with special care populations and in special services. Building and analyzing terms using work parts. Body-systems approach to terms related to structure and function, pathologies, and diagnostic procedures. Spelling and pronunciation of terms, medical abbreviations and symbols. Prerequisite: Reading Proficiency. Three lecture.

COURSE CONTENT:
1. Introduction to Medical Terminology
a. Basic work structure
b. Body as a whole
c. Common combining forms, suffixes, and prefixes
2. Body Systems
a. Structures
b. Functions
c. Pathologies
d. Diagnostics
e. Clinical procedures
f. Additional suffices, prefixes, combining forms
g. Abbreviations
3. Obstetrics
a. Conception and pregnancy
b. Hormonal interactions
c. Pregnancy and neonatal pathologies
d. Clinical tests and procedures related to obstetrics
e. Additional suffixes, prefixes, combining forms
f. Abbreviations
4. Cancer Medicine (Oncology)
a. Carcinogenesis
b. Characteristics, classification, grading, and staging of tumors
c. Pathological descriptions
d. Diagnostic, clinical procedures, and treatment terms
e. Additional suffixes, prefixes, combining forms
f. Abbreviations
5. Radiology and Nuclear Medicine
a. X-ray properties, positioning, and techniques
b. Radioactive and radionuclide tests
c. In vitro and in vivo procedures
d. Additional suffixes, prefixes, combining forms
e. Abbreviation
6. Psychiatry/Mental Health
a. Introduction
b. Clinical symptoms and disorders
c. Terminology related to treatment
d. Additional suffixes, prefixes, combining forms
e. Abbreviations

LEARNING OUTCOMES:
1. Divide medical words into their component parts (1a)
2. Define the meaning of basic combining forms, suffixes, and prefixes (1a,c, 2f, 3e, 4e, 5d, 6d)
3. Use combining forms, suffixes, and prefixes to build medical terms (1a,c, 2f, 3e, 4e, 5d, 6d)
4. Identify and define terms pertaining to the body as a whole (1b)
5. Describe positions, directions, and planes of the body (1b)
6. Name the locations and/or structures of body systems (2a)
7. Describe the functions of body systems (2b)
8. Describe disease processes and symptoms that affect body systems (2c)
9. List and explain diagnostic tests and clinical procedures common to different body systems (2d,e)
10. Identify abbreviations common to body systems, pathologies, tests, clinical procedures, and specialty areas (2g, 3f, 4f, 5e, 6e)
11. Explain how female reproductive organs and hormones function in the process of conception and pregnancy. (3a,b)
12. Identify abnormal conditions of the pregnancy and the neonate. (3c)
13. Explain important clinical tests and procedures related to obstetrics (3d)
14. Define terms that describe the growth and spread of cancer. (4a)
15. Recognize terms related to classification, grading and staging of tumors. (4b)
16. Describe oncology pathologies, diagnostics, clinical procedures and treatments (4c,d)
17. Explain terms related to x-ray properties, positioning, and techniques (5a)
18. Define terms used to describe radioactive and radionuclide tests (5b,c)
19. Differentiate between different metal health specialists. (6a)
20. Define terms that describe psychiatric symptoms and disorders. (6b)
21. Describe different psychiatric treatments and common psychiatric drugs. (6c)

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BIO160 Intro Human Anat & Physiology

COURSE DESCRIPTION:
BIO 160. Introduction to Human Anatomy and Physiology (4). Principles of scientific method. Structural organization, homeostasis and control mechanisms of the body. Specific chemistry concepts. Structure and function of the major systems of the body. Prerequisite: Reading Proficiency. Three lecture. Three lab.

COURSE CONTENT:
1. Scientific method and physiological measurements
2. Structural organization of the body
3. Homeostasis and homeostatic control mechanisms
4. Specific chemistry concepts of the body
5. Integumentary system
6. Skeletal system and joints
7. Muscular system
8. Nervous system
9. Endocrine system
10. Cardiovascular system
11. Lymphatics and immune system
12. Respiratory system
13. Digestive system
14. Urinary system
15. Reproductive system

LEARNING OUTCOMES:
1. Use the scientific method to evaluate basic principles of human physiology. (1) (PBS 1,2)
2. Identify the unifying themes of human anatomy and physiology. (2) (PBS 2)
3. Interpret numerical and graphical presentations of physiological data. (1, 12) (PBS 2,3)
4. Explain the role of specific tools and equipment utilized in clinical evaluation of human physiology. (1) (PBS 2,4)
5. Record or evaluate investigative results. (1) (PBS 2,3,5)
6. Describe the structural organization of the body. (2)
7. Describe homeostasis and homeostatic control mechanisms. (3)
8. Describe the specific chemistry concepts of the body. (4)
9. Describe the structure and function of the integumentary system and body membranes, skeletal system and joints, muscular system, nervous system, endocrine system, cardiovascular system, lymphatic system and immunity, respiratory system, digestive system, urinary system, and the reproductive system. (5-15)

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OR BIO201 Human Anatomy & Physiology I

COURSE DESCRIPTION:
BIO 201. Human Anatomy and Physiology I (4). Shared Unique Numbering LogoBIO 2201. Structure and function of the human body. Topics include cells, tissues, integumentary, muscular, skeletal, and nervous systems. Prerequisite: BIO 156 or BIO 181. Reading Proficiency. Three lecture. Three lab.

COURSE CONTENT:
1. Anatomical terms and homeostasis
2. Cytological and histological anatomy and functions
3. Integumentary system
4. Anatomy and physiology of the skeletal system
5. Axial and appendicular skeleton, joints
6. Anatomy and physiology of the muscular system
7. Gross and microscopic anatomy of muscles
8. Muscle contraction
9. Anatomy and physiology of the nervous system
10. The central and peripheral nervous systems
11. The automatic nervous system
12. The senses

LEARNING OUTCOMES:
1. Identify the parts of a typical cell and describe their function and structure. (1, 2)
2. Identify and describe the four basic tissue types, their anatomy and functions. (1, 2)
3. Describe the anatomy and functions of the integumentary system. (1, 3)
4. Identify and describe the anatomy and physiology of the skeletal system. (1, 4)
5. Identify and describe the anatomy of joints, axial and appendicular skeletal systems. (1, 5)
6. Identify and describe the anatomy and physiology of the muscular system. (1, 6)
7. Identify and describe the gross and microscopic anatomy of muscles. (1, 7)
8. Describe the biological processes involved in muscle contraction. (1, 8) (PBS 1)
9. Identify and describe the anatomy and physiology of the nervous system. (1, 9)
10. Describe and identify brain and spinal cord anatomy and reflexes. (1, 10)
11. Describe the biological processes involved in the nerve impulse. (1, 10, 11)
12. Describe and identify the anatomy and physiology autonomic nervous system. (1, 10, 11)
13. Describe and identify the anatomy and physiology of the senses. (1, 12) (PBS 2,3)
14. Use scientific reasoning to evaluate the systems of the human body. (3-12)
15. Identify the broad themes that unify studying the systems of the body. (1-12)
16. Interpret the numerical and/or graphical representation of physiological data and anatomical structures. (1-12) (PBS 2)
17. Use the tools and equipment necessary for scientific analysis and research on physiological data and anatomical structures. (2-12)
18. Record the results of investigation through writing. (1-12)

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AND BIO202 Human Anatomy & Physiology II

COURSE DESCRIPTION:
BIO 202. Human Anatomy and Physiology II (4). Shared Unique Numbering LogoBIO 2202. Structure and function of the human body. Topics include reproductive, endocrine, circulatory, respiratory, urinary, and digestive systems. Prerequisite: BIO 201. Reading Proficiency. Three lecture. Three lab.

COURSE CONTENT:
1. Anatomy and physiology of endocrine glands
2. Hormonal actions
3. Anatomy and physiology of the reproductive system
4. Anatomy and physiology of blood
5. Anatomy and physiology of the lymphatic system
6. Anatomy and physiology of the immune system
7. Fetal membranes and blood circulation
8. Anatomy and physiology of the digestive system
9. Metabolism
10. Anatomy and physiology of the circulatory system
11. Blood pressure and flow dynamics
12. Anatomy and physiology of the respiratory system
13. Ventilation mechanisms and gas transport
14. Anatomy and physiology of the urinary system
15. Urine formation

LEARNING OUTCOMES:
1. Describe the anatomy and physiology of endocrine glands. (1)
2. Describe the biological processes involved in hormonal actions. (2)
3. Identify and describe the anatomy and physiology of the reproductive system. (3)
4. Describe the anatomy and functions of blood. (4)
5. Identify and describe the anatomy and physiology of the lymphatic system. (5)
6. Identify and describe the anatomy and physiology of the immune system. (6)
7. Identify and describe the anatomy and physiology of fetal membranes and circulation. (7)
8. Identify and describe the anatomy and physiology of the digestive system. (8)
9. Describe the biological processes involved in metabolism. (9)
10. Identify and describe the anatomy and physiology of the circulatory system. (10)
11. Describe the biological processes involved in blood pressure dynamics. (11)
12. Identify and describe the anatomy and physiology of the respiratory system. (12)
13. Describe and identify ventilation mechanisms. (13)
14. Identify and describe the anatomy and physiology of the urinary system. (14)
15. Describe the biological processes involved urine formation. (15)
16. Use scientific reasoning to evaluate the systems of the body. (1-15) (PBS 1)
17. Identify the broad themes that unify studying the systems of the body. (1-15)
18. Interpret the numerical and/or graphical representation of physiological data and anatomical structures. (1-15) (PBS 2)
19. Use the tools and equipment necessary for scientific analysis and research on physiological data and anatomical structures. (1-15) (PBS 2,3)
20. Record the results of investigation through writing. (1-15)

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BSA102 Career Search and Success

COURSE DESCRIPTION:
BSA 102. Career Search and Success: Skills for Entering and Succeeding in the Workplace (1). Techniques to enhance and emphasize the relationship between resume development and job search skills. Includes a strong focus on human relations in the workplace. One lecture.

COURSE CONTENT:
1. Job search skills and employability packet including: labor market analysis; networking and job lead development; application, resume and cover letter preparation; the interview process
2. Personal financial management
3. Workplace communication and teamwork skills
4. Workplace ethics, attitudes, absenteeism, stress management skills
5. Elements of critical thinking and decision-making including setting career and educational goals

LEARNING OUTCOMES:
1. Identify employment opportunities for a field of study. (1)
2. Produce an employability packet (i.e. application, resume, cover letter, work sample, reference letter). (1)
3. Prepare for and participate in employment interview activities. (1)
4. Assess various types of communication and teamwork skills in the workplace. (3)
5. Discuss workplace ethics, attitudes, absenteeism, stress management. (4)
6. Describe the strategies involved in decision making in a job search. (5)
7. Evaluate job search efforts. (1)
8. Develop a career/educational plan. (5)
9. Identify importance of money management and budgeting. (2)

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CSA126 Microsoft Office

COURSE DESCRIPTION:
CSA 126. Microsoft Office (3). Introductory concepts and techniques of Microsoft Office including Word, Excel, Access, and PowerPoint. Three lecture.

COURSE CONTENT:
1. Windows concepts and skills
2. Microsoft Word for Windows
3. Microsoft Excel for Windows
4. Microsoft Access for Windows
5. Microsoft PowerPoint for Windows
6. Integration of Microsoft Office applications

LEARNING OUTCOMES:
1. Use file management and other basic Windows skills. (1)
2. Produce and edit word processing documents. (2)
3. Produce and edit spreadsheets and charts. (3)
4. Create a database, enter and manipulate data, create queries and reports. (4)
5. Produce and edit presentation graphics documents. (5)
6. Produce a document that integrates the use of two or more Office applications. (6)

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HIM110 Intro to Hlth Info Mgmt

COURSE DESCRIPTION:
HIM 110. Introduction to Health Information Management (3). Introduction to the history, evolution and functions performed in the Health Information Management profession. Emphasis on health record content and use within and outside the Health Information Management (HIM) Department. Three lecture.

COURSE CONTENT:
1. History, certification and accreditation
2. The health record
3. Record filing and numbering systems
4. Data sets and standards
5. Clinical vocabularies and classification systems
6. Health Information Management (HIM) department
7. Registries and indexes
8. Data sources, primary and secondary
9. Performance improvement, utilization management and review
10. Ethical issues
11. Health services organizations and delivery
12. Information technology, systems and security
13. Organizational and human resource management

LEARNING OUTCOMES:
1. Compare educational programs and professional credentials offered by the American Health Information Management Association and related organizations. (1) Domain III.A.1-2
2. Asses the role of the Health Information Management (HIM) profession in health care delivery and outline how HIM professional interact with other healthcare professionals. (1,11) Domain III.A.2
3. Report on the structure and functions of a typical HIM department. (6) Domain I.A.2
4. Summarize the structure, purposes, functions and the users of health records. (2) Domain I.A.1-4, B.1-4
5. Examine health record filing and numbering systems and describe their advantages and disadvantages in specific types of health care settings. (3) Domain I.A.1
6. Distinguish the purpose, types and use of healthcare data sets. (4) Domain I.A.1, I.A.4
7. Compare clinical vocabularies and classification systems and describe their function, structure and use. (5) Domain I.C.6
8. Classify routine functions and services performed within the HIM department. (6) Domain I.B.1-4
9. Articulate the purpose, development and maintenance of common registries and indexes in relationship to Health Information Management. (7) Domain II.A.1
10. Outline the appropriateness of data and data sources for patient care, management, billing, reports, registries and databases. (8) Domain I.A.4, II.A.1
11. Explain the role of a HIM professional in performance improvement, utilization management and risk management. (9) Domain II.B.1, II.B.2
12. Discuss ethical principles and professional values. (10) Domain III.B.5
13. Connect the organization and components of health care delivery systems and the applicable health information initiatives and standards. (11) Domain III.A.1
14. Correlate basic computer concepts relevant to hardware and software, internet technologies and health information applications. (12) Domain IV.A.1, IV.A.2
15. Connect the principles, functions and usual practices of organizational resource management (human or material), leadership and work planning. (13) Domain V.A.1, V.A.7.,V.B.1, V.B.2

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HIM173 Legal & Ethical Aspects of HIM

COURSE DESCRIPTION:
HIM 173. Legal and Ethical Aspects of Health Information Management (2). Application of general principles of law and ethics as related to health information management and patient record management in an electronic, hybrid or paper environment. Legal and ethical issues, legal terminology, records law, patient rights, privacy and security and regulations. Two lecture.

COURSE CONTENT:
1. Legal concepts and processes
2. Legal terminology
3. Health record as a legal document
4. Confidentiality, privacy and security
5. Patient rights
6. Quality assessment and improvement
7. Health care compliance and security
8. Professional and practice-related ethical issues

LEARNING OUTCOMES:
1. Explain how legal and regulatory requirements relate to legal concepts and processes in health care and in health information management (HIM). (1,2,4) Domain III.B.1
2. Summarize the structure, purposes, functions and the users of health records. (3) Domain I.B.1-2
3. Release patient records in accordance with policies and procedures for access and disclosure of personal health information. (4,5,7) Domain III.B.2
4. Assess user access logs/systems to track access to, and disclosure of, identifiable patient data. (4,7) Domain III.B.4
5. Collect, organize and present data for quality management, utilization management and risk assessment pertinent to monitoring the privacy and security of health data. (6) Domain II.A.2
6. Release patient-specific data to authorized users when appropriate. (4) Domain II.B.3
7. Assess organizational policies and procedures to ensure compliance and security regulations and standards are met. (7) Domain I.B.2
8. Argue the validity of ethical standards of practice and summarize their applicability to HIM standards of practice. (8) Domain III.B.5

Domains listed refer to CAHIIM Curriculum requirements.

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