What is Medical Transcription?

Medical Transcription is the process of converting voice dictation (typically ei ther cassette or digital format) into a permanent written record utilizing word processing equipment and software. Each day in hospitals all over the country, thousands of patients are admitted a nd discharged. Examinations are conducted, procedures are performed and recommen dations are made. It is not uncommon for multiple physicians to be involved in a simple procedure for a single patient. Radiologists, Pathologists, Anesthesiolo gists, Surgeons, and a host of other medical specialists must all coordinate the ir efforts to ensure that patient care is both adequate and appropriate. Underpinning all of these activities is a complex web of medical and patient inf ormation. Each patient-related activity and procedure must be meticulously docum ented and then added to the patient's permanent record. Physicians and medical r ecord handlers alike must be extremely careful to ensure that detailed patient i dentification information accompanies each procedure and examination report to a vert potentially disastrous mix-ups. Over time, all of this information accumula tes in a centralized medical records repository where it serves as a critical re source for patient care - facilitating accurate diagnoses and appropriate treatm ents. Indeed, timely patient care often hinges on the ability of Radiology, Path ology, and other specialty departments to quickly conduct their examinations and report their findings. Click Here for Free Information on the Medical Transcription School MTWorld.com Recommends Evolution and History of Medical Transcription In the past, these reportings consisted of very abbreviated handwritten notes th at were funneled into the patient's file for interpretation by the primary physi cian responsible for diagnosing ailments and prescribing treatment. Ultimately, this hodge-podge of handwritten notes and typed reports was consolidated into a single patient file and physically stored along with thousands of other patient records in a wall of filing cabinets in the medical records department. Whenever the need arose to review the records of a specific patient, the patient 's file would be retrieved from the filing cabinet and delivered to the requesti ng physician. To enhance this manual process, many medical record documents were produced in duplicate or triplicate by means of carbon copy. In recent years things have changed considerably. Walls of filing cabinets have given way to desktop computers connected to powerful mainframe systems where pat ient records are prepared and archived digitally. This digital format allows for immediate remote retrieval by any physician who is authorized to review the pat ient information. Reports are stored electronically and printed selectively as t he need arises. While the transition from a paper based to an electronic format will take years to complete, considerable progress has been made. Handwritten reports are largel y a thing of the past. Verbal dictation is now by far the most common method for documenting and reporting the results of examinations and procedures. Physician s generally use either a cassette based voice dictation system or a digital voic e dictation system to record their findings. Dictating reports verbally not only allows physicians to be more thorough in their reporting, it also saves them a great deal of time. The Wall Street Journal recently reported the results of a s tudy conducted by the Association of Legal Administrators suggesting that verbal dictation is the fastest way to create a document. The study states that "a 245 -word document takes 9.34 minutes to create with an electronic dictaphone, compa

red with 16.46 minutes on a personal computer and 16.49 minutes by hand." (WSJ, Tuesday, October 22, 1996, page A1, column 5). Given the salaries of most physic ians, the cumulative productivity savings associated with these technological en hancements is considerable. The process of converting voice dictation to a typewritten format is known as tr anscription. Traditionally a staff of skilled medical transcriptionists working in the medical records department of the hospital has accomplished the work of t ranscribing medical records. In the early years of medical transcription it was not uncommon for very large hospitals to have staffs of 40 or 50 medical transcr iptionists working one or more shifts. A transcription supervisor, who in turn r eported to the Medical Records Director, generally oversaw these transcriptionis ts. Click Here for Free Information on the Medical Transcription School MTWorld.com Recommends The Outsourcing Trend Increasingly, traditional hospitals are coming under competitive attack by more efficient managed care organizations. In an effort to remain competitive, many h ospitals have turned to outsourcing as a means of cutting costs. Many of the pro cesses that were previously performed internally are now being contracted out to third parties. Medical transcription is no exception. The outsourcing of transc ription and other functions relieves hospitals of the administrative headaches a nd overhead burdens associated with internal production and allows them to focus their attention on improving service and lowering costs. This new competitive climate has driven many hospitals out of business. Those or ganizations that have survived have done so by becoming more efficient and costconscious. There is considerable evidence to suggest that contracting out medica l transcription is a much less costly alternative to producing reports internall y. Most savvy healthcare providers today understand this and are responding appr opriately. The significant cost-cutting pressures which continue to drive the in dustry toward consolidation, managed care and capitation virtually guarantee tha t the outsourcing trend will not only continue but accelerate in coming years. This proliferation of outsourcing agreements has spawned a new generation of sma ll medical transcription companies intent on carving out a piece of the pie. Int erestingly, in spite of its rapid growth, the medical transcription industry is still considered a cottage industry. While there are a few truly national player s, the industry is at this point still dominated by the hundreds of small local transcription companies located wherever hospitals are found. Opportunities The outlook for quality medical transcriptionists have never been greater. Lucra tive opportunities abound today in hospitals, clinics, HMO's, and in the hundred s of Medical Transcription contracting companies located throughout the country. The timing is excellent for anyone interested in entering this exciting and lucr ative field. Like any career move, success will require patience and perseveranc e, but the opportunity to enter the medical transcription market has never been greater than it is today. Benefits The demand for Medical Transcriptionists is very great. There is currently a sho rtage of qualified Medical Transcriptionists - and demographic trends suggest th at the outlook will continue to be favorable for some time to come. Good Medical Transcriptionists typically have no problem obtaining and maintaining employmen t. Consider the following benefits of becoming a professional Medical Transcript

ionist: In-demand Profession Excellent Income Potential Flexible Hours Growth Industry Exceptional Home Based Career Opportunities Potential to get your own Clients and Build a Lucrative Business Basic Qualifications Medical Transcription is a highly skilled profession. It requires an attention t o detail and an ability to recognize and understand technical terminology. Good typing skills are a must. Typically an accurate typing speed of 50-70 words per minute is a prerequisite for most positions. Obviously the faster you type the m ore money you will be able to make as most pay is on a production basis. Spelling and grammar skills are also vitally important. On-line dictionaries and spell checks are always available to assist you, but they should not be relied upon completely. You should feel relatively well grounded in spelling and gramma r before you decide to enter this field. Most of the skill that you will acquire as a transcriptionist will come over tim e. Experience is the great teacher. Prior to gaining hands on experience, it is usually wise to go through a formal course to gain a foundation of knowledge and practical experience. Getting Started Medical Transcription is a very specialized field and requires extensive trainin g. Once trained, however, the demand is very great. One of the most difficult pa rts of breaking into this lucrative industry is receiving the requisite training . Your income potential will typically be determined by your skill level. And sk ill level will be a function of training and experience. Unfortunately, you will find that most employers will be reluctant to hire inexperienced individuals. T he learning curve can be quite steep and it will be difficult to find an employe r that is willing to invest the time and money necessary to train a person. There are a number of opportunities to receive the in-depth training necessary t o become a proficient Medical Transcriptionist. Many Technical Schools have full -time programs designed to provide a basic level of proficiency. The drawbacks w ith these programs is that they tend to be expensive and they generally require a full-time commitment - which involves quitting a job and foregoing income duri ng the course of study. An alternative to these full-time classroom training programs is the Home Study Course. Home study certainly requires a more disciplined attitude, but the cost / benefits as well as the ability to work at your own pace and in your own home are appealing. With a Home Study Course there is no need to quit your present jo b - until you have achieved a basic skill level and are ready to begin your new career. Indeed, it is often possible to begin your first Medical Transcription job on a part time basis in the evenings following completion of the home study course wh ile maintaining your present employment. This "earn while you learn" approach is a good way to develop additional proficiency while still retaining the safety n et of a full time job. Normal Lab Values

HEMATOLOGY VALUES Red Blood Cell Values RBC (Male) 4.2 - 5.6 M/L RBC (Female) 3.8 - 5.1 M/L RBC (Child) 3.5 - 5.0 M/L White Blood Cell Values WBC (Male) 3.8 - 11.0 K / mm cubed WBC (Female) 3.8 - 11.0 K / mm cubed WBC (Child) 5.0 - 10.0 K / mm cubed Hemoglobin Values Hgb (Male) 14 - 18 g/dL Hgb (Female) 11 - 16 g/dL Hgb (child) 10 - 14 g/dL Hgb (Newborn) 15 - 25 g/dL Hematocrit Values Hct (Male) 39 - 54% Hct (Female) 34 - 47% Hct (Child) 30 - 42% MCV 78 - 98 fL MCH 27 - 35 pg MCHC 31 - 37% Neutrophils 50 - 81% Bands 1 - 5% Lymphocytes 14 - 44% Monocytes 2 - 6% Eosinophils 1 - 5% Basophils 0 - 1% CARDIAC MARKERS Troponin I 0 - 0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs, return : 4-7 days) Troponin T 0 - 0.2 ng/ml (onset: 3-4 hrs, peak: 10-24 hrs, return : 10-14 days) Myoglobin (Male) 10 - 95 ng/ml (onset: 1-3 hrs, peak: 6-10 hrs, normal: 12-24 hrs) Myoglobin (Female) 10 - 65 ng/ml (onset: 1-3 hrs, peak: 6-10 hrs, normal: 12-24 hrs) GENERAL CHEMISTRY Acetone 0.3 - 2.0 mg% Albumin 3.5 - 5.0 gm/dL Alkaline Phosphatase 32 - 110 U/L Anion gap 5 - 16 mEq/L Ammonia 11 - 35 mol/L Amylase 50 - 150 U/dL AST, SGOT (Male) 7 - 21 U/L AST, SGOT (Female) 6 - 18 U/L Bilirubin, Direct 0.0 - 0.4 mg/dL Bilirubin, Indirect total minus direct Bilirubin, Total 0.2 - 1.4 mg/dL BUN 6 - 23 mg/dL Calcium (total) 8 - 11 mg/dL Carbon dioxide 21 - 34 mEq/L Carbon monoxide symptoms at greater than or equal to 10% saturation Chloride 96 - 112 mEq/L Creatine (Male) 0.2 - 0.6 mg/dL Creatine (Female) 0.6 - 1.0 mg/dL Creatinine 0.6 - 1.5 mg/dL Ethanol 0 mg%; Coma: greater than or equal to 400 - 500 mg% Folic acid 2.0 - 21 ng/mL

to normal to normal return to return to

Glucose 70 - 110 mg/dL (diuresis greater than or equal to 180 mg/dL) HDL (Male) 25 - 65 mg/dL HDL (Female) 38 - 94 mg/dL Iron 52 - 169 g/dL Iron binding capacity 246 - 455 g/dL Lactic acid 0.4 - 2.3 mEq/L Lactate 0.3 - 2.3 mEq/L Lipase 10 - 140 U/L Magnesium 1.5 - 2.5 mg/dL Osmolarity 276 - 295 mOsm/kg Parathyroid hormone 12 - 68 pg/mL Phosphorus 2.2 - 4.8 mg/dL Potasssium 3.5 - 5.5 mEq/L Protein (total) 6.0 - 9.0 gm/dL SGPT 8 - 32 U/L Sodium 135 - 148 mEq/L T3 0.8 - 1.1 g/dL Thyroglobulin Less than 55 ng/mL Thyroxine (T4) total 5 - 13 g/dL Total protein 5 - 9 gm/dL TSH Less than 9 U/mL Urea nitrogen 8 - 25 mg/dL Uric acid (Male) 3.5 - 7.7 mg/dL Uric acid (Female) 2.5 - 6.6 mg/dL LIPID PANEL (ADULT) Cholesterol (total) Less than 200 mg/dL desirable Cholesterol (HDL) 30 - 75 mg/dL Cholesterol (LDL) Less than 130 mg/dL desirable Triglycerides (Male) Greater than 40 - 170 mg/dL Triglycerides (Female) Greater than 35 - 135 mg/dL URINE VALUES Color Straw Specific Gravity 1.003 - 1.040 pH 4.6 - 8.0 Na 10 - 40 mEq/L K Less than 8 mEq/L Cl Less than 8 mEq/L Protein 1 - 15 mg/dL Osmolality 80 - 1300 mOsm/L 24 HOUR URINE VALUES Amylase 250 - 1100 IU / 24 hr Calcium 100 - 250 mg / 24 hr Chloride 110 - 250 mEq / 24 hr Creatinine 1 - 2 g / 24 hr Creatine Clearance (Male) 100 - 140 mL / min Creatine Clearance (Male) 16 - 26 mg / kg / 24 hr Creatine Clearance (Female) 80 - 130 mL / min Creatine Clearance (Female) 10 - 20 mg / kg / 24 hr Magnesium 6 - 9 mEq / 24 hr Osmolality 450 - 900 mOsm / kg Phosphorus 0.9 - 1.3 g / 24 hr Potassium 35 - 85 mEq / 24 hr Protein 0 - 150 mg / 24 hr Sodium 30 - 280 mEq / 24 hr Urea nitrogen 10 - 22 gm / 24 hr Uric acid 240 - 755 mg / 24 hr COAGULATION ACT 90 - 130 seconds APTT 21 - 35 seconds Platelets 140,000 - 450,000 / ml

Plasminogen 62 - 130% PT 10 - 14 seconds PTT 32 - 45 seconds FSP Less than 10 g/dL Fibrinogen 160 - 450 mg/dL Bleeding time 3 - 7 minutes Thrombin time 11 - 15 seconds CEREBRAL SPINAL FLUID Appearance clear Glucose 40 - 85 mg/dL Osmolality 290 - 298 mOsm/L Pressure 70 - 180 mm/H2O Protein 15 - 45 mg/dL Total cell count 0 - 5 cells WBC's 0 - 6 / L HEMODYNAMIC PARAMETERS Cardiac Index 2.5 - 4.2 L / min / m squared Cardiac Output 4 - 8 LPM Left Ventricular Stroke Work Index 40 - 70 g / m squared / beat Mean Arterial Pressure 70 - 105 mm Hg Pulmonary Vascular Resistance 155 - 255 dynes / sec / cm to the negative 5 Pulmonary Vaslular Resistance Index 255 - 285 dynes / sec / cm to the negati ve 5 Right Ventricular Stroke Work Index 7 - 12 g / m squared / beat Stroke Volume 60 - 100 mL / beat Stroke Volume Index 40 - 85 mL / m squared / beat Systemic Vascular Resistance 900 - 1600 dynes / sec / cm to the negative 5 Systemic Vascular Resistance Index 1970 - 2390 dynes / sec / cm to the nega tive 5 Systolic Arterial Pressure 90 - 140 mm Hg Diastolic Arterial Pressure 60 - 90 mm Hg Central Venous Pressure 2 - 6 mm Hg; 2.5 - 12 cm H2O Ejection Fraction 60 - 75% Left Arterial Pressure 4 - 12 mm Hg Pulmonary Artery Systolic 15 - 30 mm Hg Pulmonary Artery Diastolic 5 - 15 mm Hg Pulmonary Artery Pressure 10 - 20 mm Hg Pulmonary Artery Wedge Pressure 4 - 12 mm Hg Pulmonary Artery End Diastolic Pressure 8 - 10 mm Hg Right Atrial Pressure 4 - 6 mm Hg Right Ventricular End Diastolic Pressure 0 - 8 mm Hg NEUROLOGICAL VALUES Cerebral Perfusion Pressure 70 - 90 mm Hg Intracranial Pressure 5 - 15 mm Hg or 5 - 10 cm H2O ARTERIAL VALUES pH 7.35 - 7.45 PaCO2 35 - 45 mm Hg HCO3 22 - 26 mEq/L O2 sat 96 - 100% PaO2 85 - 100 mm Hg BE -2 to +2 mmol/L VENOUS VALUES pH 7.31 - 7.41 PaCO2 41 - 51 mm Hg HCO3 22 - 29 mEq/L O2 sat 60 - 85% PaO2 30 - 40 mm Hg BE 0 to +4 mmol/L

What is Medical Terminology? Medical terminology refers to the words and phrases which have been developed to describe the procedures, medications, instruments, anatomical structures, etc. used in the field of medicine. It is, in a very real sense, the language of medi cine. Medical terminology has a long and rich history. Most medical terms derive from Latin or Greek. So if at first medical terminology appears to be a foreign langu age - well... that's because it is! But don't despair. Like any language, the la nguage of medicine adheres to a set of fairly simple rules. Free Info on our recommended Medical Transcription Program leading to an excitin g Home Based Medical Transcription Career The Structure of Medical Terminology It may seem like an impossible task to commit the spelling and meaning of 100,00 0 different medical terms to memory - and in fact, for most of us it is. Fortuna tely, it is not necessary. The fact is that most seemingly complex medical terms are simply combinations of much smaller subsets of word parts. This is a critic ally important concept to understand with medical terminology. It is not unreasonable to expect to memorize several hundred medical prefixes, m edical suffixes and medical root words in a relatively short period of time. The n, once these word parts are learned, they can be combined to form literally tho usands of complex medical terms. How are Medical Terms Constructed? Most medical terms consist of one or more parts. These word parts may include on e or more of the following: Root Words Prefixes Suffixes Combining Vowels To help you better understand how this works, let's look at an example. Consider the word cholecystectomy. At first glance, this word seems quite comple x. Cholecystectomy, which means excision (removal) of the gall bladder, is reall y a combination of four different word parts. Let's break it down into its sub p arts and see if we can figure out why it means what it means. chol - e - cyst - ectomy chol is a root word meaning bile or gall e is a combining vowel (described in more detail below) cyst is another root word meaning bladder ectomy is a suffix which translates to excision or surgical removal. Therefore, we can see that cholecystectomy is a combination of words which trans late to mean surgical removal of the gall bladder. Each of these word parts will be seen over and over in medical language. For exa mple, the suffix ectomy is seen in such common terms as tonsillectomy (removal o f the tonsils) and appendectomy (removal of the appendix). It is not hard to see that as you begin to commit these sub-terms to memory, you will be able to deci pher more complex terms because you will recognize and understand their componen t parts. Medical terms always contain at least one root word. And as we saw with cholecys tectomy, they may have more than one root word. The root is the part of the word

that comprises the primary meaning of the term. In the example of tonsillectomy , the root word is tonsil. The suffix is ectomy. The root word tonsil is capable of standing alone. The suffix ectomy, (meaning surgical removal) requires the r oot word tonsil to confer relevance. Prefixes and suffixes cannot stand alone. M edical terms may have, but are not required to have, a prefix and/or a suffix. Combining Vowels Combining vowels are sometimes used to create a more fluid transition between wo rd parts and to make medical terms easier to pronounce. For example, the term sp lenomegaly means enlargement of the spleen. It is a combination of the root word splen meaning spleen, and the suffix megaly meaning enlargement. The "O" which follow the root word splen is a combining vowel which simply makes the word flow better. The vowel used most often to combine medical words is "O", but other vowels are also sometimes used. It should be noted that combining vowels may be used betwee n two root words, or between a root word and a suffix, but they are never used b etween prefixes and root words.

Commonly Misspelled Medical Words and Medical Sound Alikes

A abscess accommodation adolescent afferent vs efferent (Sound Alikes) alopecia Alzheimer analyze aneurysm anorexia anuresis vs. enuresis (Sound Alikes) arrhythmia ascites aphagia vs aphasia (Sound Alikes) asphyxia asystole asymmetry auscultation B basilar barbiturates brachial branchial C callus (noun) callous (adjective) catheter catheterization Caucasian chalazion circumferential cirrhosis chickenpox

chlamydia colostrum vs. claustrum (Sound Alikes) cord vs. chord (Sound Alikes) cor (heart) curettage D debridement decubitus dependent vs dependant (Sound Alikes) diabetes mellitus diaphoresis diaphragm dilatation diphtheria dyspareunia dysphagia vs. dysphasia (Sound Alikes) E eczema effusion elicit vs. illicit (Sound Alikes) enuresis vs anuresis (Sound Alikes) elicit vs illicit (Sound Alikes epididymis / epididymitis erythematosus exacerbated vs exasperated (Sound Alikes) F fascia flaccid G gamma globulin gases, gassy, gaseous gallbladder gangrene gauge gonorrhea H hemoptysis hemorrhoid hippocampus homeostasis humerus humeral vs. humoral hygiene I icterus ileum vs ilium (Sound Alikes) inoculate insufflate intraocular intussusception ischemia M malacia

melanin menstruation mucus (noun) mucous (adjective) myxedema O occur, occurring, occurrence oophorectomy Ophthalmology orthopnea P pacemaker palliative palpate palpitation paroxysmal perfusion vs. profusion (Sound Alikes) perineal vs. peroneal (Sound Alikes) perineum periosteum peritoneum persistent petechia plane vs plain (Sound Alikes) pleural vs. plural (Sound Alikes) pleurisy polyposis prostate vs prostrate (Sound Alikes) prosthesis protocol pruritus pterygium R regime vs. regimen vs. regiment (Sound Alikes) rhythm S sagittal, scalene scarring seborrheic sedentary sequela, serotonin senile shotty lymph nodes sieve spleen splenectomy supersede, suppuration symmetry syncope syphilis T tonsils tonsillectomy trachea

tricuspid trochlear V vesicle vs. vesical ventricle vertical X xerosis xiphoid

Medical Transcription Line Count Definition and Methodology

Tired of trying to unravel the medical transcription line count mystery? Frustra ted with looking for but not finding a standard medical transcription line count definition? Well, you're not alone. In fact, it turns out that this is one of t he most controversial, frustrating, misunderstood, misused, and abused concepts in the medical transcription industry. The sad fact is that the concept of medical transcription line counts is a conce pt that is begging for standardization. Why hasn't it been standardized to this point? Good question. The short answer is that there is a lot of money involved and not everyone would benefit equally from MT line count standardization. And i f history is any indication, it will require a great many more years of politica l wrangling to get everyone on the same page. One of the great lessons of Econom ics is that power comes from the assymetry of information. In other words, the f uzziness surrounding this issue of what constitutes a medical transcription line is a source of great financial benefit for some medical transcription industry players and obviously is a source of consternation for others. The good news is that over the past several years there has been some modest pro gress in the area of medical transcription line counts. We are seeing a slow but unmistakable trend toward standardization. Definitions Let's start with a few basic definitions that have been adopted by the leading i ndustry medical transcription organizations: AHDI, AHIMA & MTIA. 1. Gross Medical Transcription Character: In counting medical transcription l ines, any letter, number, symbol or function key necessary for the final appeara nce and content of a medical transcription document, including the space bar, ca rriage return, underscore, bold, and any character contained within a macro, hea der or footer. 2. Net Medical Transcription Character: Printed characters only. onvert to Gross Characters multiply Net Characters by 1.2 Note: to c

3. Net Medical Transcription Line: A defined line length that includes a pre determined number of gross characters (55, 60, 65, 70, 75, etc.). Note: Net li nes are generally determined by dividing the total gross characters in a report by the defined line length. 4. Gross Medical Transcription Line: Any printed line that has one or more c haracters. Note: no distinction is made here between full and partial lines. (T o convert Gross Lines to Net Lines multiply Gross Lines by .70).

5. Medical Transcription Keystroke: Each stroke of a key is counted - includ ing the space bar, carriage return, underscore, bold, etc. constitutes a medical transcription keystroke. Note: macros become an issue here - technically, if a macro requires three keystrokes, then for billing purposes, three keystrokes wo uld be billed. 6. Net Medical Transcription Word: A net word is defined as five (5) alpha/n umeric characters plus one(1) space for a total of six (6) characters. 7. Recorded Minute: One recorded minute of medical transcription dictation i s equal to an average of 777 gross characters for Medical Records dictation (inc luding ER) and an average of 782 gross characters for Physician Practices dictat ion. Medical Transcription Line Definition: The Elusive "Standard" Over the years the definition of a medical transcription line has varied signifi cantly in terms of gross characters and keystrokes. The range has typically been from 55 to 80 keystrokes. More recently, a 65 keystroke (gross character) line has emerged as something of an industry standard, although a fair amount of vari ation continues to exist. However, even as this standard has emerged, there cont inues to be significant controversy over gross characters, net characters, macro characters, etc. In other words, a 65 character line can still mean different t hings to different people. Some companies actually have two ways of measuring a line - one for billing purposes and one for wage payment purposes. The idea is t o create a small spread - bill for all keystrokes while paying only for hard cha racters. The Billing Conundrum It turns out that there is a fair degree of flexibility in establishing medical transcription billing parameters. It boils down to negotiating a rate with a pro spective client. Even if you determine that you will attempt to adhere to the st andards provided in the definitions above there is still a fair amount of lattit ude that derives from the subjectivity inherent in the definitions. For example, assume that you decide to bill based on a 65 character line. What about partial lines? Again it depends on how the contract is written. On the one hand you cou ld structure the contract to require that all gross characters in a given report be added up and divided by 65 to produce a total billable line count. In other words you are basing the billing on the definition of a Net Line above. I person ally like this method. It is clean and is likely to become the defacto standard for billing large accounts. Free Info on our recommended Medical Transcription Program leading to an excitin g home based medical transcription career For example: Assume that for the billing period, your medical transcription line count softwa re calculates a total of 3,500,000 transcribed gross characters and that your co ntract defines a billable line as 65 gross characters. Assume that you have nego tiated a price of 14 cents per billable line. Your bill would be calculated as f ollows: 3,500,000 divided by 65 = 53,846 billable lines 53,846 multiplied by .14 = $7,538.00 Alternatively, you could deliver formatted medical transcription reports to the client that are based on a 65 gross character line and then count all lines. Ful

l and partial lines would count the same for billing purposes (See Gross Lines d efinition above). Consider how this might affect your bill for the same billing period. Using the Gross to Net Line conversion factor shown above (multiply Gross Lines by .70 to get Net lines or conversely divide Net Lines by .70 to get Gross lines ) we discover that we have produced 76,922 Gross Lines. If we are billing for gr oss lines at the same billing rate of 14 cents per line then our bill would read as follows: 76,922 multiplied by .14 = $10,769.00 A significant difference is noted between the two bills. There is nothing wrong with negotiating a more favorable contract for yourself o r your company as long as things are clearly spelled out in advance. And as it t urns out, this simple fact is primarily responsible for the billing variation th at continues to persist in the industry. Companies attempt to negotiate terms th at favor them by playing with character and line definitions. Another factor that could be used to influence medical transcription billing is the font size of finished formatted reports. A 12 point font with a 1 inch margi n will yield a very different line count than a 10 point font with the same 1 in ch margin. These subtle differences can mean big money over the life of a contra ct and should be thought through carefully. Obviously, a gross character definit ion for a line (65 gross characters per line, for example) will eliminate this p roblem. A gross character is billed the same regardless of whether it is a 10 po int or 12 point font - which, I believe is as it should be. Billing by the Medical Transcription Page Depending on the average length of the reports you are transcribing, billing mme dical transcription reports by the page can also make sense. Typically this is m ost beneficial when dealing with a higher quantity of partial page reports. Bill ing by the page for these shorter reports essentially guarantees a minimum line count for each report. This can be important as the setup and formatting require ments for the larger volume of shorter reports can become onerous. If negotiated properly, billing by the page can be yield more income per line of transcriptio n than billing for straight line counts. Obviously, certain types of accounts le nd themselves more readily to this type of billing arrangement. For example, if you charge $4.00 per page and the average line count for the cli ent is 20 lines per report, then you are averaging 20 cents per line - which may be more than you would otherwise bill on a per line basis. Line Count Utilities A number of companies have developed software technology to facilitate the line counting and billing process. These include: Abacus - Sorcerer Software, InstantTextPro, Version III - Textware Solutions MedPen - Emmaus MedPen MP Count - Emmaus MedPen Slycount II - Sylvan Software

Slycount IV (MS Word) - Sylvan Software WP Count - Productive Performance, Inc. In addition, Microsoft Word and other word processing software packages have the ir own built in line counting utility - which may prove adequate depending on yo ur application. The best programs provide the option of including or excluding s paces, carriage returns, headers, footers, etc. This allows for optimal flexibil ity in tracking and billing line counts.

Common Medical Abbreviation

Abbreviation Meaning A TOP A&P Auscultation and percussion A&P Anterior and posterior A-fib Atrial fibrillation a.c. Before meals A/a Alveolar-arterial oxygen gradient AAA Abdominal aortic aneurysm AB / ab Abortion ABCs Airway, breathing, circulation ABG Arterial blood gas ABO A system of classifying blood groups AC Acromioclavicular AC Abdominal Circumference ACE Angiotensin converting enzyme ACL Anterior cruciate ligament ACLS Advanced Cardiac Life Support ACTH Adrenocorticotropic hormone, corticotropin AD Alzheimer's dementia or disease ad lib As desired ADH Antidiuretic hormone ADL Activities of daily living AFB Acid-fast bacilli AFL Atrial flutter AFP Alpha-fetoprotein AFV Amniotic fluid volume AI Artificial Insemination AI Amnioinfusion AIDS Acquired immunodeficiency syndrome AKA Above knee amputation ALL Acute lymphocytic leukemia ALT Alanine aminotransferase AMA Against medical advice ANA Antinuclear antibody AP Anteroposterior appy Appendectomy APTT Activated partial thromboplastin AQ Water ARC AIDS-related complex

ARDS ARF ASAP ASHD ASO AST ATN ATNC AV AVB AVM AVN AVR

Adult respiratory distress syndrome Acute renal failure As soon as possible Atherosclerotic heart disease Antistreptolysin-O Aspartate aminotransferase Acute tubular necrosis Atraumatic, normocephalic Arteriovenous, atrioventricular Atrioventricular block Arteriovenous malformation Atrioventricular node Aortic valve replacement

Forming Plurals of Medical Words Forming proper plurals of medical words can be one of the more challenging aspec ts of medical transcription. The problem is exacerbated by the fact that even di ctating physicians frequently have difficulty with plurals. They cannot always b e counted on to dictate the correct plural form. This pushes the burden of ident ifying and transcribing the proper plural straight back on the transcriptionist. The good news is that plurals generally follow some basic rules. Once you have mastered these rules, you will be able to quickly form proper plurals for most m edical terms that you encounter. The bad news is that for every rule there is an exception. This means that you will also need to memorize (or look up) these ex ceptions. With practice you will become very familiar with all common plurals. The chart below is designed to provide basic rules of thumb for forming plurals. But remember that there are exceptions to most of these rules. Basic Rules of Thumb for Forming Medical Plurals If the Plural is um us a ix ex ax ma on nx y yx en Singular Ending Is: Singular Example: The Plural Rule Is: Form: diagnosis Drop the is and add es diagnoses ileum Drop the um and add a ilea alveolus Drop the us and add i alveoli vertebra Drop the a and add ae vertebrae appendix Drop the ix and add ices appendices cortex Drop the ex and add ices cortices thorax Drop the x and add ces thoraces sarcoma Retain the ma and add ta sarcomata spermatozoon Drop the on and add a spermatozoa larynx Drop the x and add ges larynges deformity Drop the y and add ies deformities calyx Drop the yx and add yces calyces foramen Drop the en and add ina foramina

10 Common Exceptions to Basic Plural Rules: 1. Sometimes the proper plural of a word ending in is will be formed by droppin g the is and adding ides. For example, epididymis becomes epididymides. 2. Sometimes the proper plural of a word ending in us will be formed by droppi ng the us and adding era or ora. For example: viscus becomes viscera; corpus bec omes corpora. 3. Some words ending in ix or ax have more than one acceptable plural form. Fo r example: The plural of appendix can be either appendices or appendixes - altho

ugh the most common plural form would utilize the ices ending. 4. The proper plural for certain words ending in ion can be formed simply by a dding an s. For example: chorion becomes chorions. 5. 6. The plural form of the term vas is vasa. The plural form of pons is pontes.

7. The plural form of the dual meaning word os is ora when referring to "mouth s" and ossa when referring to "bones". 8. 9. 10. The plural form of the term femur is femora. The plural form of cornu is cornua. The plural form of paries is parietes.

What is HIPAA? The Department of Health and Human Services has developed a series of privacy re gulations known collectively as the Health Insurance Portability and Accountabil ity Act of 1996 ("HIPAA"). These regulations are designed to protect the privacy rights of individuals with regard to their confidential medical records. The ac t greatly restricts the dissemination and transmittal of personal patient inform ation and will dramatically affect the way healthcare information is handled. Who do the HIPAA Regulations Apply to? HIPAA regulations have been crafted to have broad application. The provisions of the Act extend to all health care plans, health care providers who transmit hea lth records in an electronic format, and health care clearinghouses and billing companies. The bill refers to these organizations as "Covered Entities". Ultimat ely, however, almost everyone will be affected in one way or another by these re gulations, which will impact both consumers and providers of health care service s. Are Medical Transcription Services Considered "Covered Entities"? Most Medical Transcription Services and their employees are not considered "Cove red Entities" under the Act unless their organization also engages in services t hat put them in the category of "Covered Entity". Medical Transcription Services are typically regarded under the Act as "Business Associates". The Act defines a Business Associate as "any person or organization that performs a function or activity on behalf of a Covered Entity, but is not part of the Covered Entity's workforce (employees, volunteers, trainees and others under the Covered Entity's direct control, regardless of whether they are paid by the Covered Entity." Be aware that state regulations may differ from national regulations and certain St ates may define MT Services as Covered Entities. Free Info on our recommended Medical Transcription Program leading to an excitin g home based medical transcription career As a Business Associate, a Medical Transcription Service may not be directly gov erned by HIPAA regulations. However, Business Associates are governed indirectly by virtue of the fact that Covered Entities are required to obtain written assu rances from the Business Associates that they deal with to ensure that patient i dentifying information is appropriately safeguarded. These written assurances mu st be included in a written contract between the Covered Entity and the Business

Associate. Because of the strict requirements of the Act relating to Covered Entities, Busi ness Associates can expect that the Covered Entities for whom they perform servi ces will be vigilant in requiring evidence of compliance from their Business Ass ociate partners. This will likely take different forms from organization to orga nization. However, MT Services should plan to understand and implement their own action plans and oversight mechanisms to ensure that they meet the requirements of the Act. Free Info on our recommended Medical Transcription Program leading to an excitin g home based medical transcription career How does HIPAA Apply to Independent Medical Transcriptionists? Medical transcriptionists who operate as Independent Contractors to Medical Tran scription Services (Business Associates) and who have direct access to patient h ealth information are referred to by the Act as "Third Parties." Third Parties m ust have a written contract with the Business Associate for whom they provide co ntract services to assure that patient information conveyed to them will be appr opriately safeguarded and that all electronic data transmissions between the Thi rd Party and the Business Associate are conducted in accordance with the approve d national standard. This contract should be similar in nature and scope to the contract between the Business Associate and the Covered Entity. When does HIPAA Become Effective? The rules became officially effective on April 14, ed for a period of time before complete compliance re plans, for example, had until April 14, 2004 to All other covered entities were required to become 2003. 2001. However, the Act provid was mandated. Small health ca become completely compliant. fully compliant by April 14,

Free Info on our recommended Medical Transcription Program leading to an excitin g home based medical transcription career Does the Act Govern the Transmittal of Electronic Patient Information? The Act calls for the standardization of electronic document transmittal. The na tional standard which has been prescribed by HIPAA for electronic health record transmittal is ANSI X12. This national standard governs both the content and the format of patient information that is sent electronically between two organizat ions. What are the Other Key Provisions of the Act? The primary focus of the Act is to restrict the dissemination of patient health care information. The conditions under which information can be conveyed are spe lled out very explicitly. If the Act does not specifically allow for health care information to be shared in a certain manner or under a certain set of conditio ns, it is prohibited. The rules specifically pertain to health information that is transmitted or main tained in any form (oral, paper, electronic, etc.) and which contains patient id entifying information. Patient identifying information includes such things as n ame, address, social security number, phone number, and any other information wh ich could be used to identify an individual. In order to be compliant, covered entities must implement measures to ensure tha t patient information is protected in accordance with the provisions of the Act. Specifically:

Written notification must be given to individuals telling them how information w ill be used and to whom it will be disseminated (insurance and billing companies , or other health care practitioners, for example). Written consent must be obtained from the individual allowing for the use and ma intenance of personal information as provided for by the Act. Disclosure or use of information for any other purpose or to any other organizat ion requires specific authorization from the individual. Reasonable efforts must be made by covered entities to minimize the dispersal of patient information. Health information can be conveyed to Business Associates ("Business Associates" is a term that typically includes Medical Transcription Service Providers and t heir employees) only after written assurance is provided to guarantee the protec tion of the information. Privacy officials must be appointed by each covered entity to develop, implement and oversee privacy policy for the covered organization. A primary contact pers on must also be designated to handle complaints and inquiries about the organiza tion's policy. All employees of the covered entity must receive formal training to ensure that they understand the requirements of the privacy Act as they pertain to their spe cific duties. Covered entities must establish adequate administrative, technical and physical safeguards to ensure that all privacy requirements are upheld within the organiz ation. What are the Penalties for Non-Compliance? Covered entities which fail to comply with the final regulations by the mandated compliance date may incur stiff penalties, including the payment of a fine. In certain cases, criminal charges may be brought against the non-compliant entity.

Grammar Rules Basic Grammar Definitions and Usage PARTS OF SPEECH I. NOUNS A. Common Nouns Common nouns are used to name a general person, place, or thing. Examples: man, baby, city, month

B. Proper Nouns Proper nouns are used to name a specific person, place, or thing. Note: Proper nouns are generally capitalized.

Examples: John, Chloe, Miami, August C. Collective Nouns Collective nouns are used to name groups of people, places, or things. Examples: team, herd, flock, gaggle, pride D. Plural Forms of Nouns General rules: In most cases, an s is added to the end of the noun to form the plural. Examples: bananas, cars

Sometimes, es is added to the end of the noun to form the plural. This generally occurs when the noun ends in s, z, ch, or sh. Examples: Exceptions: 1. Nouns that end in a vowel plus o: add s. patios, radios bushes, glasses, porches

Examples: 2.

Nouns that end with a consonant plus o: add es. potatoes

Example: 3.

Nouns that end in f or fe: change the f to v and add es.

Example: calf / calves 4. Certain noun plural forms are irregular and must be memorized: Example: 5. mouse / mice; ox / oxen; goose / geese; person / people

For some nouns, the plural form is the same as the singular form. sheep / sheep; deer / deer; elk / elk; moose / moose

Example:

II. PRONOUNS A pronoun replaces a noun. Example: other. Sally is looking for Matt. She needs to give him a message from his m

In the second sentence She has replaced Sally and him has replaced Matt. III. VERBS Verbs are words that express action or a state of being.

A. Action verbs tell what the subject of the sentence is doing, has done, or w ill be doing. Example: The man ran across the street. The horse jumped over the fence.

B. Helping verbs are sometimes combined with a main verb to help express an act ion more fully. Example: Bill has run fifty marathons. In this sentence, has is a helping verb which adds meaning to the main verb run. C. Linking verbs connect the subject of a sentence to the rest of the sentence. Example: David is happy.

IV. ADJECTIVES Adjectives are sometimes called modifiers. They are used to describe nouns or pr onouns. They provide information on size, number, color, kind, etc. Example: The woman struggled to lift the enormous pumpkin. In this sentence the adjective "enormous" describes the noun "pumpkin". V. ADVERBS Adverbs are similar to adjectives, but instead of describing nouns and pronouns, adverbs are used to describe verbs, adjectives, and other adverbs. It tells how , when, where, or how much. Example: The mother screamed loudly at the little boy as he ran into the busy s treet. In this sentence, the adverb "loudly" describes the verb "screamed". VI. CONJUNCTIONS Conjunctions are used to join words, phrases or clauses. Use and to combine two things or ideas. Example: I like grapes and peaches the best. Use but to contrast two things or ideas. Example: I like grapes, but I don't like peaches.

Use or to provide a choice between two things or ideas. Example: Would you like a serving of grapes or a serving of peaches? VII. PREPOSITIONS Prepositions relate nouns and pronouns to other words in a sentence. Example: John went in the house with Jill. In this sentence "in" relates John to the house and with relates John to Jill. Prepositions are always followed by nouns or pronouns. A noun or pronoun followe r is referred to as the object of the preposition. In the example above, "house" is the object of the preposition "in" and "Jill" is the object of the prepositi on "with". Common Prepositions about beside inside through

above across after along around at before behind

between by down during except for from in

into of off on onto out outside over

to toward under until up upon with

PUNCTUATION Punctuation Rules A. Commas Commas are commonly used to: 1. Set off nonessential words from the rest of the sentence 2. 3. 4. Set off parenthetical expressions Set off introductory phrases Separate words in a series

5. Separate two independent clauses B. Periods Periods are commonly used: 1. To end a sentence 2. After capitalized word abbreviations

3. After some lowercase abbreviations C. Semicolons Semicolons are commonly used: 1. Between two independent clauses which are not separated by a conjunction 2. Between two independent clauses if either or both are already punctuated

3. Between a series of phrases when one or more elements in the series contain s internal commas D. Colon Colons are commonly used: 1. To introduce an example 2. 3. Following a salutation in a business letter To introduce a list of items

4. Following headings in certain reports or outlines

E. Apostrophe Apostrophes are commonly used: 1. To demonstrate singular or plural possession 2. In contractions 3. To form the plural of certain words

F. Parentheses Parentheses are commonly used to: Set off obviously nonessential words or phrases G. Quotation Marks Quotation Marks are commonly used to: 1. Identify and enclose exact words of a third party 2. Emphasize certain words or phrases

This article first appeared in Today's Dallas Woman, May 1997 Avoiding Work Related Injuries What you can do While your career presents many daily mental challenges, you may believe that yo u'll never face the physical challenge of an on-the-job injury. After all, you p robably don't work in a warehouse where you have to throw around heavy boxes. No r do you move furniture or deliver heavy, bulky office supplies. Your sedentary, sit-at-the-desk-all-day job could, however, leave you at just as much risk for workplace injuries as your warehouse and furniture-moving colleag ues. In today's era of 12-hour work days and excessive telephone and computer us e, job-related injuries involving neck, shoulders, back and arms are increasing. The human body was not meant to sit in one place for long periods of time. By th e same token, hands were never meant to pound on keyboards, nor were necks and s houlders developed to cradle heavy, bulky telephone receivers. In my chiropractic practice, we're seeing an increase of "computer shoulder," "t elephone shoulder," and "office chair backache," as well as the more well-known "carpal tunnel syndrome." Although many of these injuries aren't found in the me dical dictionary, they are real -- and can cause a great deal of crippling harm. You may have already experienced minor forms of these injuries. You know how tig ht your shoulders feel after hunching over a computer keyboard all morning. You feel the ache in your lower back when you've been forced to sit in your office c hair for hours on end so you can get that deadline-oriented project out the door .You know how stiff your shoulders and neck can become after a prolonged telepho ne conversation where you're cradling the receiver. And unfortunately, you proba bly know all about the physical manifestations of emotional stress -- a tight ja w, headaches, stiff shoulders, and a sore upper back. Stiffness isn't the worst that can happen, however. Rounded shoulders and a slum ped posture ultimately create considerable stress on the spine, eventually causi

ng neck and upper back problems. If left untreated, you could suffer headaches o r even osteoarthritis (degeneration of the joints). Nor are the back and neck the only vulnerable points on your body. An estimated one in 10 Americans will develop carpal tunnel syndrome (CTS), a numbing conditi on that can become permanently debilitating. Symptoms can vary from pain in the fingers, wrists, and forearms to numbness, tingling, and loss of finger motor co ntrol. CTS occurs when nerves inside the protective wrist sheath, or "tunnel," b ecome inflamed through improper use of hands and arms. The pounding that fingers , wrists and arms take during a long session at the computer can be one culprit of CTS, as can gripping something hard for hours on end, such as a pen. The good news is that you can avoid -- or at least minimize -- workplace injurie s with the following suggestions. Take frequent breaks throughout the day. Whether you're at risk for a badback o r painful wrists, stop what you're doing at least once an hour and stand up. Mov e around. Stretch out. That urgent project can wait five minutes! Watch your posture. Many of today's workplace injuries are aggravated by poor p osture. Many people "jut" their heads out to see the computer screen better, or use their necks and shoulders to cradle telephones. The best thing you can do fo r your neck is to keep your entire spine in its proper alignment. If you aren't certain what good posture "feels" like, talk to your chiropractor. Keep in shape. If you aren't in shape, get there. Part of the cause of many bac k problems is weak back and stomach muscles caused by a sedentary lifestyle and obesity. Strengthening your abs is one good way to provide good back support, as is gently building your back muscles. If you're not sure about which back exerc ises to do, consult your chiropractor. And you don't need to join a fancy health club -- walking 20 minutes a day and p racticing a regular stretch regimen (such as yoga) can do wonders to tone and st rengthen your entire body. Develop an ergonomically-sound work space. Even if you can't afford those fancy chairs and desks, you can convert your workspace into one that's easier on your back, neck and wrists. Make sure your chair has a straight back and is set so y our feet are flat on the floor (use a footstool, if necessary). Place a small "l umbar roll" in the small of your back for support. Raise your keyboard so that y our wrists don't "break" when you type, and make sure that your forearms are par allel with the floor. Also, set your computer monitor high enough so you're look ing at it straight on. One final note, if you use the phone a good deal, invest in a telephone headset so you aren't forced to "balance" the phone between shoul der and neck. If you suffer from pain or stiffness in your back neck or arms, contact a profe ssional immediately. Many insurance companies today are recognizing the high cos t of workplace injuries. As a result, many policies will now cover chiropractic and orthopedic care. While technology has helped make today's office more efficient and productive, i t's also created a new realm of muscle, tendon, and joint problems. But these pr oblems are avoidable. With a little forethought and common sense, you can help p ut an end to these '90s workplace injuries.

Basic Computer Operations How Computers Work

Input: Information and programs are entered into the computer through Input devi ces such as the keyboard, disks, or through other computers via network connecti ons or modems connected to the Internet. The input device also retrieves informa tion off disks. Output: Output Devices displays information on the screen (monitor) or the print er and sends information to other computers. They also display messages about wh at errors may have occurred and brings up message or dialog box asking for more information to be input. The output device also saves information on the disk fo r future use. Processing: The CPU or central processing unit is sometimes called the Control U nit and directs the operation of the input and output devices. The Coprocessor o r the Arithmetic-Logic Unit does arithmetic and comparisons. The memory or RAM t emporarily stores information (files and programs) while you are using or workin g on them. The BIOS or basic input/output system controls the dialogue between t he various devices. Keyboard Layout and Data Entry ENTER or RETURN - Moves the cursor down one line and to the left margin. Enter a lso process commands such as choosing an option in a dialog (message) boxes and submitting a form. DEL or DELETE - Deletes the character at cursor and/or characters to the right o f the cursor and all highlighted (or selected) text. BKSP or BACKSPACE - Deletes the character to the left of cursor and all hightlig hted text. SPACE BAR - Moves the cursor one space at a time to the right SHIFT KEY - Use the shift keys to type capital letters and to type the upper cha racter on keys with two characters on them CAPS LOCK - Locks the keyboard so it types capital letters (a light goes on when caps lock is on) TAB - Moves the cursor five spaces to the right (number of spaces are usually ad justable). Tab moves to the next field in a form or table (Shift-Tab for previou s field). ESC or ESCAPE - Cancels a menu or dialog box ARROW KEYS - Moves the cursor around document without changing text FUNCTION KEYS or F KEYS - Access commands by themselves or in combination with t he three command keys; CTRL, SHIFT, and ALT

Command or Special Keys Command keys normally do nothing on their own but work in combination with other keys. Each piece of software uses the command keys differently though there is a move to standardize some functions. The Control key or Ctrl is often used to a ccess commands. The Alternative key or Alt is often used to access menus. The Sh ift key is used to type CAPITAL LETTERS. As well the command keys are all used t

o move through documents and edit text faster and easier. As well many computers have Special keys design specifically for the particular computer. Apple comput ers have the Apple keys and Macs have Command keys. Many keyboards now have a Wi ndows key specifically for Windows 9x and newer systems. Many older computers al so have special keys used for a variety of different functions. Some Notebook or Laptop keys are left out because of space limitations and they usually have a Special function key which allows other keys to double for the mi ssing ones. Basic Typing Rules Place one space between each word, after a punctuation mark and at the end of a sentence. Always start a sentence with a capital letter. Use capitals for names, addresses, provinces and countries, places, organizations, businesses, associat ions, schools, colleges, universities, days of the week, months, holidays, natio nalities, ethnic groups and languages. Learning the keyboard is the first step to learning computers. Learning involves practice. It really is as simple as that. There are two kinds of typing. The first is called Touch Typing. The Touch Typist uses the Home Keys (asdf for the left hand and jkl; for the right) and all the fingers on both hands as well as the thumbs for the Space Bar while typing. There are many commercial and publ ic domain programs that are designed to teach this method. The other method is some times called 'Hunt and Peck' or depending on finger str ength 'Search and Destroy'. This involves using one or more fingers on one or tw o hands to type. It is a perfectly acceptable way of using a computer and many p eople get along fine with this technique.

Medical Transcription Equipment Medical transcription equipment and technology has really come a long way. There are so many software programs and tools out there to make out jobs a whole lot easier. And don t be scared of technology, most transcription equipment is pretty straight forward to use and some just takes a little getting used to. Medical Transcription Equipment & Dictation Equipment Firstly, you ll have to decide what type of dictation/transcription equipment to u se. Chances are during your course you practiced on a mini cassette transcrib er. This is quite standard for MT courses and also for many doctors. The doctor dictates into a hand-held recorder and his dictation gets recorded on to the mini cassette inside the recorder. You then transcribe the dictated ca ssette using your mini cassette transcriber. As mentioned, this practice is quite standard but only allows you to have lo cal clients (unless your client is willing to mail the tapes to you). You wou ld either pick up these tapes from the doctor s office, have them mailed out, or u se a courier service. A fast-growing option for transcriptionists and doctors is digital dictation. The doctor dictates the notes onto a hand-held digital recorder or computer. The file can then be download, using FTP (file transfer protocol) via the inter net onto the transcriptionist s computer and transcribed. The formatted WAV fil es are then directly typed from the computer.

This option allows you to work for clients world wide, and you don t have to pick up and drop off tapes or notes. This is a great option whether you want to ta ke your transcription business to the next level or simply automate it more to s ave time. Some transcriptionists are flexible and adopt both methods of transcription to b etter suit the needs of their clients. Whichever method you go with, you ll also need a foot pedal and headphones. For cassette transcription the foot pedal and headphones is attached to your transc riber, which is attached to the computer. With digital dictation you plug the fo ot pedal into your computer s serial port and the headphones into your speakers or sound card. Equipment for the Office Aside from your transcription equipment you really only need a few other bits an d pieces to start your business. The beauty of owning an MT business is start -up costs are generally low and you ll usually make a profit quite quickly. Other than a computer (which you probably things. Below is a list of things you n mind that other than the computer, your s you may not need all of these things to already have) you just need a few more ll need or could possibly use. Keep i transcription equipment and a few book start with.

You can start out with the basics and build up slowly as your business and needs grow. Here is a list of must have MT tools. MT Must Haves - Tools Of The Trade Computer Dictation/transcription equipment (see above) Printer and ink cartridges Medical Dictionary Medical Spellchecker Software Drug/pharmaceutical guide Several medical specialty books (such as orthopedics, surgery, cardiology, etc.) Word processing program (Word or Word Perfect) Fax Machine (may be optional depending on situation) Desk (obviously J) and basic office supplies such as paper clips, highlighter, pens, etc. Comfortable chair (A must) MT Business Building Tools (for Expanding and Growing your business) A Website Whether local or Nationwide you ll enhance your business presence with a well constructed website Nowadays you can easily build one yourself without any knowledge of HTML (computer language). Business License You don t need this right at the beginning as you can work as a s elf-employed individual, but something to consider as your business grows. Business Cards Courier Service s. Almost a must have if you re targeting local clients. For picking up and dropping off all those local tapes and report

MT Library

More MT books and software (as needed to make you more productive) A separate phone line for your business needs.

Additional Phone Line

As you can see the list is relatively small compared to other types of businesse s. And keep in mind all the above are also tax deductible so make sure you kee p your receipts.

Eight Parts of Speech verbs, nouns, pronouns, adjectives, adverbs, prepositions, conjunctions and inte rjections The eight basic parts of speech are simple. They are verbs, nouns, pronouns, adj ectives, adverbs, prepositions, conjunctions, and interjections. All English wor ds fit into one of these grammatical categories. Many English words function as more than one part of speech. Take the word fly for example. When you fly in a p lane, it is a verb; when you swat a fly, it is a noun; and when you wear fly sha des, it is a slang adjective. English can be confusing because words can mean mo re than one thing, but if you know your eight parts of speech, you will avoid co nfusion. Verbs are words used to express action, condition, or a state of being. They are used in speech to move the meanings of sentences along. An action verb expresse s an action. Words such as throw, create, and draw express physical action. Ment al actions can be expressed by words such as believe, desire, and visualize. Ver bs such as be and feel are used to show states of being. Helping verbs, or auxil iary verbs, are used to help the main verb express action or create verb phrases . Some examples of auxiliary verbs are would, might and am. Nouns are words that name a person, place, thing or idea. A few examples of noun s are person, place, thing and idea. Proper nouns name specific things such as J eff, California, and English. To change a noun from singular form to plural form an s or es must be added to the end of the word. Two examples are thing/things and dish/dishes. Some nouns have irregular plural forms and are a little harder to spell sometimes. A couple of these nouns are man/men, and reality/realities. To show ownership, one must add an apostrophe s to the end of a singular noun, o r just an apostrophe to a plural noun. Examples of the possessive form are Jeff s possession and fools wisdom. Pronouns are words used in place of nouns to shorten a repeated noun that has al ready been mentioned. The noun that the pronoun replaces is called the anteceden t of the pronoun. My girlfriend goes shopping a lot. She spends a bunch of money on garbage. In these last two sentences, she is the pronoun, and girlfriend is the antecedent. There are many forms of pronouns, such as personal, possessive, reflexive, intensive, indefinite, demonstrative, interrogative, relative and rec iprocal. Adjectives are very useful words. They add information to sentences by telling u s more about nouns and pronouns, usually by describing, identifying, or quantify ing those words. Adjectives usually come before the words they modify, but somet imes follow linking verbs. Here are two examples. She is a nice woman. That woma n is nice. Quantifying adjectives come in the form of articles and numbers such as an, and twenty-one. An adverb is defined as a word that gives more information about a verb, adjecti

ve or other adverbs. In the sentence: She runs slow, slow describes how sue perf orms the adjective, runs. In the sentence She runs very slow, very describes the adverb slow, and tells how slow she runs. Most, but not all adverbs end in ly, but not all words that end in ly are adverbs. Ugly is an adjective. Supply can b e a noun. Quickly and not are both adverbs. A preposition is a word, which shows relationships between other words in the se ntence. Relationships between words can be in the form of time or space. She wen t to the mall again. To is a preposition that shows direction or space. She will find more clothes than you could imagine in thirty minutes. In is the prepositi on that shows time. A preposition always goes with a noun or pronoun, which is c alled the object of the preposition. The preposition is almost always before the noun or pronoun and that is why it i s called a preposition. The preposition and the object of the preposition togeth er are called a prepositional phrase. In the sentence She went to the mall, to t he mall is the prepositional phrase. A conjunction is a word that connects words, or groups of words, to tell somethi ng about the relationship between these words. In the sentence she and I are fri ends, and connects two pronouns, she and I. Coordinating conjunctions are conjun ctions, which connect two equal parts of a sentence. The most common ones are an d, or, but, and so. She is small but strong. But is used as a coordinating conju nction. Subordinating conjunctions connect two parts of a sentence that are not equal. Some subordinating conjunctions are whether, though and because. Correlat ive conjunctions are pairs of conjunctions that work together. Both she and I li ve in San Diego. Both/and, neither/nor, whether/or are all common correlative co njunctions. Conjunctive adverbs are adverbs that show a transition between ideas within a sentence. They normally show comparison, contrast, or cause-effect rel ationships. She was sick; however, she still could muster up enough energy to go to the mall. An interjection is a word, or a short phrase used to express emotion or surprise . Interjections are often sentence fragments, or stand by themselves. Yeah! I m do ne. Yeah is used to show the long awaited emotion of freedom. Interjections are also often used as commands, or as part of a protest. Stop! Don t assign so much h omework. Interjections are very important, and that s why they are mentioned last, but not least, in the eight parts of speech. (1)Interjection (2)Verb (3)Noun (4)Conjunction (5)Pronoun (6)Adjective (1)Hey! This class keeps me from (2)sleeping in all (3)day; (4)although, (5)it h as a (6)negative (7)Preposition (8)Adverb effect on my sleep, because I like staying up (7)all night, or until I can (8)ha rdly keep my eyes open.

Parts of a Sentence If you know the parts of a sentence, you understand the sentence better. A sentence is not simply some words randomly thrown together. It is something bu ilt from words and phrases (i.e. groups of words) according to some system. How does a sentence work? As I said, according to some system...

What is a system? Not as difficult as it sounds... A system is something in which... there are parts, all the parts do different tasks, so that the purpose of the whole is fulfilled. A sentence too is a system. So, the important questions are... What are the different parts of a sentence and what jobs do these sentence parts do? How do these parts inter-relate so that a grammatically correct sentence is crea ted? correct sentences grammatically correct sentence pianos What are the Different Sentence Parts? As we learn about the parts of a sentence, we shall hear more about these differ ent names. Subject (For a detailed treatment of this part, click here) Predicate Finite Verb (Transitive, Intransitive, or Linking) The Object (Direct or Indirect) Complement (Subjective or Objective) Adverbial Subject and Predicate Traditionally, a sentence is divided into two parts: The Subject tells us which person, animal, place or thing we are talking about; the Predicate tells us what we are saying about that subject. Have a look at these sentences... Mohan ate those mangoes. Cricket is played in India. His sister is a teacher in Delhi. The bold-faced part is the subject and the remaining part is the predicate in ea ch of the three sentences above. This division of the sentence into Subject and Predicate is clearly according to meaning. There is a more sophisticated explanation of these two sentence parts. Read here a detailed explanation about the Subject. Finite Verb

A finite verb is a one-word, two-word, three-word or four-word verb, which acts as a single meaningful sentence part and is essential (necessary) for the existe nce of the sentence. Examples of finite verbs are: eat is eating has been eaten will have been eating Read more about finite verbs here. The Object This is usually a noun phrase, i.e. a group of words built around a noun or a pr onoun. The object answers the question: finite verb + whom? or finite verb + what? as in these examples: The teacher praised the student. (praised whom? Answer: the student) Mohan eats mangoes. (eats what? Answer: mangoes) The student and mangoes are the objects in the above sentences. Adverbial Sentences may contain words or phrases of information about when, where, how or why some action took place or something is in existence. Such words or phrases a re called Adverbials. Here are some examples... in the morning She completed the story in the morning. at the railway station I met him at the railway station. brilliantly She played the piano brilliantly. for permission to go home You should meet me for permission to go home. Complement As the name suggests, a complement is something that completes something. What does it complete? A complement completes... sometimes the meaning of the Subject (subject complement or subjective complemen t) and sometimes that of the Object (object complement or objective complement). How does the Complement Complete? The Complement completes either by renaming the subject or object or by describi ng them. Here are some examples:

Peter is a student. the phrase a student renames the subject Peter. (Subject Compl ement) That girl is clever. the word clever describes the subject that girl. (Subject Com plement) We made Mohan monitor of the class. the word monitor renames the object Mohan. (Ob ject Complement) The people found Susanna innocent. the word innocent describes the object Susanna. (Object Complement) http://www.english-language-grammar-guide.com/parts-of-a-sentence.html Last modified: Friday, 21 January 2011, 10:07 AM Medical Transcription - Code of Ethics Healthcare is an essential service along with the other basic necessities like a ir, water, food, clothing and housing. Therefore the practice of healthcare requ ires that healthcare professionals and other entities associated with healthcare come under a strict code of ethics. Medical transcription is a profession closely associated with the healthcare ind ustry in both the commercial and operational aspects by documenting the patienthealthcare professional encounter. The Association for Healthcare Documentation Integrity (AHDI) has come up with t he guidelines for code of conduct for healthcare documentation professionals. Th e code of ethics for medical transcription professionals are as follows: Maintain confidentiality of all patient information including but not limited to peer reviews, quality improvement and risk management protocols with special ef fort to maintain data security in electronic communications. Implement and maintain standards of professional transcription practice. Respect the rights and dignity of all individuals. Continue professional growth enhancing knowledge and skills, including continuin g education, networking with colleagues, professional reading and certification. Strive to provide accurate and timely information Exercise integrity in professional practices including work or professional expe rience, credentials, affiliations, productivity reporting, billing charges and p ayment practices. Comply with all laws, regulations and standards governing the practice of patien t documentation. Foster environments of employment that facilitate integrity, professionalism and protection of patient information. Strive to advance the goals and purposes of the Association and work for the adv ancement and good of the profession. These are code of ethics laid by the AHDI for the members of the association as guidelines. But these code of ethics can be used as guidelines by all entities w ho are in the business of medical transcription. Based on the code of ethics a medical transcription service provider has to run its operations: Maintaining confidentiality of patient information: Confidentiality of patient i nformation should be maintained at all levels. The confidentiality of the data n eeds to be maintained at all the stages, during transmission, during usage and d

uring storage using appropriate measures Implementing and maintaining professional standards of transcription: The servic e provider should maintain and implement professional standards of transcription by training the transcriptionists rigorously in one or two specialities enablin g them to meet standards of accuracy and turnaround time. Continuously enhancing the skills of medical transcriptionists through education : The service provider should educate their team of medical transcriptionists by constantly updating their knowledge base on the latest developments in the fiel d of medicine. Provide timely information: Timely information should be provided by the service provider whenever required. Exercising integrity in billing practices: The method of billing should fulfill all the billing method principles of being verifiable, measurable, definable, co nsistent and fair & honest. Complying with the laws of patient documentation: The service provider needs to be aware of and comply with all the laws that apply to patient documentation Foster the right atmosphere for professionalism and ethics: The service provider needs to create an atmosphere which enables an atmosphere of professionalism. While outsourcing medical transcription care should be taken to source a service provider who can not only provide accurate transcription services, in a timely manner, using the right technology, through secure means and at reasonable price s, but also follows the code of ethics as recommended by AHDI. TransDyne, a leader in the outsourced medical transcription industry offers cust omized medical transcription solutions tailored to suit the needs of healthcare facilities. Visit http://www.transdyne.com for more details. Click http://www.tr ansdyne.com/html/contactus.aspx to avail medical transcription services from Tra nsDyne. Article Source: http://EzineArticles.com/?expert=Renee_Kelly

Article Source: http://EzineArticles.com/4176904

Subject and Verb Agreement The subject and verb must agree in number: both must be singular, or both must b e plural. Problems occur in the present tense because one must add an -s or -es at the end of the verb when the subjects or the entity performing the action is a singular third person: he, she, it, or words for which these pronouns could su bstitute. Notice the difference between singular and plural forms in the following example s: Singular Plural The student sings. (He or she sings) Your children sing. (They sing) The bird does migrate. (It does) Those birds do migrate. (They do) In order to find out if your subject and verb agree, you need to be able to iden tify the subject of your sentence. Here are some helpful hints that will help yo u to decipher where your subject is and where it is not. Where is my subject? Most likely, your verb will agree with the first noun to the left of the verb:

The Supreme Court judge decides the appropriate penalty. Subject: judge Verb: decides The committee members were satisfied with the resolution. Subject: members Verb: were Occasionally, a sentence has the subject after the verb instead of before it. Th is strategy is often used for poetic effect. Over the ripples glides a small canoe. Subject: a small canoe Verb: glides There was a well-known writer at the meeting. Subject: a well-known writer Verb: was You will not find the subject in a modifying phrase (MP), a phrase that starts w ith a preposition, a gerund, or a relative pronoun and that modifies the meaning of the noun or subject under discussion. The group of students is going on a field trip. Subject: the group MP: of students Verb: is The survey covering seven colleges reveals a growth in enrollment. Subject: the survey MP: covering seven colleges Verb: reveals The speaker whom you saw at the lecture is one of the state senators from Minnes ota. Subject: the speaker MP: whom you saw at the lecture Verb: is If subjects are joined by and, they are considered plural. The quarterback and the coach are having a conference. Subject: the quarterback and the coach Verb: are having If subjects are joined by or or nor, the verb should agree with the closer subje ct. Either the actors or the director is at fault. Subjects: actors, director Verb: is Either the director or the actors are at fault. Subjects: director, actors Verb: are The relative pronouns (who, whom, which, and that) are either singular or plural , depending on the words they refer to. The sales manager is a good researcher who spends a great amount of time surfing the Web for information. Subject: the sales manager Verbs: is, spends Sales managers are good researchers who spend a great amount of time surfing the Web for information. Subject: sales managers Verbs: are, spend Indefinite pronouns (someone, somebody, each, either one, everyone, or anyone) a re considered singular and need singular verbs although they convey plural meani ng. Anyone who wants to pursue higher education has to pass entrance exams. Subject: anyone

Verbs: wants, has Everyone on the committee is welcome to express his/her ideas. Subject: everyone Verb: is A few nouns can be either plural or singular, depending on whether they mean a g roup or separate individuals. These words are rarely used as plurals in modern w riting. The jury is sequestered. Subject: jury Verb: is The jury are having an argument. Subject: jury Verb: are having A few subjects look plural but are really singular or vice versa. The news of the discovery is spreading. Subject: news Verb: is The mass media have publicized the facts. Subject: mass media Verb: have publicized The data amaze everyone. Subject: data Verb: amaze

Basic Principle: Singular subjects need singular verbs; plural subjects need plu ral verbs. My brother is a nutritionist. My sisters are mathematicians. See the section on Plurals for additional help with subject-verb agreement. The indefinite pronouns anyone, everyone, someone, no one, nobody are always sin gular and, therefore, require singular verbs. Everyone has done his or her homework. Somebody has left her purse. Some indefinite pronouns such as all, some are singular or plural depending on w hat they're referring to. (Is the thing referred to countable or not?) Be carefu l choosing a verb to accompany such pronouns. Some of the beads are missing. Some of the water is gone. On the other hand, there is one indefinite pronoun, none, that can be either sin gular or plural; it often doesn't matter whether you use a singular or a plural verb unless something else in the sentence determines its number. (Writers gener ally think of none as meaning not any and will choose a plural verb, as in "None of the engines are working," but when something else makes us regard none as me aning not one, we want a singular verb, as in "None of the food is fresh.") None None None heir of you claims responsibility for this incident? of you claim responsibility for this incident? of the students have done their homework. (In this last example, the word t precludes the use of the singular verb.

Some indefinite pronouns are particularly troublesome Everyone and everybody (li sted above, also) certainly feel like more than one person and, therefore, stude nts are sometimes tempted to use a plural verb with them. They are always singul

ar, though. Each is often followed by a prepositional phrase ending in a plural word (Each of the cars), thus confusing the verb choice. Each, too, is always si ngular and requires a singular verb. Everyone has finished his or her homework. You would always say, "Everybody is here." This means that the word is singular and nothing will change that. Each of the students is responsible for doing his or her work in the library. Don't let the word "students" confuse you; the subject is each and each is alway s singular Each is responsible. Phrases such as together with, as well as, and along with are not the same as an d. The phrase introduced by as well as or along with will modify the earlier wor d (mayor in this case), but it does not compound the subjects (as the word and w ould do). The mayor as well as his brothers is going to prison. The mayor and his brothers are going to jail. The pronouns neither and either are singular and require singular verbs even tho ugh they seem to be referring, in a sense, to two things. Neither of the two traffic lights is working. Which shirt do you want for Christmas? Either is fine with me. In informal writing, neither and either sometimes take a plural verb when these pronouns are followed by a prepositional phrase beginning with of. This is parti cularly true of interrogative constructions: "Have either of you two clowns read the assignment?" "Are either of you taking this seriously?" Burchfield calls th is "a clash between notional and actual agreement."* The conjunction or does not conjoin (as and does): when nor or or is used the su bject closer to the verb determines the number of the verb. Whether the subject comes before or after the verb doesn't matter; the proximity determines the numb er. Either my father or my brothers are going to sell the house. Neither my brothers nor my father is going to sell the house. Are either my brothers or my father responsible? Is either my father or my brothers responsible? Because a sentence like "Neither my brothers nor my father is going to sell the house" sounds peculiar, it is probably a good idea to put the plural subject clo ser to the verb whenever that is possible. The words there and here are never subjects. There are two reasons [plural subject] for this. There is no reason for this. Here are two apples. With these constructions (called expletive constructions), the subject follows t he verb but still determines the number of the verb. Verbs in the present tense for third-person, singular subjects (he, she, it and anything those words can stand for) have s-endings. Other verbs do not add s-end ings.

He loves and she loves and they love_ and . . . . Sometimes modifiers will get betwen a subject and its verb, but these modifiers must not confuse the agreement between the subject and its verb. The mayor, who has been convicted along with his four brothers on four counts of various crimes but who also seems, like a cat, to have several political lives, is finally going to jail. Sometimes nouns take weird forms and can fool us into thinking en they're really singular and vice-versa. Consult the section ms of Nouns and the section on Collective Nouns for additional as glasses, pants, pliers, and scissors are regarded as plural al verbs) unless they're preceded the phrase pair of (in which r becomes the subject). My glasses were on the bed. My pants were torn. A pair of plaid trousers is in the closet. Some words end in -s and appear to be plural but are really singular and require singular verbs. The news from the front is bad. Measles is a dangerous disease for pregnant women. On the other hand, some words ending in -s refer to a single thing but are nonet heless plural and require a plural verb. My assets were wiped out in the depression. The average worker's earnings have gone up dramatically. Our thanks go to the workers who supported the union. The names of sports teams that do not end in "s" will take a plural verb: the Mi ami Heat have been looking , The Connecticut Sun are hoping that new talent . Se e the section on plurals for help with this problem. Fractional expressions such as half of, a part of, a percentage of, a majority o f are sometimes singular and sometimes plural, depending on the meaning. (The sa me is true, of course, when all, any, more, most and some act as subjects.) Sums and products of mathematical processes are expressed as singular and require si ngular verbs. The expression "more than one" (oddly enough) takes a singular ver b: "More than one student has tried this." Some of the voters are still angry. A large percentage of the older population is voting against her. Two-fifths of the troops were lost in the battle. Two-fifths of the vineyard was destroyed by fire. Forty percent of the students are in favor of changing the policy. Forty percent of the student body is in favor of changing the policy. Two and two is four. Four times four divided by two is eight. If your sentence compounds a positive and a negative subject and one is plural, the other singular, the verb should agree with the positive subject. The department members but not the chair have decided not to teach on Valentine' s Day. It is not the faculty members but the president who decides this issue. It was the speaker, not his ideas, that has provoked the students to riot. they're plural wh on the Plural For help. Words such (and require plur case the word pai

Irregular Verbs In contrast to regular verbs, irregular verbs are those verbs that fall outside the standard patterns of conjugation in the languages in which they occur. The i dea of an irregular verb is important in second language acquisition, where the verb paradigms of a foreign language are learned systematically, and exceptions listed and carefully noted. Thus for example a school French textbook may have a section at the back listing the French irregular verbs in tables. Irregular ver bs are often the most commonly used verbs in the language. In linguistic analysis, the concept of an irregular verb is most likely to be us ed in psycholinguistics, and in first-language acquisition studies, where the ai m is to establish how the human brain processes its native language. One debate among 20th-century linguists revolved around the question of whether small child ren learn all verb forms as separate pieces of vocabulary or whether they deduce forms by the application of rules. Since a child can hear a verb for the first time and immediately reuse it correctly in a different tense which he or she has never heard, it is clear that the brain does work with rules, but irregular ver bs must be processed differently. Historical linguists rarely use the category irregular verb. Since most irregula rities can be explained historically, these verbs are only irregular when viewed synchronically, not when seen in their historical context. When languages are being compared informally, one of the few quantitative statis tics which are sometimes cited is the number of irregular verbs. These counts ar e not particularly accurate for a wide variety of reasons, and academic linguist s are reluctant to cite them. But it does seem that some languages have a greate r tolerance for paradigm irregularity than others. http://en.wikipedia.org/wiki/Irregular_verb

Irregular Verbs Base Form Simple Past Tense Past Participle awake awoke awoken be was, were been bear bore born beat beat beat become became become begin began begun bend bent bent beset beset beset bet bet bet bid bid/bade bid/bidden bind bound bound bite bit bitten bleed bled bled blow blew blown break broke broken breed bred bred bring brought brought broadcast broadcast broadcast build built built burn burned/burnt burned/burnt burst burst burst

buy bought bought cast cast cast catch caught caught choose chose chosen cling clung clung come came come cost cost cost creep crept crept cut cut cut deal dealt dealt dig dug dug dive dived/dove dived do did done draw drew drawn dream dreamed/dreamt dreamed/dreamt drive drove driven drink drank drunk eat ate eaten fall fell fallen feed fed fed feel felt felt fight fought fought find found found fit fit fit flee fled fled fling flung flung fly flew flown forbid forbade forbidden forget forgot forgotten forego (forgo) forewent foregone forgive forgave forgiven forsake forsook forsaken freeze froze frozen get got gotten give gave given go went gone grind ground ground grow grew grown hang hung hung hear heard heard hide hid hidden hit hit hit hold held held hurt hurt hurt keep kept kept kneel knelt knelt knit knit knit know knew know lay laid laid lead led led leap leaped/leapt leaped/leapt learn learned/learnt learned/learnt leave left left lend lent lent let let let lie lay lain light lighted/lit lighted lose lost lost make made made mean meant meant

meet met met misspell misspelled/misspelt misspelled/misspelt mistake mistook mistaken mow mowed mowed/mown overcome overcame overcome overdo overdid overdone overtake overtook overtaken overthrow overthrew overthrown pay paid paid plead pled pled prove proved proved/proven put put put quit quit quit read read read rid rid rid ride rode ridden ring rang rung rise rose risen run ran run saw sawed sawed/sawn say said said see saw seen seek sought sought sell sold sold send sent sent set set set sew sewed sewed/sewn shake shook shaken shave shaved shaved/shaven shear shore shorn shed shed shed shine shone shone shoe shoed shoed/shod shoot shot shot show showed showed/shown shrink shrank shrunk shut shut shut sing sang sung sink sank sunk sit sat sat sleep slept slept slay slew slain slide slid slid sling slung slung slit slit slit smite smote smitten sow sowed sowed/sown speak spoke spoken speed sped sped spend spent spent spill spilled/spilt spilled/spilt spin spun spun spit spit/spat spit split split split spread spread spread spring sprang/sprung sprung stand stood stood steal stole stolen stick stuck stuck sting stung stung

stink stank stunk stride strod stridden strike struck struck string strung strung strive strove striven swear swore sworn sweep swept swept swell swelled swelled/swollen swim swam swum swing swung swung take took taken teach taught taught tear tore torn tell told told think thought thought thrive thrived/throve thrived throw threw thrown thrust thrust thrust tread trod trodden understand understood understood uphold upheld upheld upset upset upset wake woke woken wear wore worn weave weaved/wove weaved/woven wed wed wed weep wept wept wind wound wound win won won withhold withheld withheld withstand withstood withstood wring wrung wrung write wrote written

Active & Passive Voice Introduction When the subject of a sentence does something, i.e. if the subject of a sentence is the doer of some action, we say that the sentence or the verb of that sentence is in Active Voice. When the subject of a sentence does not do anything, i.e. if the subject is he doer of any action not t

but allows the Object of the preposition to do something to it, we say that the sentence or the verb of that sentence is in PASSIVE VOICE. Confusing ? Now look at these examples: The cat killed the rat. The cat = subject of the sentence Active Voice

killed

= verb of the sentence

the rat = the object of the verb Now, who killed whom? = the cat the subject of the sentence killed the rat the object of the verb.

We say that this sentence or the verb of this sentence is in Active Voice becaus e the subject the cat does the killing.

Let s see what this sentence is about The rat was killed by the cat. The rat = subject of the sentence was killed = verb of the sentence the cat = the object of the preposition Now, who killed whom? by PASSIVE VOICE

The rat killed the cat ? Noooooo . killed the rat , but not the rat killed the cat !

Even in his sentence the cat Though the rat

is actually the subject of the sentence, it is not doing anything the cat which is the object of the preposition by to kill it.

but passively allowing

As the subject of the sentence does not do anything but allows passively somethi ng to be done to it, we say that this sentence or the verb of this sentence is in P ASSIVE VOICE. How do we know who does what? Well, the answer is in the VERB the verb was killed one verb, two parts simple past tense was killed ! Passive Voice.

Suppose the second sentence was like this: The rat killed the cat. (which might be correct according to the grammar rules but would not be sensible) we would say that this sentence or the verb of this sentence was in Active Voice. For power presentation slides on Active Passive Voice, please, click here on act ive-passive.forms . For continuity, please keep clicking after each feature in e ach slide.] Why do we use Active Voice and Passive Voice? We use Active Voice when we want to say something about the subject of the sente nce who does what. We use Passive Voice when we want to say what happened to something or someone r ather than who does it the result. For example,

He broke the window.

Active Voice who does the action of breaking

In this Active Voice sentence, we emphasise

He . So he is responsible or he should be punished and so on The window is broken (by him or somebody). PASSIVE VOICE what happened rather than

In this Passive Voice sentence, we emphasise on

who did it . So the window must be repaired or boarded up and so on Though we have an agent who did the action , we are more concerned about

the result rather than the person responsible for that. In normal conversation, we first think of who should be given importance the age nt responsible for the action or the result of the action and then make the sent ence. But to get the practice of making these different expressions, we need to learn some rules and important points. There are certain changes that take place when we change an Active Voice sentenc e into a Passive Voice sentence. Though the meaning or the sense of the sentenc e makes it clear for us whether the sentence or the verb of the sentence is Acti ve or Passive, at the initial stage, as we are now, it may help us to understand the Voice better if we know the changes first. The real purpose or use of the Voices will be dealt later in this sub-topic. The changes a) The cat killed the rat. Active Voice PASSIVE VOICE the cat in the Active Voice is changed into

The rat was killed by the cat. *The Subject of the sentence

the Object of the preposition by

in the Passive Voice.

[The Object of the preposition by is normally omitted in speech and in writing; we , however, keep using it in every sentence we make or change to get ourselves us ed to this point. Remember that just because we do not see or hear an Object of the preposition in any Passive Voice sentence, we cannot say that it is not passive. By the time w e are through with some rules and important points, we will be able to recognize the difference. We need some patience, of course. In fact, knowing the differe nce between the Active and Passive is what we are actually doing right now!] b) The cat killed the rat. The rat was killed by the cat. **The Verb of the Active Voice Active Voice PASSIVE VOICE killed is changed into Passive Voice ] Active Voice PASSIVE VOICE was killed in the

Passive Voice. [More in the Tense c) The cat killed the rat. The rat was killed by the cat.

***The Object of the verb the rat

in the Active Voice is changed into the

subject of the Passive Voice sentence. Some important points: To change an Active Voice verb into Passive, the Verb must be a TRANSITIVE VERB, i.e. the Verb must have, at least, one direct or indirect object because that o bject becomes the subject of the Passive Voice sentence. The Subject of the Acti ve sentence which becomes the Object of the preposition (normally by , but dependin g on the context, it may be with ) in the Passive is usually placed at the end of t he sentence, and is omitted in most of the expressions. There are some Verbs whi ch can never be used in the Passive even if they are in Transitive Verb position , i.e. even if they have an Object. There are certain situations where using the Passive Voice makes the sentence meaningless, senseless and ridiculous. Transitive and Intransitive Verbs: Now that we have come to know that to change a sentence or verb from Active to P assive we need that Verb to be a Transitive one, we must know what Transitive an d Intransitive Verbs are. A transitive verb is the one which has an Object, a direct or an indirect or bot h. An intransitive verb is the one which does not have any Object, direct or indire ct. TRANSITIVE VERB e.g. He drew a picture. A Transitive Verb in a sentence answers the question what? or whom? or both .

In this sentence, the verb word drew is a Transitive Verb because it answers the question what? . What did he draw? = And the answer to the question what? e.g. He told me. In this sentence, the verb word to the question told is a Transitive Verb because it has an answer me . is an Indirect Object. or = a picture . a picture is a Direct Object.

whom? . Whom did he tell? = = me

And the answer to the question whom?

In other words, a Verb word in a sentence which answers the question what?

whom? is a Transitive Verb. And the Active Voice sentence which has a Transitive V erb can be changed into Passive. INTRANSITIVE VERB e.g.

He went away. He went He went He went what? = whom? = no answer no answer

where? = away went is an Intransitive Verb because it or whom? ; and, consequently, it

In this sentence, the verb word

does not answer the question what?

does not have any Object direct or indirect. Though there is the word away after t he verb, it is not an Object because it is not the answer to what? or whom? . It is the answer to the question where? . The word away in this sentence is a complement a nd categorically it is an adverb. Consequently, this sentence cannot be changed into Passive Voice. Object or Complement? We have learned that a Direct Object is usually a noun Object can be a noun or a pronoun a thing, and an Indirect

usually a person, and it is normally placed

after the verb. However, not all nouns, representing things or persons, that com e after a verb in a sentence can be objects though they are the answers to the question what? or whom? . The nouns that come after a LINK VERB OR VERB OF INCOMPLETE PREDICATION are call ed complements . Explanation: Some verbs give us complete sense without the support of any other word or words in a sentence. For example: Birds fly. We eat. I can hear. Ice melts. They left. But there are some other verb words which need to take the support of some other word or words to give us complete sense. For example: I am She appears They remain

He feels

In these examples the verb words am , appears , remain and feels do not give us the c te sense; they need the support of some other words, such as clean , confused , silent , and sorry , for instance, to make us get the intention of the speaker or writer of these expressions. Now look at these sentences: I am clean. She appears to be confused. They remain silent. He feels sorry for what he has done. And words that help the Linking Verbs to give us complete sense are called

complements. The words clean , confused , silent , and sorry in the example sentences e are complements. We some times come across expressions with only the linking v erbs without the complements. In such cases the other part of the sentence may be omitted because the listener or the reader has some idea of what has happened before. For example, Mr. A. : Are you the new-comer?

Mr. B. : Yes, I am. [Here the new-comer is understood because this expression is an answer to the question. The sentence in complete would be Yes. I am the new-co mer. ] WHAT ARE LINK VERBS or VERBS OF INCOMPLETE PREDICATION or COPULAS? Link/linking verbs normally do not express actions. Instead they connect the su bject of the verb to some additional information about that subject mentioned in the sentence. The most common linking verbs are be forms is, am, are, was, were ( when used as main verbs) become, seem, stay, appear, feel, grow, look, prove, re main, turn, and some of the verbs of perception, such as smell, taste, feel, etc . Some of these verbs can be either linking verbs or action verbs, depending on the context. e.g. He is an accountant. In this sentence, the verb is does not show any action; it shows only the existenc e of a person. Though the phrase an accountant is a noun and is the answer to the question what? , it is not an object because it does not answer an action verb! The action does not pass from the verb to an accountant ; and such a verb is called Li nk/linking Verb or Verb of Incomplete Predication or Copula, and the word that f ollows it is called a complement. Compare: [A] She teaches English. The verb teaches is an action verb a Transitive Verb. The noun English is its object

a direct object. This sentence can be changed from Active to Passive. She is English. [= she comes from England her nationality]

The verb is expresses a state of being there is no mentioning of what she is doing. he noun English is a complement because it tells us about what she is but not what sh e has done; and therefore, is is a linking Verb. This sentence cannot be changed to Passive. She is teaching us English.

The verb word is is not the main verb in this sentence and it is not showing any st ate of being but is acting as a helping verb to form the present continuous tense o f the main verb teach ; it is a part of an action verb and the words that follow it us and English are the Objects of the verb is teaching , not of is alone. And t is a Transitive Verb and this sentence (or verb) can be changed into Passive. [B] The milk turned sour. In this sentence the verb word turned is a linking Verb. The word sour is not an ob ject because it is not the answer to the question what? and it is not a noun or pr onoun; it is an adjective . It is the complement of the subject, not the Object of the Verb. The verb word turned shows us how the milk, the subject of the senten ce, was. The action does not pass from the verb to the other word. Therefore, t he verb turned in this sentence is a linking verb, and it or the sentence cannot b e changed into Passive. The teacher turned suddenly towards the boy who dozed off. In this sentence the verb word turned is Intransitive, which means it does not hav e an object. The word suddenly is an adverb; the word towards is a preposition; and the phrase the boy , though a noun, is not the object of the verb but it is the ob ject of the preposition towards . Therefore, the word turned in this sentence is an Intransitive Verb, and so this s entence cannot be changed into Passive. He turned the picture upside down. In this sentence the action verb word turned is Transitive, which means it has an object. The picture , a noun phrase, is the Direct Object of the verb because it i s the answer to the question what? . Therefore, the word turned in this sentence is a Transitive Verb, and so this sentence can be changed into Passive. SOME MORE EXAMPLES: He seems tired. She looks charming. seems looks linking Verb; linking Verb; smelled tastes tired complement complement awful sweet complement complement

charming

His clothes smelled awful. This medicine tastes sweet. His theory was proved wrong. was proved linking Verb;

linking Verb; linking Verb;

wrong

complement

My boss felt annoyed when I gave him an incomplete report. felt linking Verb; annoyed complement

My elder brother grew taller than our father. grew linking Verb; taller complement

We stayed indoors the whole day. stayed linking Verb; indoors complement

A COMPLEMENT OR AN OBJECT? 1. He was my teacher. He told my teacher. 2. She grew a garden. She grew pale. 3. They looked up the number. They looked disappointed. 4. He was a professor. He was examining a professor. = object 5. You are the President. You are guiding the President. = object __________________________________ Tense Passive Voice = complement = object = complement = complement = complement = object = object = complement

Introduction 1. Simple Past 2. Past continuous 3. Past Perfect 4. Past Perfect Continuous 1. Simple Present 2. Present Continuous 3. Present Perfect 4. present Perfect continuous 1. Simple Future

2. future continuous 3. Future Perfect 4. Future Perfect Continuous There are only EIGHT TENSES in Passive Voice. The Past Perfect Continuous , Present Perfect Continuous , Future Continuous and the re Perfect Continuous Tenses are not used in Passive Voice in modern English. The Active Voice sentences having these four Tenses are not changed into Passive Vo ice. The Main Verb in any Tense in Passive Voice takes only the Past Participle rm! PAST 1. Simple Past formula: was/were + the past participle V3 form of the Main Verb go/goes walk/walks e.g. (i). He built a large house. A large house was built by him. [ built [ was built simple past active voice] passive voice] went gone going walked walking V3 fo

walked

simple past

(ii). They flew several kites. [ flew Several kites were flown by them. [ were flown simple past

simple past

active voice]

passive voice]

2. Past Continuous formula: was/were + being + the past participle V3 form of the Main Verb e.g. (i). She was cooking dinner. Dinner was being cooked by her. [ was being cooked past continuous passive voice] [ was cooking past continuous active voice]

(ii). They were painting some attractive pictures on the wall. [ were painting past continuous active voice]

Some attractive pictures were being painted on the wall by them. [ were being painted 3. Past Perfect past continuous passive voice]

formula: had + been + the Past Participle V3 form of the Main Verb e.g. (i). She had posted the letter before she got the phone call. [ had posted past perfect active voice; and in this sentence got s better kept in the active voice] The letter had been posted (by her) before she got the phone call. [ had been posted past perfect passive voice] in the second part

(ii). Mac had answered five questions before the final bell went. [ had answered past perfect active voice]

Five questions had been answered (by Mac) before the final bell went. [ had been answered past perfect passive voice]

4. Past Perfect Continuous no passive voice for this tense PRESENT 1. Simple Present formula: is/am/are + the Past Participle V3 form of the Main Verb e.g. (i). The grocer sells fresh vegetables. Fresh vegetables are sold by the grocer. [ are sold simple present passive voice] [ sells simple present active voice]

(ii). He gives me an expensive watch. [ gives simple present active voice] me and

The verb gives in this sentence has two objects: is sentence can be changed in two ways:

an expensive watch , and so t passive voic

*(a) I am given an expensive watch by him. [ am given e] *(b) An expensive watch is given to me by him. [ is given simple present passive voice]

simple present

2. Present Continuous formula: is/am/are + being + the Past Participle V3 form of the Main Verb e.g. (i). My boss is giving many assignments.

[ is giving

present continuous

active voice]

Many assignments are being given by my boss. [ are being given present continuous passive voice]

(ii). She is giving some lecture. [ is giving present continuous active voice]

Some lecture is being given by her. [ is being given 3. Present Perfect formula: has/have + been + the past participle V3 form of the Main Verb e.g. (i). I have taken him out. He has been taken out by me. [ has been taken present perfect passive voice] [ have taken present perfect active voice] present continuous passive voice]

(ii). She has shown them an interesting book. [ has shown present perfect active voice]

*a) They have been shown an interesting book by her. [ have been shown present perfect passive voice]

*b) An interesting book has been shown to them by her. [ has been shown present perfect passive voice]

4. Present Perfect Continuous no passive voice for this tense Future 1. Simple Future formula: will/shall + be + the Past Participle V3 form of the Main Verb e.g. I will give you a present. [ will give -- simple present active voice]

*a) You shall be given a present by me. [ will be given -- simple future passive voice]

*b) A present will be given to you by me. [ will be given simple future passive voice]

2. Future Continuous no passive voice for this tense 3. Future Perfect formula: will/shall + have + been + the Past Participle V3 form of the Main Verb e.g. The doctor shall have examined ten patients by 10 O clock. [ shall have examined future perfect active voice]

Ten patients will have been examined by 10 O clock by the doctor. [ will have been examined 4. Future Perfect Continuous no passive form for this tense ****************************** Round up of Tenses verb tense voice parts give simple present active one verb one part is given simple present passive one verb two parts am giving present continuous active one verb two parts am being given present continuous passive one verb three parts has given present perfect active one verb two parts has been given present perfect gave simple past active was given simple past was giving past continuous was being given past continuous had given past perfect had been given past perfect will give simple future will be given simple future passive one verb three parts one verb one part passive one verb two parts active one verb two parts passive one verb three parts active one verb two parts passive one verb three parts active one verb two parts passive one verb three parts three parts Active & Passive future perfect passive voice]

will have given future perfect active one verb

will have been given future perfect passive one verb A SPECIAL NOTE ON THE VERB WORD LET :

four parts let woul

The verb word let has no passive form; and therefore, Active sentences with d take allowed or permitted in Passive For example, She didn t let her children go out alone. Active Voice

The children were not allowed (or permitted) to go out alone by her. Passive V oice ABOUT THE USE OF THE ACTIVE AND PASSIVE: Learning how the different Passive forms are constructed may be easy once we und erstand the rules, but what is often difficult to understand is when it is prope r to use an Active Voice sentence and when it is appropriate to use a Passive Vo ice sentence. We must remember that Active and Passive forms are often not equivalent and we c annot use either of them to suit a particular context. Luckily for us there are some clear-cut cases, such as: Doctor: Patient: But not Patient: My arm was broken by me. Passive Voice What s the matter? I broke my arm. Active Voice

It would be ridiculous using Passive in this expression!

Use a period [ . ] at the end of a sentence that makes a statement. There is no space between the last letter and the period. Use one space between the period a nd the first letter of the next sentence. This goes against the grain for people using the typography instilled by generations of old-fashioned typewriter users , but modern word-processors nicely accommodate the spacing after a period, and double-spacing after a period can only serve to discombobulate the good intentio ns of one's software. See Quotation Marks and Parentheses for special placement considerations with th ose marks. Use a period at the end of a command. Hand in the poster essays no later than noon on Friday. In case of tremors, leave the building immediately. Use a period at the end of an indirect question. The teacher asked why Maria had left out the easy exercises. My father used to wonder why Egbert's ears were so big. Use a period with abbreviations:

Dr. Espinoza arrived from Washington, D.C., at 6 p.m. Notice that when the period ending the abbreviation comes at the end of a senten ce, it will also suffice to end the sentence. On the other hand, when an abbrevi ation ends a question or exclamation, it is appropriate to add a question mark o r exclamation mark after the abbreviation-ending period: Did you enjoy living in Washington, D.C.? Occasionally, a statement will end with a question. When that happens, it is app ropriate to end the sentence with a question mark. We can get to Boston quicker, can't we, if we take the interstate? His question was, can we end this statement with a question mark? She ended her remarks with a resounding why not? Acronyms (abbreviations [usually made up of the first letter from a series of wo rds] which we pronounce as words, not a series of letters) usually do not requir e periods: NATO, NOW, VISTA, LASER, SCUBA, RADAR. Abbreviations we pronounce by spelling out the letters may or may not use periods and you will have to use a d ictionary to be sure: FBI, NAACP, NCAA, U.S.A., U.N.I.C.E.F., etc.

Use a question mark [ ? ] at the end of a direct question. It is considered bad form to use a question mark in combination with other marks, although that is of ten done in informal prose in an attempt to convey complex tones: He told you wh at!? That combination (or similar combination) of punctuation marks is sometimes called an interrobang, but the interrobang currently has no role in academic pr ose.* A tag question is a device used to turn a statement into a question. It nearly a lways consists of a pronoun, a helping verb, and sometimes the word not. Althoug h it begins as a statement, the tag question prevails when it comes to the end-m ark: use a question mark. Notice that when the statement is positive, the tag qu estion is expressed in the negative; when the statement is negative, the tag que stion is positive. (There are a few exceptions to this, frequently expressing an element of surprise or sarcasm: "So you've made your first million, have you?" "Oh, that's your plan, is it?") The following are more typical tag questions: He should quit smoking, shouldn't he? He shouldn't have quit his diet, should he? They're not doing very well, are they? He finished on time, didn't he? She does a beautiful job, doesn't she? Harold may come along, mightn't he? There were too many people on the dock, weren't there? (Be careful of this last one; it's not "weren't they?") Be careful not to put a question mark at the end of an indirect question. The instructor asked the students what they were doing. I asked my sister if she had a date. I wonder if Cheney will run for vice president again. I wonder whether Cheney will run again. Be careful to distinguish between an indirect question (above), and a question t hat is embedded within a statement which we do want to end with a question mark. We can get to Boston quicker, can't we, if we take the interstate? His question was, can we end this statement with a question mark? She ended her remarks with a resounding why not? I wonder: will Cheney run for office again? Put a question mark at the end of a sentence that is, in fact, a direct question

. (Sometimes writers will simply forget.) Rhetorical questions (asked when an an swer is not really expected), by the way, are questions and deserve to end with a question mark: How else should we end them, after all? What if I said to you, "You've got a real problem here"? (Notice that the questi on mark here comes after the quotation mark and there is no period at the end of the statement.) Sometimes a question will actually end with a series of brief questions. When th at happens, especially when the brief questions are more or less follow-up quest ions to the main question, each of the little questions can begin with a lowerca se letter and end with a question mark. Who is responsible for executing the plan? the coach? the coaching staff? the pl ayers? If a question mark is part of an italicized or underlined title, make sure that the question mark is also italicized: My favorite book is Where Did He Go? (Do not add a period after such a sentence that ends with the title's question m ark. The question mark will also suffice to end the sentence.) If the question m ark is not part of a sentence-ending title, don't italicize the question mark: Did he sing the French national anthem, la Marseillaise? When a question ends with an abbreviation, end the abbreviation with a period an d then add the question mark. Didn't he use to live in Washington, D.C.? When a question constitutes a polite request, it is usually not followed by a qu estion mark. This becomes more true as the request becomes longer and more compl ex: Would everyone in the room who hasn't received an ID card please move to the fro nt of the line.

Use an exclamation point [ ! ] at the end of an emphatic declaration, interjecti on, or command. "No!" he yelled. "Do it now!" An exclamation mark may be used to close questions that are meant to convey extr eme emotion, as in What on earth are you doing! Stop! An exclamation mark can be inserted within parentheses to emphasize a word withi n a sentence. We have some really(!) low-priced rugs on sale this week. Note that there is no space between the last letter of the word so emphasized an d the parentheses. This device should be used rarely, if ever, in formal text. An exclamation mark will often accompany mimetically produced sounds, as in "All night long, the dogs woof! in my neighbor's yard" and "The bear went Grr!, and I went left." If an exclamation mark is part of an italicized or underlined title, make sure t hat the exclamation mark is also italicized or underlined:

My favorite book is Oh, the Places You'll Go! (Do not add a period after such a sentence that ends with the title's exclamatio n mark. The exclamation mark will also suffice to end the sentence.) If the excl amation mark is not part of a sentence-ending title, don't italicize the exclama tion mark: I've asked you not to sing la Marseillaise! In academic prose, an exclamation point is used rarely, if at all, and in newspa per writing the exclamation point is virtually nonexistent.

Use a colon [ : ] before a list or an explanation that is preceded by a clause t hat can stand by itself. Think of the colon as a gate, inviting one to go on: There is only one thing left to do now: confess while you still have time. The charter review committee now includes the following people: the mayor the chief of police the fire chief the chair of the town council You nearly always have a sense of what is going to follow or be on the other sid e of the colon. (Compare the function of a semicolon in this regard.) You will f ind differing advice on the use of a colon to introduce a vertical or display li st. See Using Numbers and Creating Lists. We will often use a colon to separate an independent clause from a quotation (of ten of a rather formal nature) that the clause introduces: The acting director often used her favorite quotation from Shakespeare's Tempest : "We are such stuff as dreams are made on; and our little life is rounded with a sleep." With today's sophisticated word-processing programs (which know how much space t o put after punctuation marks), we insert only one space (hit the space-bar only once) after a colon. It might be useful to say, also, when we don't use a colon. Remember that the cl ause that precedes the mark (where you're considering a colon) ought to be able to stand on its own as an independent clause. Its purpose might be strictly to i ntroduce the clause that follows, so it might feel rather incomplete by itself, but grammatically it will have both a subject and a predicate. In other words, w e would not use a colon in situations like the following: Her recipe for gunpowder included saltpeter, dry oatmeal, and ground-up charcoal briquets. (no colon after "included") His favorite breakfast cereals were Rice Krispies, Cheerios, and Wheaties. (no c olon after "were") Her usual advice, I remember, was "Keep your head up as you push the ball up the court." (no colon after "was") One of the most frequently asked questions about colons is whether we should beg in an independent clause that comes after a colon with a capital letter. If the independent clause coming after the colon is a formal quote, begin that quoted l anguage with a capital letter. Whitehead had this to say about writing style: "Style is the ultimate morality o f mind." If the explanatory statement coming after a colon consists of more than one sent ence, begin the independent clause immediately after the colon with a capital le tter:

There were two reasons for a drop in attendance at NBA games this season: First, there was no superstar to take the place of Michael Jordan. Second, fans were d isillusioned about the misbehavior of several prominent players. If the introductory phrase preceding the colon is very brief and the clause foll owing the colon represents the real business of the sentence, begin the clause a fter the colon with a capital letter: Remember: Many of the prominent families of this New England state were slavehol ders prior to 1850. If the function of the introductory clause is simply to introduce, and the funct ion of the second clause (following the colon) is to express a rule, begin that second clause with a capital: Let us not forget this point: Appositive phrases have an entirely different func tion than participial phrases and must not be regarded as dangling modifiers. There is some disagreement among writing reference manuals about when you should capitalize an independent clause following a colon. Most of the manuals advise that when you have more than one sentence in your explanation or when your sente nce(s) is a formal quotation, a capital is a good idea. The NYPL Writer's Guide urges consistency within a document; the Chicago Manual of Style says you may be gin an independent clause with a lowercase letter unless it's one of those two t hings (a quotation or more than one sentence). The APA Publication Manual is the most extreme: it advises us to always capitalize an independent clause followin g a colon. The advice given above is consistent with the Gregg Reference Manual. We also use a colon after a salutation in a business letter . . . Dear Senator Dodd: It has come to our attention that . . . . . . . . and when we designate the speaker within a play or in court testimony: BIFF: He had the wrong dreams. All, all, wrong. HAPPY (almost ready to fight Biff): Don't say that! BIFF: He never knew who he was.

Use a semicolon [ ; ] to help sort out a monster list: There were citizens from Bangor, Maine; Hartford, Connecticut; Boston, Massachus etts; and Newport, Rhode Island. OR We had four professors on our committee: Peter Wursthorn, Professor of Mathemati cs; Ronald Pepin, Professor of English; Cynthia Greenblatt, Professor of Educati on; and Nada Light, Professor of Nursing. to separate closely related independent clauses: My grandmother seldom goes to bed this early; she's afraid she'll miss out on so mething. The semicolon allows the writer to imply a relationship between nicely balanced ideas without actually stating that relationship. (Instead of saying because my grandmother is afraid she'll miss out on something, we have implied the because. Thus the reader is involved in the development of an idea a clever, subliminal wa y of engaging the reader's attention.) It is rare, but certainly possible, that you will want a semicolon to separate t wo independent clauses even when those two independent clauses are connected by

a coordinating conjunction. This is especially true when the independent clauses are complex or lengthy and when there are commas within those independent claus es. You might consider breaking those two independent clauses into separate sent ences when this happens. Coach Auriemma realized that his next recruiting class contained two superb guar ds, a fine post player, and a power forward; but as of the end of the spring rec ruiting season, he was still pushing to discover better first-year players for t he interior positions.

Although smart word-processors seem to have taken over the job of hyphenating br oken words at the right-hand end of our lines and spellcheckers can review our u se of hyphens in other places, these technological marvels are by no means infal lible. Microsoft Word, for example, flags as misspelled almost any word with an unhyphenated prefix: antidiscrimination and cogeneration, for example, are marke d as misspelled words and re-sign, co-bra, ever-green, and be-loved are marked a s correctly hyphenated words by that software.* Generally, it is a good idea not to use justified text in academic papers; that will cut down on a lot of decisi ons about hyphenating. The APA Publication Manual, in fact, insists that you not break words at line-endings in any case, but that can lead to lines that are to o brief and aesthetically unbalanced. The rules for hyphenating at line endings are so complicated that no one can be expected to keep track of them. If you're ever in a situation where you have to hyphenate at line-breaks, go to a dictionary unless you can explain why you would break experience between the e and the r, that is, and then you can do whatever you want. Remember that if you adjust one line-break for aesthetic reasons, that may well affect subsequent line-breaks in the text. Probably the best reference text for these decisions (next to looking up everyth ing in a dictionary, that is) is The Chicago Manual of Style. An excellent onlin e resource on hyphen use is the Editing Workshop by Sonia Jaffe Robbins at New Y ork University. Tom Little voices a dissenting opinion in "The Great Hyphenation Hoax," which seeks to free writers of the innumerable rules and imponderable ta bles of the Chicago Manual of Style. Hyphens have other uses creating compound words, particularly modifiers before nouns (the well-known act or, my six-year-old daughter, the out-of-date curriculum writing numbers twenty-one to ninety-nine and fractions (five-eighths, one-fourt h) creating compounds on-the-fly for fly-by-night organizations adding certain prefixes to words: When a prefix comes before a capitalized word or the prefix is capitalized, use a hyphen (non-English, A-frame, I-formation). The prefixes self-, all-, and ex- nearly always require a hyphen (ex-husband, al l-inclusive, self-control), and when the prefix ends with the same letter that b egins the word, you will often use a hyphen (anti-intellectual, de-emphasize), b ut not always (unnatural, coordinate, cooperate). By all means, use a good dicti onary when in doubt! For further information about compound nouns and compound m odifiers, see the separate section on Compound Words. There is no space between a hyphen and the character on either side of it. Suspended Compounds With a series of nearly identical compounds, we sometimes delay the final term o f the final term until the last instance, allowing the hyphen to act as a kind o f place holder, as in

The third- and fourth-grade teachers met with the parents. Both full- and part-time employees will get raises this year. We don't see many 3-, 4-, and 5-year-old children around here. Be careful not to overuse this feature of the hyphen; readers have to wait until that final instance to know what you're talking about, and that can be annoying . Use a dash [ ] (or two hyphens [ -- ] on old-fashioned typewriters) or dashes as a super-comma or set of super-commas to set off parenthetical elements, especia lly when those elements contain internal forms of punctuation: All four of them Bob, Jeffrey, Jason, and Brett did well in college. In most word-processors, the dash is created by holding down the option key and hitting the key that has the underline mark above the hyphen. This can vary, tho ugh, from program to program. Usually, you get an en dash (see below) with the o ption + hyphen key, and you get the larger em dash (used more frequently) with o ption + shift + hyphen keys. Do not use dashes to set apart material when commas would do the work for you. U sually, there are no spaces between the dash and the letters on either side of a dash, although the dash is frequently shown that way in documents prepared for the World Wide Web and e-mail for typographical and aesthetic reasons (because t he WWW authoring and e-mail clients have little control over line-breaks). In writing dialogue, the dash is used to show breaks in thought and shifts in to ne: "How many times have I asked you not to ked out the window. "Not to do what?" I prompted. "Not to Oh heck, I forget!" " Jasion suddenly stopped talking and loo

A dash is sometimes used to set off concluding lists and explanations in a more informal and abrupt manner than the colon. We seldom see the dash used this way in formal, academic prose. Modern word processors provide for two kinds of dashes: the regular dash or em d ash (which is the same width as the letter "M," ) and the en dash (which is abou t half the width, the same as the letter "N," ). We use the em dash for most pur poses and keep its smaller brother, the en dash, for marking the space between d ates in a chronological range: "Kennedy's presidency (1961 1963) marked an extraor dinary era. . . ."; in time: 6:30 8:45 p.m.; and between numbers and letters in an indexing scheme: table 13 C, CT Statute 144 A. The en dash is also used to join compound modifiers made up of elements that are themselves either open compounds (frequently two-word proper nouns) or already hyphenated compounds: the Puerto Rican United States collaboration, the New York New Jersey border, post-Darwinian pre-Freudian theorems. The Gregg Reference Manual a nd the Chicago Manual of Style both recommend using the en dash whenever a compo und modifier is combined with a participle as in "a Frank Lloyd Wright designed bu ilding," "a White House backed proposal," and "a foreign exchanged related issue." A string of modifiers in a single compound, though, is joined with hyphens: hilar ious, never-to-be-forgotten moments. If you are using an old-fashioned typewrite r that cannot create an en dash, you can denote to your typesetter or editor tha t a hyphen is to be converted to an en dash by using a hyphen and hand-writing t he letter "n" above it.

Some reference manuals are urging editors and publishers to get rid of the en da sh altogether and to use the em dash exclusively, but en and em are still handy words to know when you're trying to get rid of those extra e's at the end of a S crabble game. Finally, we use what is called a 3-em dash (or six typewriter hyph ens) when we're showing that someone's name or a word has been omitted (perhaps for legal reasons or issues of taste):

Use parentheses [ ( ) ] to include material that you want to de-emphasize or tha t wouldn't normally fit into the flow of your text but you want to include nonet heless. If the material within parentheses appears within a sentence, do not use a capital letter or period to punctuate that material, even if the material is itself a complete sentence. (A question mark or exclamation mark, however, might be appropriate and necessary.) If the material within your parentheses is writt en as a separate sentence (not included within another sentence), punctuate it a s if it were a separate sentence. Thirty-five years after his death, Robert Frost (we remember him at Kennedy's in auguration) remains America's favorite poet. Thirty-five years after his death, Robert Frost (do you remember him?) remains A merica's favorite poet. Thirty-five years after his death, Robert Frost remains America's favorite poet. (We remember him at Kennedy's inauguration.) If the material is important enough, use some other means of including it within your text even if it means writing another sentence. Note that parentheses tend t o de-emphasize text whereas dashes tend to make material seem even more importan t. Use brackets [ [ ] ] in the following situations: You can use them to include explanatory words or phrases within quoted language: Lew Perkins, the Director of Athletic Programs, said that Pumita Espinoza, the n ew soccer coach [at Notre Dame Academy] is going to be a real winner. If you are quoting material and you've had to change the capitalization of a wor d or change a pronoun to make the material fit into your sentence, enclose that changed letter or word(s) within brackets: Espinoza charged her former employer with "falsification of [her] coaching recor d." See the description of the ellipsis for information on using brackets to set off an ellipsis that you have used to indicate omitted language in a quotation. Also within quotations, you could enclose [sic] within brackets (we italicize bu t never underline the word sic and we do not italicize the brackets themselves) to show that misspelled words or inappropriately used words are not your own typ os or blunders but are part of an accurately rendered quotation: Reporters found three mispelings [sic] in the report. (It is bad manners, however, to use this device to show that another writer is a lousy speller or otherwise unlettered. Also, use it only when it is important t o maintain the original spelling for some reason. If you can edit (remove) the e rror without violating some scholarly or ethical principle, do so.) Note, also, that the word sic means "thus" or "that's how it was" and is not an abbreviation ; thus, no period. If you have italicized or underlined words within quoted language that was not i

talicized or underlined in the original, you can note that change in brackets in cluded within the sentence or paragraph: It was the atmosphere of the gym that thrilled Jacobs, not the eight championshi p banners hanging from the beams [italics added]. ("Italics mine" or "emphasis added" would be other acceptable phrases.) You can use brackets to include parenthetical material inside parenthetical mate rial: Chernwell was poet laureate of Bermuda (a largely honorary position [unpaid]) fo r ten years. Be kind to your reader, however, and use this device sparingly.

An ellipsis [ ] proves to be a handy device when you're quoting material and you want to omit some words. The ellipsis consists of three evenly spaced dots (per iods) with spaces between the ellipsis and surrounding letters or other marks. L et's take the sentence, "The ceremony honored twelve brilliant athletes from the Caribbean who were visiting the U.S." and leave out "from the Caribbean who wer e": The ceremony honored twelve brilliant athletes visiting the U.S. If the omission comes after the end of a sentence, the ellipsis will be placed a fter the period, making a total of four dots. See how that works? Notice that th ere is no space between the period and the last character of the sentence. The ellipsis can also be used to indicate a pause in the flow of a sentence and is especially useful in quoted speech: Juan thought and thought and then thought some more. "I'm wondering " Juan said, bemused. Note carefully the spacing of the ellipsis marks and the surrounding characters in the examples above. In mid-sentence, a space should appear between the first and last ellipsis marks and the surrounding letters. If a quotation is meant to trail off (as in Juan's bemused thought), leave a space between the last letter and the first ellipsis mark but do not include a period with the ellipsis marks. If words are left off at the end of a sentence, and that is all that is omitted, indicate the omission with ellipsis marks (preceded and followed by a space) an d then indicate the end of the sentence with a period . If one or more sentences are omitted, end the sentence before the ellipsis with a period and then insert your ellipsis marks with a space on both sides. As in this example. A coded ell ipsis (used in the construction of this page) will appear tighter (with less of a space between the dots) than the use of period-space-period-space-period. When words at the beginning of a quoted sentence are omitted, it is not necessar y to use an ellipsis to indicate that words have been left out when that fragmen t can fit into the flow of your text. An exception: in a blockquoted fragment, u se an ellipsis to indicate an omission: According to Quirk and Greenbaum, the distinctions are unimportant for count nou ns with specific reference to definite and indefinite pronouns. However, if the material quoted can be read as a complete sentence, simply capit alize the first word of the material and leave out the ellipsis marks: This principle is described by Quirk and Greenbaum: The distinctions for count nouns with specific reference to definite and indefin

ite pronouns remain unimportant. When a lengthy quotation begins with a complete sentence and ends with a complet e sentence, do not use an ellipsis at either the end or the beginning of the quo tation unless it is, for some reason, important to emphasize that some language has been omitted.* The ellipsis should be regarded as one unit and should not be broken at the end of a line. Toward that end, it is useful to know the code that will create an un broken and unbreakable ellipsis for you on the word-processing program you are u sing. On most machines, it's a simple matter of holding down the option key and hitting the semicolon, but this varies from program to program. To avoid problem s when you reformat a paper (change margins, font sizes, etc.), the spaces that surround the ellipsis should also be created as "non-breaking spaces." The MLA Handbook recommends using square brackets on either side of the ellipsis points to distinguish between an ellipsis that you've added and the ellipses th at might have been in the original text. Such a bracketed ellipsis in a quotatio n would look like this: "Bohr [ ] used the analogy of parallel stairways [ ]" (Smith 55). (Other research manuals the APA Publication Manual and the Chicago Manual of Sty le do not address this use of bracketed ellipses.) The plural of ellipsis is ellipses (handy to remember when you're playing Scrabb le), but the points themselves (the dots that make up the ellipsis) are called e llipsis points or ellipsis marks.

We use an apostrophe [ ] to create possessive forms, contractions, and some plur als (see below). The apostrophe shows where a letter or letters have been left o ut of a contracted verb: I am = I'm you are = you're she is = she's it is = it's do not = don't she would = she'd he would have = he would've let us = let's who is = who's she will = she'll they had = they'd Whether or not contractions are appropriate in academic prose is a matter of per sonal taste and debate. See the section on Tone for a discussion of contractions . Also, ask your instructor before using contractions in a paper that will be gr aded. This Guide has an entire section devoted to a description of possessives. You ca n click HERE to go to that section (and accompanying quizzes) or read this summa ry. In possessives, the placement of the apostrophe depends on whether the noun that shows possession is singular or plural. Generally, if the noun is singular, the apostrophe goes before the s. The witch's broom. If the noun is plural, the apo strophe goes after the s: The witches' brooms. However, if the word is pluralize d without an s, the apostrophe comes before the s: He entered the men's room wit h an armload of children's clothing. If you create a possessive with a phrase li ke of the witches, you will use no apostrophe: the brooms of the witches. Remember that it's means it is or it has. Confusing it's with its, the possessiv e of it, is perhaps the most common error in writing. Remember, too, that there is no appropriate contraction for "there are." Don't confuse "they're," which me ans "they are" with "there are" (which can sound like "ther're," [or some such s et of rumbling r's] in casual speech).

An apostrophe is also used to form some plurals, especially the plural of letter s and digits. Raoul got four A's last term and his sister got four 6's in the ic e-skating competition. This is particularly useful when the letter being plurali zed is in the lower case: "minding one's p's and q's" or "Don't forget to dot yo ur i's." (In a context in which the plural is clear, apostrophes after upper-cas e letters are not necessary: "He got four As, two Bs, and three Cs.") It is no l onger considered necessary or even correct to create the plural of years or deca des or abbreviations with an apostrophe: He wrote several novels during the 1930s. There are fifteen PhDs on our faculty. My sister and I have identical IQs. (If you wrote Ph.D. with periods, you would add an apostrophe before the plurali zing "s": Ph.D.'s) If the abbreviation or acronym ends in "S," it's a good idea to separate this final "S" from the pluralizing "s" with an apostrophe: SOS's

Use quotation marks [ ] to set off material that represents quoted or spoken lan guage. Quotation marks also set off the titles of things that do not normally st and by themselves: short stories, poems, and articles. Usually, a quotation is s et off from the rest of the sentence by a comma; however, the typography of quot ed material can become quite complicated. Here is one simple rule to remember: In the United States, periods and commas go inside quotation marks regardless of logic. Click HERE for an explanation (sort of). In the United Kingdom, Canada, and islands under the influence of British educat ion, punctuation around quotation marks is more apt to follow logic. In American style, then, you would write: My favorite poem is Robert Frost's "Design." But in England you would write: My favorite poem is Robert Frost's "Design". The pla cement of marks other than periods and commas follows the logic that quotation m arks should accompany (be right next to) the text being quoted or set apart as a title. Thus, you would write (on either side of the Atlantic): What do you think of Robert Frost's "Design"? and I love "Design"; however, my favorite poem was written by Emily Dickinson. Further, punctuation around quoted speech or phrases depends on how it fits into the rest of your text. If a quoted word or phrase fits into the flow of your se ntence without a break or pause, then a comma may not be necessary: The phrase "lovely, dark and deep" begins to suggest ominous overtones. Following a form of to say, however, you'll almost always need a comma: My father always said, "Be careful what you wish for." If the quoted speech follows an independent clause yet could be part of the same sentence, use a colon to set off the quoted language: My mother's favorite quote was from Shakespeare: "This above all, to thine own s elf be true." When an attribution of speech comes in the middle of quoted language, set it apa rt as you would any parenthetical element: "I don't care," she said, "what you think about it." Be careful, though, to begin a new sentence after the attribution if sense calls for it: "I don't care," she said. "What do you think?" Convention normally insists that a new paragraph begins with each change of spea ker:

"I don't care what you think anymore," she said, jauntily tossing back her hair and looking askance at Edward. "What do you mean?" he replied. "What do you mean, 'What do I mean?'" Alberta sniffed. She was becoming impatien t and wished that she were elsewhere. "You know darn well what I mean!" Edward huffed. "Have it your way," Alberta added, "if that's how you feel." In proofreading and editing your writing, remember that quotation marks always t ravel in pairs! Well, almost always. When quoted dialogue carries from one parag raph to another (and to another and another), the closing quotation mark does no t appear until the quoted language finally ends (although there is a beginning q uotation mark at the start of each new quoted paragraph to remind the reader tha t this is quoted language). Also, in parenthetical documentation (see the Guide to Writing Research Papers), the period comes after the parenthetical citation w hich comes after the quotation mark" (Darling 553). In reporting "silent speech" noting that language is "said," but internally and no t spoken out loud writers are on their own. Writers can put quotation marks around it or not: Oh, what a beautiful morning, Curly said to himself. "Oh, what a beautiful morning!" Curly said to himself. Some writers will set such unspoken language in italics or indent it in order to set it off from other "regular" language. That's probably not a good idea if th ere is a lot of it because the indents can be confusing and italics can become t iresome to read after a while. The decision will probably depend on the amount o f silent speech within the text. Probably the best way to handle silent speech i s to find an author whom you like who does a lot of this Graham Swift in his novel Last Orders, for instance and copy that author's style. Consistency, of course, i s very important. Be careful not to use quotation marks in an attempt to emphasize a word (the kin d of thing you see in grocery store windows Big "Sale" Today!). Underline or itali cize that word instead. (The quotation marks will suggest to some people that yo u are using that word in a special or peculiar way and that you really mean some thing else or that your sale is entirely bogus.) The American Medical Association Manual of Style (9th ed, 1998) calls misused qu otation marks like this Apologetic Quotation Marks and says: Quotation marks used around words to give special effect or to indicate irony ar e usually unnecessary. When irony or special effect is intended, skillful prepar ation can take the place of using these quotes. Resort to apologetic quotation m arks or quotation marks used to express irony only after such attempts have fail ed, keeping in mind that the best writing does not rely on apologetic quotation marks. (p 220) Refer to Capital's Guide for Writing Research Papers and, especially, the Englis h faculty's Suggestions for Writing Papers for Literature Courses for further he lp in handling quotations. We do not enclose indirect quotations in quotation marks. An indirect quotation reports what someone says but not in the exact, original language. Indirect quot ations are not heard in the same way that quoted language is heard. The President said that NAFTA would eventually be a boon to small businesses in both countries. Professor Villa told her students the textbooks were not yet in the bookstore. Double Punctuation with Quotations

Occasionally very occasionally, we hope we come across a sentence that seems to demand one kind of punctuation mark within quotation marks and another kind of p unctuation mark outside the quotation marks. A kind of pecking order of punctuat ion marks takes over: other marks are stronger than a period and an exclamation mark is usually stronger than a question mark. If a statement ends in a quoted q uestion, allow the question mark within the quotation marks suffice to end the s entence. Malcolm X had the courage to ask the younger generation of American blacks, "Wha t did we do, who preceded you?" On the other hand, if a question ends with a quoted statement that is not a ques tion, the question mark will go outside the closing quotation mark. Who said, "Fame means when your computer modem is broken, the repair guy comes o ut to your house a little faster"? If a question ends with a quotation containing an exclamation mark, the exclamat ion mark will supersede the question and suffice to end the sentence. Wasn't it Malcolm X who declared, "Why, that's the most hypocritical government since the world began!" A single question mark will suffice to end a quoted question within a question: "Didn't he ask, 'What did we do, who preceded you?'" queried Johnson. Authority for this section: New York Public Library Writer's Guide to Style and Usage HarperCollins: New York. 1994. 277. Cited with permission, examples our ow n. Single Quotation Marks In the United States, we use single quotation marks [ ] to enclose quoted materi al (or the titles of poems, stories, articles) within other quoted material: "'Design' is my favorite poem," he said. "Did she ask, 'What's going on?'" Ralph Ellison recalls the Golden Age of Jazz this way: "It was itself a texture of fragments, repetitive, nervous, not fully formed; its melodic lines undergrou nd, secret and taunting; its riffs jeering 'Salt peanuts! Salt peanuts!'" British practice, again, is quite different. In fact, single-quote marks and dou ble-quote marks are apt to be reversed in usage. Instructors in the U.S. should probably take this into account when reading papers submitted by students who ha ve gone to school in other parts of the globe. In newspapers, single quotation marks are used in headlines where double quotati on marks would otherwise appear. Congress Cries 'Shame!' In some fields, key terms may be set apart with single-quote marks. In such case s, periods and commas go outside the single-quote marks: Sartre's treatment of 'being', as opposed to his treatment of 'non-being', has b een thoroughly described in Kaufmann's book. When the term is case-sensitive, capitalization remains unchanged despite placem ent in the sentence. 'tx_send' determines whether the signal will be output through TX Output Port. If the constant REG_RESET is set, then resets will be registered.

A slash or slant or solidus or virgule [ / ] (take your pick of names) is used t o indicate a choice between the words it separates. Using the pass/fail option backfired on her; she could've gotten an A. The slash can be translated as or and should not be used where the word or could not be used in its place. To avoid gender problems with pronouns, some writers use he/she, his/her, and him/her. Many authorities despise that construction and urge writers either to pluralize when possible and appropriate (to they, their, them) or to use he or she, etc. instead. Notice there is no space between the s lash and the letters on either side of it. There is, however, a space when the slash is used to indicate a line-break in qu oted poetry: "The woods are lovely, dark, and deep / but I have promises to keep ." (This way of quoting poetry is limited to four or five lines of verse, within the normal flow of text.) When using slashes in a Uniform Resource Locator (URL) for a World Wide Web addr ess (http://www.ccc.commnet.edu/grammar/), be especially sure not to include spa ces and not to confuse the slash with its backward cousin, \, used as a path sep arator in Windows (for example, c:\program files\Adobe).

Use a comma to separate the elements in a series (three or more things), includi ng the last two. "He hit the ball, dropped the bat, and ran to first base." You may have learned that the comma before the "and" is unnecessary, which is fine i f you're in control of things. However, there are situations in which, if you do n't use this comma (especially when the list is complex or lengthy), these last two items in the list will try to glom together (like macaroni and cheese). Usin g a comma between all the items in a series, including the last two, avoids this problem. This last comma the one between the word "and" and the preceding word is o ften called the serial comma or the Oxford comma. In newspaper writing, incident ally, you will seldom find a serial comma, but that is not necessarily a sign th at it should be omitted in academic prose. Use a comma + a little conjunction (and, but, for, nor, yet, or, so) to connect two independent clauses, as in "He hit the ball well, but he ran toward third ba se." Contending that the coordinating conjunction is adequate separation, some writer s will leave out the comma in a sentence with short, balanced independent clause s (such as we see in the example just given). If there is ever any doubt, howeve r, use the comma, as it is always correct in this situation. One of the most frequent errors in comma usage is the placement of a comma after a coordinating conjunction. We cannot say that the comma will always come befor e the conjunction and never after, but it would be a rare event, indeed, that we need to follow a coordinating conjunction with a comma. When speaking, we do so metimes pause after the little conjunction, but there is seldom a good reason to put a comma there.

Use a comma to set off introductory elements, as in "Running toward third base,

he suddenly realized how stupid he looked." It is permissible to omit the comma after a brief introductory element if the om ission does not result in confusion or hesitancy in reading. If there is ever an y doubt, use the comma, as it is always correct. If you would like some addition al guidelines on using a comma after introductory elements, click HERE. Use a comma to set off parenthetical elements, as in "The Founders Bridge, which spans the Connecticut River, is falling down." By "parenthetical element," we m ean a part of a sentence that can be removed without changing the essential mean ing of that sentence. The parenthetical element is sometimes called "added infor mation." This is the most difficult rule in punctuation because it is sometimes unclear what is "added" or "parenthetical" and what is essential to the meaning of a sentence. Appositives are almost always treated as parenthetical elements. Calhoun's ambition, to become a goalie in professional soccer, is within his rea ch. Eleanor, his wife of thirty years, suddenly decided to open her own business. Sometimes the appositive and the word it identifies are so closely related that the comma can be omitted, as in "His wife Eleanor suddenly decided to open her o wn business." We could argue that the name "Eleanor" is not essential to the mea ning of the sentence (assuming he has only one wife), and that would suggest tha t we can put commas both before and after the name (and that would, indeed, be c orrect). But "his wife" and "Eleanor" are so close that we can regard the entire phrase as one unit and leave out the commas. With the phrase turned around, how ever, we have a more definite parenthetical element and the commas are necessary : "Eleanor, his wife, suddenly decided to open her own business." Consider, also , the difference between "College President Ira Rubenzahl voted to rescind the w ithdrawal policy" (in which we need the name "Ira Rubenzahl" or the sentence doe sn't make sense) and "Ira Rubenzahl, the college president, voted to rescind the withdrawal policy" (in which the sentence makes sense without his title, the ap positive, and we treat the appositive as a parenthetical element, with a pair of commas). As pointed out above (Rule #3), an adverbial clause that begins a sentence is se t off with a comma: Although Queasybreath had spent several years in Antarctica, he still bundled up warmly in the brisk autumns of Ohio. Because Tashonda had learned to study by herself, she was able to pass the entra nce exam. When an adverbial clause comes later on in the sentence, however, the writer mus t determine if the clause is essential to the meaning of the sentence or not. A "because clause" can be particularly troublesome in this regard. In most sentenc es, a "because clause" is essential to the meaning of the sentence, and it will not be set off with a comma: The Okies had to leave their farms in the midwest because the drought conditions had ruined their farms. Sometimes, though, the "because clause" must be set off with a comma to avoid mi sreading: I knew that President Nixon would resign that morning, because my sister-in-law worked in the White House and she called me with the news. Without that comma, the sentence says that Nixon's resignation was the fault of my sister-in-law. Nixon did not resign because my sister-in-law worked in the Wh ite House, so we set off that clause to make the meaning clearly parenthetical.

When a parenthetical element an interjection, adverbial modifier, or even an adv erbial clause follows a coordinating conjunction used to connect two independent clauses, we do not put a comma in front of the parenthetical element. The Red Sox were leading the league at the end of May, but of course, they alway s do well in the spring. [no comma after "but"] The Yankees didn't do so well in the early going, but frankly, everyone expects them to win the season. [no comma after "but"] The Tigers spent much of the season at the bottom of the league, and even though they picked up several promising rookies, they expect to be there again next ye ar. [no comma after "and"] (This last piece of advice relies on the authority of William Strunk's Elements of Style. Examples our own.) When both a city's name and that city's state or country's name are mentioned to gether, the state or country's name is treated as a parenthetical element. We visited Hartford, Connecticut, last summer. Paris, France, is sometimes called "The City of Lights." When the state becomes a possessive form, this rule is no longer followed: Hartford, Connecticut's investment in the insurance industry is well known. Also, when the state or country's name becomes part of a compound structure, the second comma is dropped: Heublein, a Hartford, Connecticut-based company, is moving to another state. An absolute phrase is always treated as a parenthetical element, as is an interj ection. An addressed person's name is also always parenthetical. Be sure, howeve r, that the name is that of someone actually being spoken to. A separate section on Vocatives, the various forms that a parenthetical element related to an addr essed person's name can take, is also available. Their years of training now forgotten, the soldiers broke ranks. Yes, it is always a matter, of course, of preparation and attitude. I'm telling you, Juanita, I couldn't be more surprised. (I told Juanita I couldn 't be more surprised. [no commas]) Use a comma to separate coordinate adjectives. You could think of this as "That tall, distinguished, good looking fellow" rule (as opposed to "the little old la dy"). If you can put an and or a but between the adjectives, a comma will probab ly belong there. For instance, you could say, "He is a tall and distinguished fe llow" or "I live in a very old and run-down house." So you would write, "He is a tall, distinguished man" and "I live in a very old, run-down house." But you wo uld probably not say, "She is a little and old lady," or "I live in a little and purple house," so commas would not appear between little and old or between lit tle and purple. And what does a comma do, a comma does nothing but make easy a thing that if you like it enough is easy enough without the comma. A long complicated sentence sh ould force itself upon you, make you know yourself knowing it and the comma, wel l at the most a comma is a poor period that lets you stop and take a breath but if you want to take a breath you ought to know yourself that you want to take a breath. It is not like stopping altogether has something to do with going on, bu t taking a breath well you are always taking a breath and why emphasize one brea th rather than another breath. Anyway that is the way I felt about it and I felt that about it very very strongly. And so I almost never used a comma. The longe r, the more complicated the sentence the greater the number of the same kinds of words I had following one after another, the more the very more I had of them t he more I felt the passionate need of their taking care of themselves by themsel

ves and not helping them, and thereby enfeebling them by putting in a comma. So that is the way I felt about punctuation in prose, in poetry it is a little d ifferent but more so Gertrude Stein from Lectures in America Use a comma to set off quoted elements. Because we don't use quoted material all the time, even when writing, this is probably the most difficult rule to rememb er in comma usage. It is a good idea to find a page from an article that uses se veral quotations, photocopy that page, and keep it in front of you as a model wh en you're writing. Generally, use a comma to separate quoted material from the r est of the sentence that explains or introduces the quotation: Summing up this argument, Peter Coveney writes, "The purpose and strength of the romantic image of the child had been above all to establish a relation between childhood and adult consciousness." If an attribution of a quoted element comes in the middle of the quotation, two commas will be required. But be careful not to create a comma splice in so doing . "The question is," said Alice, "whether you can make words mean so many things." "I should like to buy an egg, please," she said timidly. "How do you sell them?" Be careful not to use commas to set off quoted elements introduced by the word t hat or quoted elements that are embedded in a larger structure: Peter Coveney writes that "[t]he purpose and strength of . . ." We often say "Sorry" when we don't really mean it. And, instead of a comma, use a colon to set off explanatory or introductory lang uage from a quoted element that is either very formal or long (especially if it' s longer than one sentence): Peter Coveney had this to say about the nineteenth-century's use of children in fiction: "The purpose and strength of . . . . " Use commas to set off phrases that express contrast. Some say the world will end in ice, not fire. It was her money, not her charm or personality, that first attracted him. The puppies were cute, but very messy. (Some writers will leave out the comma that sets off a contrasting phrase beginn ing with but.) Use a comma to avoid confusion. This is often a matter of consistently applying rule #3. For most the year is already finished. For most, the year is already finished. Outside the lawn was cluttered with hundreds of broken branches. Outside, the lawn was cluttered with hundreds of broken branches. I have spent most of the day putting in a comma and the rest of the day taking i t out. Oscar Wilde Grammar English's Famous Rule of Punctuation: Never use only one comma between a subject and its verb. "Believing completely and positively in oneself is essent ial for success." [Although readers might pause after the word "oneself," there is no reason to put a comma there.]

Typographical Reasons: Between a city and a state [Hartford, Connecticut], a dat e and the year [June 15, 1997], a name and a title when the title comes after th e name [Bob Downey, Professor of English], in long numbers [5,456,783 and $14,68 2], etc. Although you will often see a comma between a name and suffix Bob Downe y, Jr., Richard Harrison, III this comma is no longer regarded as necessary by m ost copy editors, and some individuals such as Martin Luther King Jr. never used a comma there at all. Note that we use a comma or a set of commas to make the year parenthetical when the date of the month is included: July 4, 1776, is regarded as the birth date of American liberty. Without the date itself, however, the comma disappears: July 1776 was one of the most eventful months in our history. In international or military format, no commas are used: The Declaration of Independence was signed on 4 July 1776. Use Commas With Caution As you can see, there are many reasons for using commas, and we haven't listed t hem all. Yet the biggest problem that most students have with commas is their ov eruse. Some essays look as though the student loaded a shotgun with commas and b lasted away. Remember, too, that a pause in reading is not always a reliable rea son to use a comma. Try not to use a comma unless you can apply a specific rule from this page to do so. Concentrating on the proper use of commas is not mere form for form's sake. Inde ed, it causes writers to review their understanding of structure and to consider carefully how their sentences are crafted. General tips for proofing Read it out loud and also silently. Read it backwards to focus on the spelling of words. Read it upside down to focus on typology. Use a spell checker and grammar checker as a first screening, but don't depend o n them. Have others read it. Read it slowly. Use a screen (a blank sheet of paper to cover the material not yet proofed). Point with your finger to read one word at a time. Don't proof for every type of mistake at once do one proof for spelling, another f or missing/additional spaces, consistency of word usage, font sizes, etc. Keep a list of your most common errors (or of the writers you are proofing) and proof for those on separate "trips." If you are editing within Word, use the "track changes" or "mark changes" functi on to make your comments apparent to other reviewers (additions and deletions ca n be set to appear in different colors). Print it out and read it. Read down columns in a table, even if you're supposed to read across the table t o use the information. Columns may be easier to deal with than rows. Use editor's flags. Put #s in the document where reviewers need to pay special a ttention, or next to items that need to be double-checked before the final proof print. Do a final search for all # flags and remove them. Give a copy of the document to another person and keep a copy yourself. Take tur ns reading it out loud to each other. While one of you reads, the other one foll ows along to catch any errors and awkward-sounding phrases. This method also wor ks well when proofing numbers and codes. First, proof the body of the text. Then go back and proof the headings. Headings

are prone to error because copy editors often don't focus on them. Double check fonts that are unusual (italic, bold, or otherwise different). Carefully read type in very tiny font. Be careful that your eyes don't skip from one error to the next obvious error, m issing subtle errors in between. Double check proper names. Double check little words: "or," "of," "it," and "is" are often interchanged. Double check boilerplate text, like the company letterhead. Just because it's fr equently used doesn't mean it's been carefully checked. Double check whenever you're sure something is right certainty is dangerous. Closely review page numbers and other footer/header material for accuracy and co rrect order. Editing for content Ask yourself who, what, when, where, why, and how when reading for content. Does the text answer all the questions you think it should? Highlight the sentences that best answer these questions, just so you can see if the facts flow in logical order. Do the math, do the math, and then do the math again. Somewhere between the scre en and the printer 2+2 often becomes 3. Make a list of "bugaboo" words and do a search for them before final proof. Incl ude every swear word, words related to product terminology, and other words that pop up on occasion. Then do a "find" for all these words. Actually do every step in procedures to make sure they are complete, accurate, a nd in correct order. Count the number of steps a list promises to make sure they are all there. Check that figure numbers match their references in the text and are sequential. Check that illustrations, pictographs, and models are right-side up. Preparing yourself to proof or edit Write at the end of the day; edit first thing in the morning. (Usually, getting some sleep in between helps.) Listen to music or chew gum. Proofing can be boring business and it doesn't requ ire much critical thinking, though it does require extreme focus and concentrati on. Anything that can relieve your mind of some of the pressure, while allowing you to still keep focused, is a benefit. Don't use fluorescent lighting when proofing. The flicker rate is actually slowe r than standard lighting. Your eyes can't pick up inconsistencies as easily unde r fluorescent lighting. Spend a half-hour a month reviewing grammar rules. Read something else between edits. This helps clear your head of what you expect to read and allows you to read what really is on the page. Make a list of things to watch for a kind of "to do" list as you edit. http://www.lrcom.com/tips/proofreading_editing.htm

Quality Assurance We consider our medical transcriptionist as medical language specialists who mus t possess a unique set of core competencies in order to convert voice to text. L ike Sign Language interpreters, what goes into their ears must come out through their fingers. Below we have an overview of our technology and quality control. Please feel free to contact us with any additional questions. Quality is assured using: All transcribed text reports go through 3 levels of checking by editors, proof r eaders and medical editors to provide 99% accuracy. We always use the same transcription unit for the same office. Transcriptions are done using Software which includes:

Stedman's electronic medical dictionary along with the entire range of Stedman's books American drug index Our own database We support Microsoft Word of MS Office 97/98 and 2000, WordPerfect 9. Sound / Me dia Players and converters such as GoldWave, Windows media player, DVIPS, WinAmp , MSV, ICS, DVF, DSS and PC Dart PlayAll, are all used that allow adjustment of pitch and speed, for more accurate transcription. Personal Health Records What kind of information would you put in a personal health record? You could st art with Your name, birth date, blood type and emergency contact Date of last physical Dates and results of tests and screenings Major illnesses and surgeries, with dates A list of your medicines, dosages and how long you've taken them Any allergies Any chronic diseases Any history of illnesses in your family History And Physical History-physicals are generally developed at the entry level, the first time the doctor sees and examines a patient. A history is done (what has happened to the patient in the current problem and any relative past history), and the physical examination is ( performed; this information is then dictated. History physicals may include the headings as listed below. The abbreviation is sometimes used (de pending on the client) rather than the full formal heading. In the reports in th is Volume, when an abbreviation is used, we have attempted to define its meaning in parenthesis following the heading. Other headings, as you will see, are spel led out and are generally all in capital letters and may or may not be in bold-f ace type, or underlined, again depending on the preferences of the practice or t he hospital. HISTORY AND PHYSICAL: A main heading only. Note that the history portion relates to the patient's "subjective" account of his/her current condition or illness, whereas the physical portion focuses on the "objective" characteristics or findi ngs of the patient's condition or illness, usually by the physician. DATE: The date of the examination. CC (Chief Complaint): What the patient subjectively states is wrong. HPI (History of Present Illness): What the current disease process or injury is, as related to the chief complaint necessitating this particular workup. PMH (Past Medical History): What the patient's problems or diagnoses have been i n the past, both medical and surgical, and any pregnancy or gynecologic history, if significant, to this workup. FH (Family History): The immediate family s medical problems and genetic predispos ition to problems or diseases. SH (Social History): The patient's education, work, marital status, children; ha bits, such as smoking, drinking, drugs, and may even include hobbies and recreat ional activities.

ROS (Review of Systems): The review of the systems of the body. MEDICATIONS: Any medications patient is currently using either prescribed or ove r the counter. ALLERGIES: Notable allergic reactions, particularly to medications and food prod ucts. PE (Physical Examination): Main heading. The PE is composed of the following fou r types of evaluation: visual what is seen; auditory or aural what is heard; olfactory what is sensed by the nose; and tactile what is felt. The examination should include: GENERAL: How the patient appears to the examiner. VITAL SIGNS: Temperature, pulse, respirations, blood pressure, height and weight . SKIN: Turgor, colon tone, etc. HEENT: Head, eyes, ears, nose and throat. NECK: Pulses, thyroid. CHEST: Includes heart (cardiac), lungs, breasts. ABDOMEN: Includes exam of the palpable internal organs. GENITALIA: Male/Female anatomy appearance. RECTAL: Tone, hemorrhoids. EXTREMITIES: Arms, hands, legs, feet. NEUROLOGIC: Neurologic examination/testing. LABORATORY DATA: Any intercurrent labs, which have been obtained at either the a office, by the referring physician, or the hospital outpatient/inpatient depart ment. IMPRESSION: Main heading. What the examiner thinks is wrong with the patient. So metimes this appears as PROBLEM in a PROBLEM-ORIENTED record, listing each probl em numerically and discussing it in the order presented. PLAN: Main heading. The further workup (diagnostic tests, etc.) of the problem(s ), what medication or surgery is anticipated, return visits required or anticipa ted, referral to other providers, etc. Common Grammar Blunders advice opinion; e.g., "I gave the patient advice regarding her diet."

advise to offer advice, counsel; e.g., "I advised the patient to resume her regu lar activities." cite sight site to quote; "I cited Ernest Hemingway in my speech." ability to see; "The patient s sight is diminished in the left eye." location or to locate (v); "The wound site is healing well." showing prudence; e.g., "She was discreet when addressing Sally s tardine

discreet ss."

discrete

distinct; e.g., "I palpated no discrete masses."

elicit to bring about or induce; e.g., "Forward bending did not elicit the patie nt s back pain." illicit it s its loose " lose unlawful; e.g., "The patient denies use of illicit drugs." contraction; e.g., "It s really hot in here." possessive; e.g., "I put the book back in its proper place." not restrained; e.g., "Her bowel movements have been loose in consistency. to mislay or not keep; e.g., "I d love to lose 10 pounds before the reunion."

principal highest in importance, chief; e.g., "The principal diagnosis is conges tive heart failure." principle subtle y." supple a rule or standard; "Dr. Smith is a man of principle." slight, elusive; "I gave my husband subtle reminders about our anniversar flexible; "The patient s neck is supple."

than used to introduce a second element or clause; e.g., "Sally has more cats th an Bill." then at that time, next in order, besides; e.g., "She then will need an ultrasou nd of the gallbladder." verses versus a rhythmical composition, e.g., "The poem contained three verses." against; e.g., "Diagnosis is bronchitis versus pneumonia."

Common Grammar, and spelling Mistakes Effective written communication relies on correct grammar and spelling. Avoiding common misspellings and grammatical errors ensures that your writing is clear, precise, and comprehensible. Readers often do not notice good grammar because th e text is easily understood and enjoyable to read, but they do notice confusing grammatical errors that force them to re-read text and fumble for the author s mea ning. Punctuation equally affects the readability of a text: a misplaced comma o r apostrophe can change the meaning of a sentence, often in confusing ways. Corr ect grammar and spelling makes a positive impression on readers, which is partic ularly important in business and academic communications. Common Errors: Common grammar and spelling errors explained; includes frequently confused words. Grammar and Style Guide: Corrects common grammar errors and gives style suggesti ons. Grammar and Usage Help: Handouts on commonly misspelled words, spelling hints, g rammar and punctuation explanations, and other writing tips. Punctuation, Syntax, Usage, and Style: A guide to grammar, usage, and style. Spelling mistakes and typographical errors make written communication difficult to read and understand. Spelling errors in academic and business documents, such as resumes and letters, can make the document appear unprofessional. Using an a utomated spell-checker will catch many spelling mistakes, but not all. Hand-writ

ten texts, such as letters, cards, and some academic exams, must be written with out the benefit of automatic spell-check and the writer must be equipped to chec k his own spelling. Familiarity with the following commonly misspelled words is useful for all writers.

Weird: Essential spelling rules, including an explanation of the rules governing weird . Weird is an exception to the rule that i generally comes before the e , exce ter a c or a long -a sound, such as weigh . Definitely: Spelling rules for adverbs. To form an adverb, add -ly to the adjectiv e, but do not drop a final -e from the adjective (the exception is truly ). Definite + -ly = Definitely. Acclaim: An explanation of why acclaim has a double consonant. Acclaim is the additi on of a form of the Latin prefix ad , meaning to , to the root clamare , or to shout . of ad- often result in double consonants. Accidentally: Commonly misspelled words, including a way to remember accidentally . When adding the suffix -ly to an adjective to form an adverb, the final consonant is not dropped, even if it results in a double ll . Consensus: Commonly misspelled words, including an explanation of how to spell co nsensus . Consensus comes from the same root as consent consentire but a different root om that of census , censere . It's: An explanation of possessives, including it s . It s is the contraction of it is le its is a possessive. Acceptable: A list of common misspellings and corrections, including acceptable . A nother example of the ac- prefix producing a double consonant. Spelling Quiz: A self-checking spelling quiz to improve your spelling of commonl y misspelled words. While automated spell-checkers catch many spelling mistakes, they cannot catch m any errors in usage. Many word pairs have different but related meanings that co mmonly cause confusion. Writing affect for effect would be incorrect usage, but a sp ell-checker may miss the error because the word is spelled correctly. Homonyms, words that have the same pronunciation and may have different spellings, often a re not caught by spell-checkers because both spellings are correct English words . Homophones, words that sound the same but have different meanings and spelling s, are likewise not flagged as errors by spell-checkers. When typing quickly, th e substitution of pear for pare may go unnoticed by the writer and not be flagged by the spell-checker. Learning the following common usage errors can help writers avoid mistakes.

Then, Than: An explanation of the difference in usage between than and then . Then is n adjective that refers to time: First I ate breakfast and then I went to the sto re. Than is a conjunction used in comparisons: He is smarter than Justin . Lose, Loose: Explanations of common usage errors, including lose and loose . Lose is a verb pronounced with a z sound. Lose means to fail to win, to misplace an item, to f ail to use, or to be deprived of something: We do not want to lose the game. Loos e is used more commonly an adjective meaning unfastened or not attached, free, or not close-fitting: Mice loose in the house makes me nervous. As a verb, loose mea ns to set free or to let loose . Their, There, They're: Common grammar and usage mistakes explained, including th e difference between their , there , and they re . Their is a possessive pronoun: Thei s blue. There is an adverb of location: The car is over there. They re is a contractio n of they are : They re going to the movies tonight. Your, You're: Common usage errors, including an explanation of your and you re . Your a possessive pronoun: Your car is green. You re is a contraction of you are : You re a g eat swimmer. Affect, Effect: A guide to the usage of affect and effect . Affect is a verb meaning t alter or change : Adding salt affects the taste of the soup. Effect is a noun meanin g a result, outcome, or consequence of an action: Drowsiness is a common effect of listening to boring speeches. Accept, Except: A list of commonly confused word pairs and explanations for corr ect usage, including accept and except . Accept is a verb that means to receive, agre

assent to, or acknowledge : I accept your offer. Except is a preposition that means t o exclude, leave out, take out, or omit : Everyone except Carol is going to the mo vies. Capital, Capitol: Definitions and practice sentences with capital and capitol . Capita l as a noun means the seat of government, property or assets owned by a person or business, or an uppercase letter: The capital of New Jersey is Trenton. Capitol i s the building in which a legislature meets: The capitol in Trenton was construc ted in the late 18th century. Principle, Principal: Definitions of principle and principal and an explanation of t heir usage. Principle is a noun meaning a law, doctrine, assumption, or underlying faculty: The principles of liberty and justice are fundamental to our country. P rincipal may be a noun or an adjective. As a noun, it means the most important : The principal ingredient in bread is flour. As an adjective, it refers to the headm aster or mistress of a school or to the capital sum of money that earns interest or forms a debt: The principal left on the mortgage is $215,000. Weather, Whether: An explanation of weather and whether and their usage. Weather is a noun that refers to atmospheric conditions: The weather today is sunny and warm. Whether is a conjunction that introduces an indirect question, usually related to a choice or possibility: He wondered whether to stay or go. To, Too, Two: A printable explanation of the homophones to , too , and two . To is a p ition used to indicate movement toward a person, place, or thing, an addition to something, or to indicate direction: Let s go to the store. Too means excessively or ore than enough : That necklace was too expensive for me. Two refers to the number: Jane has two dogs but I only have one. Lay, Lie: An explanation of lay versus lie . Lie is an intransitive verb that means t ssume a horizontal position or to recline : I want to lie down now. Lay is a transitiv e verb that means to set something down : Lay your jacket on the bed. Could have, would have, should have: Explanation of could , would , and should and how o use them properly. Could , would , and should are the past tense forms of the auxilia y verbs will , shall , and can . It is correct to say I should have eaten breakfast thi orning , not I should of eaten breakfast . Never use the phrases "could of", "would o f," "should of". A lot: The correct spelling of a lot , which is not alot . A lot , meaning many or a mount or number , is an informal expression that should be written as two words. A properly formed sentence is the basic building block of effective, clear writi ng. Sentences must have a subject and a predicate. The subject is a noun or pron oun that performs an action. To identify the subject of a sentence, identify who did the action. In the sentence Andrea buys three oranges , Andrea is the subject. T he predicate is introduced by a verb. The verb indicates action, occurrence, or existence. In the previous example, buys is the verb. The subject and the verb mus t agree in number. The sentence Andrea buy three oranges is incorrect because the subject is the third person singular but the verb is not. In addition to sentenc e fragments, writers should avoid run-on sentences. Run-ons contain more than on e sentence without proper punctuation. The example Andrea is a great teacher, she buys three oranges is incorrect because the writer uses commas to join two compl ete and unrelated sentences instead of separating them with a period.

Tips in Transcribing ESL Dictation by JENNIFER on MAY 4, 2011 Here are 6 tips sent in by Sara J. to help when transcribing ESL (English as a s econd language) dictation: 1. English is the most complex language to understand. The best thing you can a rm yourself with against problematic dictation or ESL dictation is your attitude . 2. At the end of some words, ESL dictators add ed in an attempt to emphasize a fin

al consonant or as a separate syllable. This is called extra syllables. 3. ESL dictators sometimes pronounce abbreviations as words similar to how acron yms are pronounced. 4. ESL dictators may pronounce a verb incorrectly by ending in an open sound. T hey may drop the consonants at the end of the English words. This is evident wi th some English plurals and singular verbs ending in s.

5. Sounds that are difficult for ESL dictators are w and v, the lack of an r sound, t e two I sounds, substitutions from Spanish letters, and problem sounds combined in words. 6. There are 26 letters in the English alphabet. There are 21 consonants but 24 consonant sounds. ESL dictators may be confused because letters are combined t o make sounds that do not exist in the second language.

Free transcription guidelines

In the free transcription guidelines I will outline areas that you need to ascer tain before you commence a piece of transcription work. So you need to know: . how many people will be speaking . is it a focus group, a presentation, a Q&A, etc . do you know the names of the speakers . does the client need names specified in the document? . where in the world is the client situated, ie: which form of English will you use, American or British, you know: colour/color, specialise/specialize, check/c heque, etc, etc. . how does the client want you to deal with inaudible words, unsure spellings, t ape/audio glitches, etc. . margins, page numbering, spacing, double/single, will there be headings, etc. Basically I will expand on the above and more in the free transcription guidelin es below: Layout of particular transcription This depends on how many people are speaking in the audio, what kind of an it is,etc. Check out free transcription templates for most common formats I have used in the past. The templates do not include layouts for straight r typing or templates on particular individual report formats that clients eed. audio that lette may n

Most commonly Q&A is used. But your transciption template will change if the cli ent wants speaker names put in, it's a focus group, it's a presentation, etc. Mo st clients supply speaker names, but this can get awfully difficult if there are lots of speakers and they forget to introduce themselves before they speak each time. Don't worry you're not a mind reader. No matter what template or layout I am using I always put END OF TRANSCRIPT at t he bottom of every document. Sometimes a transcript ends abruptly and without th

ese words at the end it won't be known if there is information missing or not. Time stamping for digital audio files Time stamping is used to enable the document to be edited. Audio files display t heir file length in numbered format on your transcription platform and you can t rack every second of the audio. So for example I type through the document and t ime stamp anything that I didn't get, hear or understand or know the spelling of . So if I type and get to say the 24:22 minute mark in the document and I can't understand something there, I put *24:22 in place of the missed bit. Then I go back at the end of the typing to see if I can get the missed word. 50% of the time you get it the second time around. Google is your best friend for p lace names, difficult terminology, etc. Then if I am left with some time stamps in the document, which is highly inevitable, I highlight the 24:22 in yellow for the client. The client may then wish to listen to the audio on his end and see if he can get the missed word. Inaudible words Some clients know some audio is not good so may just instruct you to put (inaudi ble) in place of missed words. I also time stamp inaudibles the first time aroun d for myself and if I then hear the word properly the second time around I type it in and if I dont, then I change the time stamp to (inaudible). Inaudibles ere trying Basically amp it and are subjective and difficult to define. You can waste a lot of time h to decide if it's an inaudible word or a word worthy of a time stamp. if the word/phrase is clear but you don t know what it is, then time st if the word/phrase is not clear, then (inaudible) it.

Then sometimes clients want the inaudibles time stamped as well as they may be a ble to fill in the blanks. Glitches Sometimes there is an audio glitch (or tape glitch for cassette transcription) a nd I just put [glitch] or [tape glitch] in that section of the document. Spelling and grammar If you do not know how to spell a name put '[name]' and time stamp it, eg: '*[na me]12:16'. If you can get the start or part of the name put eg: '*[Sandra name]1 2:16 or [S name] if you can hear the first letter. There is no need to time stam p all occurences of a name, only the first occurence and just use the square bra ckets for subsequent uses of this name. The client may globally replace the name when they receive the transcribed document. If there is a difficult name and I can hear it, but I don't know how it is spelt , then I type it phonetically and still time stamp it. Make sure you are using the correct spelling according to your client requiremen ts, ie: British or American English. Take care with your spelling, ie: their/there, your/you're, its/it's, council/co unsel, principle/principal, etc. Verbatim or not Sometimes a client may want the document typed verbatim, ie: word for word, exac tly what you hear. This is necessary in anything legal, police files, insurance

investigations, etc. And they mean everything, ums,ahs, hm, etc. Most of the time clients would not want these words typed. And also ask if the c lient wants word like 'you know' and words like that typed, that people tend to use all the time throughout their speaking. Formatting See if the client needs footers, page numbers, heading, double spacing, etc in t he files. I think as a general rule always page number on the bottom right or to p right anyway. Hopefully these free transcription guidelines can assist you when it comes to pr oviding a quality professional transcript back to your client. These free transcription guidelines are not the be all and end all of guidelines , they are just that, a guide.

Basic Rules of Transcription I. Spacing With Punctuation Marks Do Not Type a Space ... following a period with an abbreviation following a period used as a decimal point between quotation marks and the quoted material before or after a hyphen before or after a slash before or after a dash between a number and percent sign between parentheses and the enclosed material between any word and the punctuation following it. between the number and the colon used to indicate a dilute solution or ratio. on either side of the colon when expressing the time of day before an apostrophe before or after a comma used within numbers before or after an ampersand in abbreviations, e.g., C&S on either side of the colon when expressing ratios e.g. 1:1 after the closing parenthesis if another mark of punctuation follows Type One Space... between words after a comma after a semicolon after a period following an initial after the closing parenthesis on each side of the x in an expression of dimension, e.g. 4 x 4 Type Two Spaces... after punctuation at the end of a sentence after a colon except when expressing time or a dilution ratio II. Numbers Spell out WHOLE numbers zero through nine, use numerals for 10 and above (this m ay change in the near future as the AAMT is trying to standardize using numerals only. When the next edition of the AAMT Book of Style is published (Spring 2002

), you can probably expect new guidelines). Use numerals when numbers are directly used with symbols. Use numerals when expressing ages. Medical Transcription Guidelines -14 Format 1. Various medical report formats and styles exist nationwide. On the job, trans criptionists use the report formats ap-proved by their transcription supervisor or department head. 2. Headings. The purpose of headings and subheadings is to categorize medical da ta so that important information is easy to locate within the report. Generally speaking, the transcriptionist may add headings and subheadings to a dictated re port as appropriate. The transcriptionist should also be alert for important headings that are not di ctated but are a vital part of the report, such as Diagnosis or Impression in a history and physical examination report, or Final Diagnosis in a discharge summa ry, and Preoperative Diagnosis and Postoperative Diagnosis in an operative repor t. If any of these headings are not dictated, the transcriptionist should supply them and flag the report to the attention of the dictator so that the Diagnosis can be stated. 3. Adding headings not dictated. If a physician dictates a narrative portion tha t belongs under a particular heading but fails to dictate the heading, the trans criptionist may insert the proper heading. For example, it is not uncommon for p hysicians to finish dictating the physical examination section of a discharge su mmary and begin to dictate laboratory test results or x-ray results without givi ng a heading for a new section. The transcriptionist should paragraph after the Physical Examination and may insert an appropriate paragraph heading such as Lab oratory Data or Laboratory and X-ray Data before transcribing the information. Exception: Some physicians do not dictate an initial heading (Chief Complaint or History, for example) but begin by detailing the events that led to the patient 's hospitalization. Because the information at the beginning of a report is dist inct and clearly evident, it is not necessary to add a heading here if one is no t dictated, although it is acceptable to do so. The transcriptionist on the job would follow the dictator's preference, if such preference is known, or the form at specified by the transcription department where the dictation originated. Dictated: PHYSICAL EXAMINATION: The fracture site was tender to palpation. He had good sen sation and circulation in the leg. Multiple views of the tibia revealed there wa s a stairstep-type fracture at the distal portion of the tibia. The CBC and diff erential were normal. Transcribed: PHYSICAL EXAMINATION: The fracture site was tender to palpation. He had good sen sation and circulation in the leg. LABORATORY AND X-RAY DATA: Multiple views of the tibia revealed there was a stai rstep-type fracture at the distal portion of the tibia. The CBC and differential were normal. 4. Abbreviations in Headings. Doctors may take shortcuts by dictating abbreviati ons, even for major report headings, such as CC (Chief Complaint) and HPI (Histo ry of Pres-ent Illness). Headings should always be spelled out in full. Note: Do not confuse a CC dictated for Chief Complaint with the other definitions of the abbreviation cc: cubic centimeter and carbon copy. 5. Diagnosis/Diagnoses. If a physician dictates the singular form Diagnosis and then lists several diagnoses, the transcriptionist may use either Diagnosis or D iagnoses to head the list. 6. Numbered diagnoses listed vertically. Physicians frequently number the diagno ses and want them listed vertically for ease in reading. The transcriptionist ma y elect to enumerate a long list of diagnoses, whether or not numbers are dictat ed. Occasionally a dictator will begin to number the diagnoses and then give onl y one diagnosis; in that case, omit the number (no need for a 1 without a 2). Be

aware that in listing several diagnoses, dictators often lose track of the next number. They may inadvertently give the wrong number (which should be corrected by the transcriptionist) or delegate the numbering to the transcriptionist by s aying "number next" to indicate the next diagnosis. 7. Varied acceptable formats. There are several acceptable formats for medical r eports, and even alternative acceptable formats for the same sentence. Dictated: Extremities unremarkable. Transcribed: The extremities are unremarkable. EXTREMITIES: Unremarkable. EXTREMITIES: The extremities are unremarkable. 8. Paragraphing. Transcribe paragraphs as dictated unless paragraphing would alt er the medical meaning or continuity of the report. Paragraphing may be added to break up long reports appropriately, to set up a new heading and its accompanyi ng paragraph, and to separate the findings from the operative procedure. Be awar e that when some physicians dictate "new line," they mean to begin a new paragra ph. 9. Standard formats. With the advent of computers, many hospitals and clinics ha ve instituted standard format outlines for each type of report dictated. These a re stored in the computer's memory as templates that can be "pulled up" by the t ranscriptionist. This practice has introduced greater conformity in format style within an institution and has made adjusting and remembering formats relatively painless. POSTED BY SATYA RAO AT 6:14 PM Medical Plurals [Words] Forming Plurals of Medical Words Forming proper plurals of medical words is one of the more challenging aspects o f medical transcription. The problem is exacerbated by the fact that even dictat ing physicians frequently have difficulty with plurals. They cannot always be co unted on to dictate the correct plural form. This pushes the burden of identifyi ng and transcribing the proper plural straight back on the transcriptionist. The good news is that plurals generally follow some basic rules. Once you have mast ered these rules, you will be able to quickly form proper plurals for most medic al terms that you encounter. The bad news is that for every rule there is an exc eption. This means that you will also need to memorize (or look up) these except ions. With practice you will become very familiar with all common plurals. 10 Common Exceptions to Basic Plural Rules: (note the sometimes )

1. Sometimes the proper plural of a word ending in is will be formed by dropping the is and adding ides. For example, epididymis becomes epididymides. 2. Sometimes the proper plural of a word ending in us will be formed by dropping t he us and adding era or ora. For example: viscus becomes viscera ; corpus become 3. Some words ending in ix or ax have more than one acceptable plural form. For exam ple, the plural of appendix can be either appendices or appendixes, although the most common plural form would utilize the ices ending. 4. The proper plural for certain words ending in ion can be formed simply by addin g an s. For example, chorion becomes chorions. 5. The plural form of the term vas is vasa. 6. The plural form of pons is pontes. 7. The plural form of the dual meaning word os is ora when referring to mouths and o when referring to bones. 8. The plural form of the term femur is femora. 9. The plural form of cornu is cornua. 10. The plural form of paries is parietes. The chart below is designed to provide basic rules of thumb for forming plurals.

But remember that there are exceptions to most of these rules. If the Singular Ending Is: Singular Example: The Plural Rule Is: Plural Form: is diagnosis Drop the is and add es diagnoses um ileum Drop the um and add a ilea us alveolus Drop the us and add i alveoli a vertebra Drop the a and add ae vertebrae ix appendix Drop the ix and add ices appendices ex cortex Drop the ex and add ices cortices ax thorax Drop the x and add ces thoraces ma sarcoma Drop the ma and add ta sarcomata on spermatozoon Drop the on and add a spermatozoa nx larynx Drop the x and add ges larynges y deformity Drop the y and add ies deformities yx calyx Drop the yx and add yces calyces en foramen Drop the en and add ina foramina WHY PLURAL FORMS ARE SOMETIMES DIFFICULT A noted author of medical publications had this to say about Latin plurals: Genitive (designating case that indicates possession or source) Forms/Derivation s Why plurals and possessives are sometimes so difficult. Why does one use the Latin genitive form in the phrase cyanosis retinae, but prefe r the anglicized form retinas to the Latin plural retinae ? Genitive forms of Latin n ouns occur in many medical phrases: abruptio placentae, cervix uteri, chrondroma lacia patellae, etc. Physicians often misspell and mispronounce some of these, n ot sounding the last letter, abruptio placenta-ee, saying just placenta. Certainly Latin words have become naturalized in English. Pluralized Latin words s uch as curriculum, focus, lacuna are commonly used without the Latin pluralizing: c urricula, foci, lacunae. This group also includes Latin nouns whose singular and plural forms both end in -es (facies, pubes, series, species). In contrast, some L atin words are pleuralized by the addition of s : areas, arenas, auras, lumens, ome ns, specimens, or -es, bonuses, calluses, lenses. One reason for treating Latin words under English rules is that the patterns for forming plurals are far more complex in Latin. For example, nouns that end in -u s in the singular do not change in the plural (like English words deer and salmon ), s uch as arcus, decubitus, ductus, fetus, hiatus, ictus, introitus, etc. Because using the unaltered noun as a plural may cause confusion ( Some meatus are too small to admit even an 8 F catheter and all the above plexus are strictly m otor ). Those words are best pluralized by the addition of -es. Although meatuses an d plexuses may seem awkward to pronounce, they are preferable to the incorrect m eati and plexi. On becoming plural some words undergo vowel and consonant shifts, consonant inse rtions or a combination: appendix = appendices, cortex = cortices, dens = dentes , femur = femora, genus = genera. Failure to grasp how this process works result s in forming incorrect singular words like phalanx = phalanges, but using phalan ge for the singular. Also, an interesting evolutionary process is the English tr anslation process of adding a mispronounced final syllable, eez as in abscesses [abs cess-eez], interstices [interstish-eez], processes [process-eez]. Some singular Latin nouns ending in s are often mistaken for plurals, ( obstetrical forceps consist of a left and a right blade and scabies are highly contagious ). Or incorrectly used without change as plural forms ( both biceps and quadriceps are s ymmetrical ). Singular nouns ending in a are also sometimes treated as plurals ( No st

ria were noted and

lacuna are conspicuous in size and number ).

Conversely, Latin nouns that are chiefly or exclusively used in the plural are o ften mistaken for singular nouns, adnexa, agenda, data, errata, fasces, fauces, f eces, nares, etc. Hence, such nouns are often used with singular verbs (The left adnexa is boggy and tender) or equipped with illegitimate endings to make them p lural (both adnexae). These double plurals can also result from confusion regard ing which form of a Latin noun is singular. Thus, the plurals, diverticula, haust ra and septa are often mistaken for singulars and pluralized as diverticulae or diver iculi, haustrae and septae or septi. The divergence of sense among current reference works (and reference sources oft en disagree) has almost certainly arisen from different assessments of patterns of usage among health professionals. The variations arise from uncertainty regar ding the etymologic meanings of the words. For example, hyphemia, an abstract noun denoting a condition of deficiency of blood first became tangled with the Greek a djective hyphaimos (bruised, ecchymotic, suffused with blood). Then because the te rms were often applied to hemorrhage in the anterior chamber of the eye where bl ood typically settles by gravity to form a crescent below the pupil, they were r edefined as meaning blood in a lower position. The Greek prefix hypo- has been inter preted with no fewer than 4 related meanings: 1) beneath, 2) deficient, 3) sligh tly or to a lesser degree, 4) in a lower position. Though confusing at times, you can see why what you hear and what you type are o ften difficult to decide. http://www.meditec.com/resourcestools/medical-words/medical-plurals/ What is Medical Terminology? Medical terminology refers to the words and phrases which have been developed to describe the procedures, medications, instruments, anatomical structures, etc. used in the field of medicine. It is, in a very real sense, the language of medi cine. Medical terminology has a long and rich history. Most medical terms derive from Latin or Greek. So if at first medical terminology appears to be a foreign langu age - well... that's because it is! But don't despair. Like any language, the la nguage of medicine adheres to a set of fairly simple rules. The Structure of Medical Terminology It may seem like an impossible task to commit the spelling and meaning of 100,00 0 different medical terms to memory - and in fact, for most of us it is. Fortuna tely, it is not necessary. The fact is that most seemingly complex medical terms are simply combinations of much smaller subsets of word parts. This is a critic ally important concept to understand with medical terminology. It is not unreasonable to expect to memorize several hundred medical prefixes, m edical suffixes and medical root words in a relatively short period of time. The n, once these word parts are learned, they can be combined to form literally tho usands of complex medical terms. How are Medical Terms Constructed? Most medical terms consist of one or more parts. These word parts may include on e or more of the following: Root Words Prefixes Suffixes Combining Vowels

To help you better understand how this works, let's look at an example. Consider the word cholecystectomy. At first glance, this word seems quite comple x. Cholecystectomy, which means excision (removal) of the gall bladder, is reall y a combination of four different word parts. Let's break it down into its sub p arts and see if we can figure out why it means what it means. chol - e - cyst - ectomy chol is a root word meaning bile or gall e is a combining vowel (described in more detail below) cyst is another root word meaning bladder ectomy is a suffix which translates to excision or surgical removal. Therefore, we can see that cholecystectomy is a combination of words which trans late to mean surgical removal of the gall bladder. Each of these word parts will be seen over and over in medical language. For exa mple, the suffix ectomy is seen in such common terms as tonsillectomy (removal o f the tonsils) and appendectomy (removal of the appendix). It is not hard to see that as you begin to commit these sub-terms to memory, you will be able to deci pher more complex terms because you will recognize and understand their componen t parts. Medical terms always contain at least one root word. And as we saw with cholecys tectomy, they may have more than one root word. The root is the part of the word that comprises the primary meaning of the term. In the example of tonsillectomy , the root word is tonsil. The suffix is ectomy. The root word tonsil is capable of standing alone. The suffix ectomy, (meaning surgical removal) requires the r oot word tonsil to confer relevance. Prefixes and suffixes cannot stand alone. M edical terms may have, but are not required to have, a prefix and/or a suffix. Combining Vowels Combining vowels are sometimes used to create a more fluid transition between wo rd parts and to make medical terms easier to pronounce. For example, the term sp lenomegaly means enlargement of the spleen. It is a combination of the root word splen meaning spleen, and the suffix megaly meaning enlargement. The "O" which follow the root word splen is a combining vowel which simply makes the word flow better. The vowel used most often to combine medical words is "O", but other vowels are also sometimes used. It should be noted that combining vowels may be used betwee n two root words, or between a root word and a suffix, but they are never used b etween prefixes and root words.

Forming Plurals of Medical Words Forming proper plurals of medical words can be one of the more challenging aspec ts of medical transcription. The problem is exacerbated by the fact that even di ctating physicians frequently have difficulty with plurals. They cannot always b e counted on to dictate the correct plural form. This pushes the burden of ident ifying and transcribing the proper plural straight back on the transcriptionist. The good news is that plurals generally follow some basic rules. Once you have mastered these rules, you will be able to quickly form proper plurals for most m edical terms that you encounter. The bad news is that for every rule there is an exception. This means that you will also need to memorize (or look up) these ex ceptions. With practice you will become very familiar with all common plurals.

The chart below is designed to provide basic rules of thumb for forming plurals. But remember that there are exceptions to most of these rules. Basic Rules of Thumb for Forming Medical Plurals If the Plural is um us a ix ex ax ma on nx y yx en Singular Ending Is: Singular Example: The Plural Rule Is: Form: diagnosis Drop the is and add es diagnoses ileum Drop the um and add a ilea alveolus Drop the us and add i alveoli vertebra Drop the a and add ae vertebrae appendix Drop the ix and add ices appendices cortex Drop the ex and add ices cortices thorax Drop the x and add ces thoraces sarcoma Retain the ma and add ta sarcomata spermatozoon Drop the on and add a spermatozoa larynx Drop the x and add ges larynges deformity Drop the y and add ies deformities calyx Drop the yx and add yces calyces foramen Drop the en and add ina foramina

10 Common Exceptions to Basic Plural Rules: 1. Sometimes the proper plural of a word ending in is will be formed by droppin g the is and adding ides. For example, epididymis becomes epididymides. 2. Sometimes the proper plural of a word ending in us will be formed by droppi ng the us and adding era or ora. For example: viscus becomes viscera; corpus bec omes corpora. 3. Some words ending in ix or ax have more than one acceptable plural form. Fo r example: The plural of appendix can be either appendices or appendixes - altho ugh the most common plural form would utilize the ices ending. 4. The proper plural for certain words ending in ion can be formed simply by a dding an s. For example: chorion becomes chorions. 5. 6. The plural form of the term vas is vasa. The plural form of pons is pontes.

7. The plural form of the dual meaning word os is ora when referring to "mouth s" and ossa when referring to "bones". 8. 9. 10. The plural form of the term femur is femora. The plural form of cornu is cornua. The plural form of paries is parietes.

SURGICAL HISTORY AND PHYSICAL EXAMINATION Identifying Data: patient's name, age, race, sex; referring physician. Chief Complaint: Reason given by patient for seeking surgical care; place reason in "quotation marks." History of Present Illness (HPI): Describe the course of the patient's illness, including when it began, character of the symptoms; pain onset (gradual or rapid ), precise character of pain (constant, intermittent); other factors associated with pain (defecation, urination, eating, strenuous activities); location where

the symptoms began; aggravating or alleviating factors. Vomiting (characteristic s, appearance, frequency, associated pain). Change in bowel habits; bleeding, ch aracter of blood, (clots, bright or dark red), trauma; recent weight loss or ano rexia; other related diseases; past diagnostic testing. Past Medical History (PMH): past diseases. All previous surgeries and indication s; dates and types of procedures; serious injuries, hospitalizations; significan t medical problems; history of diabetes, hypertension, peptic ulcer disease, ast hma, myocardial infarction; hernia, gallstones. Medications: Allergies: Penicillin: Codeine? Family History: Medical problems in relatives. Family history of colonic polypos is, carcinomas, multiple endocrine neoplasia (MEN syndrome). Social History: Alcohol, smoking, drug usage. Review, of Systems (ROS): General: Weight gain or loss; appetite loss, fever, fatigue, night sweats. Head: Headaches, seizures. Eyes: Visual changes, diplopia, eye pain. Mouth & Throat: Dental disease, hoarseness, sore throat, pain, masses. Respiratory: Cough, shortness of breath, sputum. Cardiovascular: Chest pain, orthopnea, dyspnea on exertion, claudication, extrem ity edema. Gastrointestinal: Dysphasia, abdominal pain, nausea, vomiting, hematemesis, mele na (black tarry stools), hematochezia (bright red blood per rectum), constipatio n, bloody stool, change in bowel habit; hernia, hemorrhoids, gallstones. Genitourinary: Dysuria, frequency, hesitancy, hematuria, polyuria, discharge; im potence, prostate problems. Gynecological: Last menstrual period, breast masses. Skin: Easy bruising, bleeding tendencies. Lymphatics: Lymphadenopathy. SURGICAL PHYSICAL EXAMINATION Vital Signs: Temperature, heart rate, respirations, blood pressure, weight. Head, Eyes, Ears, Nose, Throat (HEENT): Eyes: Pupils equally round and react to light and accommodation (PERRLA): extrao cular movements intact (EOMI); Neck: Jugular venous distention (JVD), thyromegaly, masses, bruits; lymph nodes. Chest: Equal expansion; rhonchi, crackles, breath sounds. Heart: Regular rate & rhythm (RRR), first & second heart sounds; murmurs (grade 1-6), pulses (graded 0-2+). Breast: Retractions, tenderness, lumps, nipple discharge, dimpling, gynecomastia ; axillary nodes. Abdomen: contour (flat, scaphoid, obese, distended); scars, bowel sounds, tender ness, organomegaly, masses, liver span; splenomegaly, guarding, rebound, bruits; percussion note (tympanic), costovertebral angle tenderness (CVAT), inguinal ma sses. Genitourinary: External lesions, hernias, scrotum, testicles, varicoceles. Extremities: Edema (grade 1-4+); cyanosis, clubbing, edema (CCE); pulses (radial ulnar, femoral, popliteal, posterior tibial, dorsalis pedis; simultaneous palpa tion of radial and femoral pulses), Homan's sign (dorsiflexion of foot elicits c alf tenderness). Rectal Exam: Sphincter tone, masses, hemorrhoids, fissures; guaiac test for occu lt blood; prostate masses. Neurological: Mental status; gait, strength (graded 0-5); deep tendon reflexes. Labs: Electrolytes (sodium, potassium, bicarbonate, chloride, BUN, creatinine), CBC; X-rays, ECG (if older than 35 yrs or history of cardiovascular disease), ur ine analysis (UA), liver function tests, PT/PTT. Assessment (Impression): Assign a number to each problem and discuss each proble m separately. Plan: Describe surgical plans including preoperative testing, laboratory studies , medications, antibiotics.

PREOPERATIVE NOTE Preoperative Diagnosis: Procedure Planned: Type of Anesthesia Planned: Laboratory Data: Electrolytes, BUN, creatinine, CBC, PT/PTT, UA, EKG, Chest X-ra y; type and screen for blood or cross match if indicated; liver function tests, ABG. Risk Factors: Cardiovascular, pulmonary, hepatic, renal, coagulopathic, nutritio nal risk factors. Consent: Document explanation to patient of risk and benefits of procedure, and document patient's informed consent or guardian's consent and understanding of p rocedure. Allergies: Major Medical Problems: Medications: BRIEF OPERATIVE NOTE (Written immediately after the procedure) Date of the Procedure: Preoperative Diagnosis: Postoperative Diagnosis: Procedure: Names of Surgeon and Assistant: Anesthesia: Estimated Blood Loss (EBL): Fluids and Blood Products Administered During Procedure: Specimens: Pathology specimens, cultures, blood samples. POSTOPERATIVE NOTE Subjective: Mental status & patient's subjective condition; pain control. Vital Signs: Temperature, blood pressure, pulse, respirations. Physical Exam: Chest and lungs; inspection of wound and surgical dressings; cond itions of drains; characteristics and volume of output of drains. Labs: Impression: Plan: PROBLEM-ORIENTED PROGRESS NOTE Problem List: Postoperative day number, antibiotic day number if applicable. Hos pital day number, hyperalimentation day number. List each surgical problem separ ately (status post-appendectomy, hypokalemia). Address each numbered problem dai ly in progress note. Subjective: Write how the patient feels in the patient's own words; and give obs ervations about the patient. Objective: Vital signs; physical exam for each system; thorough examination and description of wound. Condition of dressings; purulent drainage, granulation tis sue, erythema; condition of sutures, dehiscence. Amount and color of drainage, l aboratory data. Assessment: Evaluate each numbered problem separately. Plan: For each numbered problem, discuss any additional orders, surgical plans. Discuss changes in drug regimen or plans for discharge or transfer. Discuss conc lusions of consultants. DISCHARGE SUMMARY Patient's Name: Chart Number: Date of Admission: Date of Discharge: Admitting Diagnosis:

Discharge Diagnosis: Attending or Ward Team: Surgical Procedures, Diagnostic Tests, Invasive Procedures: Brief History & Pertinent Physical Examination & Laboratory Data: Describe the c ourse of the patient's disease up until the patient came to the hospital includi ng physical exam & laboratory data. Hospital Course: Describe the course of the patient's illness while in the hospi tal; include evaluation, treatment, outcome of treatment, and medications given while in the hospital. Discharge Condition: Describe improvement or deterioration in patient's conditio n. Disposition: Describe the situation to which the patient will be discharged (hom e, nursing home), and person who will take care of patient. Discharged Medications: List medications and instructions. Discharged Instructions & Follow-up Care: Date of return for follow-up care at c linic; diet, exercise. Problem List: List all active and past problems. Copies: Send copies to attending physician, clinic, consultants and referring ph ysician. http://www.utmb.edu/surgery/clerks/surgdocu.htm Anatomy and Physiology!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!11 Laboratory Pharmacology Cardiology Dx, Hx & PE Guide, Notes Other terms for Cardio Pulmonary Dx, Hx & PE Guide Respiratory System Gastrointestinal System Dx, Hx and PE guide Integumentary System Dx, Hx and PE -Common Diseases Urinary System Cancer classification Endocrine drugs Musculoskeletal System Nervous System Neuro-Psychiatry EENT