MSQH would like to conduct a research on the performance of the Health Information

Management System (HIMS) in MSQH accredited hospitals. We need your assistance to obtain
some information on the services from the Facility as indicated below. All information provided
will be kept strictly confidential. Please complete this form and return to the MSQH.

1. Facility Code :

2. Qualification of Medical Records Officer in-charge:

3. Number of ICD coder :

4. Number of medical records audit done per year (Last 5 years):

5. Percentage of medical records audited per year (Last 5 years):

6. Issues found during medical records audit :

Inadequate personal particulars of the patients

‘Alert” notation not displayed in the medical records
Illegible writing
Incompleteness of medical records
No signature from author/person making the entry

Others:

Name : Date:

Your participation in the research is important and appreciated. Thank you.