1

whot is Medico/ 1ronscription?

Medlcal 1ranscrlpLlon ls Lhe process of converLlng volce dlcLaLlon (Lyplcally elLher casseLLe or dlglLal formaL) lnLo a
permanenL wrlLLen record uLlllzlng word processlng equlpmenL and sofLware

Lach day ln hosplLals all over Lhe counLry Lhousands of paLlenLs are admlLLed and dlscharged LxamlnaLlons are
conducLed procedures are performed and recommendaLlons are made lL ls noL uncommon for mulLlple physlclans Lo
be lnvolved ln a slmple procedure for a slngle paLlenL 8adlologlsLs aLhologlsLs AnesLheslologlsLs Surgeons and a hosL
of oLher medlcal speclallsLs musL all coordlnaLe Lhelr efforLs Lo ensure LhaL paLlenL care ls boLh adequaLe and
approprlaLe

underplnnlng all of Lhese acLlvlLles ls a complex web of medlcal and paLlenL lnformaLlon Lach paLlenLrelaLed acLlvlLy
and procedure musL be meLlculously documenLed and Lhen added Lo Lhe paLlenLs permanenL record hyslclans and
medlcal record handlers allke musL be exLremely careful Lo ensure LhaL deLalled paLlenL ldenLlflcaLlon lnformaLlon
accompanles each procedure and examlnaLlon reporL Lo averL poLenLlally dlsasLrous mlxups Cver Llme all of Lhls
lnformaLlon accumulaLes ln a cenLrallzed medlcal records reposlLory where lL serves as a crlLlcal resource for paLlenL
care faclllLaLlng accuraLe dlagnoses and approprlaLe LreaLmenLs lndeed Llmely paLlenL care ofLen hlnges on Lhe ablllLy
of 8adlology aLhology and oLher speclalLy deparLmenLs Lo qulckly conducL Lhelr examlnaLlons and reporL Lhelr
flndlngs

Cllck Pere for lree lnformaLlon on Lhe Medlcal 1ranscrlpLlon School M1Worldcom 8ecommends


vo/ution ond nistory of Medico/ 1ronscription
ln Lhe pasL Lhese reporLlngs conslsLed of very abbrevlaLed handwrlLLen noLes LhaL were funneled lnLo Lhe paLlenLs flle
for lnLerpreLaLlon by Lhe prlmary physlclan responslble for dlagnoslng allmenLs and prescrlblng LreaLmenL ulLlmaLely
Lhls hodgepodge of handwrlLLen noLes and Lyped reporLs was consolldaLed lnLo a slngle paLlenL flle and physlcally
sLored along wlLh Lhousands of oLher paLlenL records ln a wall of flllng cablneLs ln Lhe medlcal records deparLmenL

Whenever Lhe need arose Lo revlew Lhe records of a speclflc paLlenL Lhe paLlenLs flle would be reLrleved from Lhe flllng
cablneL and dellvered Lo Lhe requesLlng physlclan 1o enhance Lhls manual process many medlcal record documenLs
were produced ln dupllcaLe or LrlpllcaLe by means of carbon copy

ln recenL years Lhlngs have changed conslderably Walls of flllng cablneLs have glven way Lo deskLop compuLers
connecLed Lo powerful malnframe sysLems where paLlenL records are prepared and archlved dlglLally 1hls dlglLal formaL
allows for lmmedlaLe remoLe reLrleval by any physlclan who ls auLhorlzed Lo revlew Lhe paLlenL lnformaLlon 8eporLs are
sLored elecLronlcally and prlnLed selecLlvely as Lhe need arlses

Whlle Lhe LranslLlon from a paper based Lo an elecLronlc formaL wlll Lake years Lo compleLe conslderable progress has
been made PandwrlLLen reporLs are largely a Lhlng of Lhe pasL verbal dlcLaLlon ls now by far Lhe mosL common meLhod
for documenLlng and reporLlng Lhe resulLs of examlnaLlons and procedures hyslclans generally use elLher a casseLLe
based volce dlcLaLlon sysLem or a dlglLal volce dlcLaLlon sysLem Lo record Lhelr flndlngs ulcLaLlng reporLs verbally noL
only allows physlclans Lo be more Lhorough ln Lhelr reporLlng lL also saves Lhem a greaL deal of Llme 1he Wall SLreeL
!ournal recenLly reporLed Lhe resulLs of a sLudy conducLed by Lhe AssoclaLlon of Legal AdmlnlsLraLors suggesLlng LhaL
verbal dlcLaLlon ls Lhe fasLesL way Lo creaLe a documenL 1he sLudy sLaLes LhaL a 243word documenL Lakes 934
mlnuLes Lo creaLe wlLh an elecLronlc dlcLaphone compared wlLh 1646 mlnuLes on a personal compuLer and 1649
mlnuLes by hand (WS! 1uesday CcLober 22 1996 page A1 column 3) Clven Lhe salarles of mosL physlclans Lhe
cumulaLlve producLlvlLy savlngs assoclaLed wlLh Lhese Lechnologlcal enhancemenLs ls conslderable

1he process of converLlng volce dlcLaLlon Lo a LypewrlLLen formaL ls known as LranscrlpLlon 1radlLlonally a sLaff of skllled
medlcal LranscrlpLlonlsLs worklng ln Lhe medlcal records deparLmenL of Lhe hosplLal has accompllshed Lhe work of
Lranscrlblng medlcal records ln Lhe early years of medlcal LranscrlpLlon lL was noL uncommon for very large hosplLals Lo
have sLaffs of 40 or 30 medlcal LranscrlpLlonlsLs worklng one or more shlfLs A LranscrlpLlon supervlsor who ln Lurn
reporLed Lo Lhe Medlcal 8ecords ulrecLor generally oversaw Lhese LranscrlpLlonlsLs

Cllck Pere for lree lnformaLlon on Lhe Medlcal 1ranscrlpLlon School M1Worldcom 8ecommends


1he Outsourcinq 1rend
lncreaslngly LradlLlonal hosplLals are comlng under compeLlLlve aLLack by more efflclenL managed care organlzaLlons ln
an efforL Lo remaln compeLlLlve many hosplLals have Lurned Lo ouLsourclng as a means of cuLLlng cosLs Many of Lhe
processes LhaL were prevlously performed lnLernally are now belng conLracLed ouL Lo Lhlrd parLles Medlcal LranscrlpLlon
ls no excepLlon 1he ouLsourclng of LranscrlpLlon and oLher funcLlons relleves hosplLals of Lhe admlnlsLraLlve headaches
and overhead burdens assoclaLed wlLh lnLernal producLlon and allows Lhem Lo focus Lhelr aLLenLlon on lmprovlng
servlce and lowerlng cosLs

1hls new compeLlLlve cllmaLe has drlven many hosplLals ouL of buslness 1hose organlzaLlons LhaL have survlved have
done so by becomlng more efflclenL and cosLconsclous 1here ls conslderable evldence Lo suggesL LhaL conLracLlng ouL
medlcal LranscrlpLlon ls a much less cosLly alLernaLlve Lo produclng reporLs lnLernally MosL savvy healLhcare provlders
Loday undersLand Lhls and are respondlng approprlaLely 1he slgnlflcanL cosLcuLLlng pressures whlch conLlnue Lo drlve
Lhe lndusLry Loward consolldaLlon managed care and caplLaLlon vlrLually guaranLee LhaL Lhe ouLsourclng Lrend wlll noL
only conLlnue buL acceleraLe ln comlng years

1hls prollferaLlon of ouLsourclng agreemenLs has spawned a new generaLlon of small medlcal LranscrlpLlon companles
lnLenL on carvlng ouL a plece of Lhe ple lnLeresLlngly ln splLe of lLs rapld growLh Lhe medlcal LranscrlpLlon lndusLry ls
sLlll consldered a coLLage lndusLry Whlle Lhere are a few Lruly naLlonal players Lhe lndusLry ls aL Lhls polnL sLlll
domlnaLed by Lhe hundreds of small local LranscrlpLlon companles locaLed wherever hosplLals are found

CpporLunlLles
1he ouLlook for quallLy medlcal LranscrlpLlonlsLs have never been greaLer LucraLlve opporLunlLles abound Loday ln
hosplLals cllnlcs PMCs and ln Lhe hundreds of Medlcal 1ranscrlpLlon conLracLlng companles locaLed LhroughouL Lhe
counLry

1he Llmlng ls excellenL for anyone lnLeresLed ln enLerlng Lhls exclLlng and lucraLlve fleld Llke any career move success
wlll requlre paLlence and perseverance buL Lhe opporLunlLy Lo enLer Lhe medlcal LranscrlpLlon markeL has never been
greaLer Lhan lL ls Loday

8eneflLs
1he demand for Medlcal 1ranscrlpLlonlsLs ls very greaL 1here ls currenLly a shorLage of quallfled Medlcal
1ranscrlpLlonlsLs and demographlc Lrends suggesL LhaL Lhe ouLlook wlll conLlnue Lo be favorable for some Llme Lo
come Cood Medlcal 1ranscrlpLlonlsLs Lyplcally have no problem obLalnlng and malnLalnlng employmenL Conslder Lhe
followlng beneflLs of becomlng a professlonal Medlcal 1ranscrlpLlonlsL

lndemand rofesslon
LxcellenL lncome oLenLlal
llexlble Pours
CrowLh lndusLry
LxcepLlonal Pome 8ased Career CpporLunlLles
oLenLlal Lo geL your own CllenLs and 8ulld a LucraLlve 8uslness


osic uo/ificotions
Medlcal 1ranscrlpLlon ls a hlghly skllled professlon lL requlres an aLLenLlon Lo deLall and an ablllLy Lo recognlze and
undersLand Lechnlcal Lermlnology Cood Lyplng skllls are a musL 1yplcally an accuraLe Lyplng speed of 3070 words per
mlnuLe ls a prerequlslLe for mosL poslLlons Cbvlously Lhe fasLer you Lype Lhe more money you wlll be able Lo make as
mosL pay ls on a producLlon basls

Spelllng and grammar skllls are also vlLally lmporLanL Cnllne dlcLlonarles and spell checks are always avallable Lo asslsL
you buL Lhey should noL be relled upon compleLely ?ou should feel relaLlvely well grounded ln spelllng and grammar
before you declde Lo enLer Lhls fleld

MosL of Lhe sklll LhaL you wlll acqulre as a LranscrlpLlonlsL wlll come over Llme Lxperlence ls Lhe greaL Leacher rlor Lo
galnlng hands on experlence lL ls usually wlse Lo go Lhrough a formal course Lo galn a foundaLlon of knowledge and
pracLlcal experlence

CeLLlng SLarLed
Medlcal 1ranscrlpLlon ls a very speclallzed fleld and requlres exLenslve Lralnlng Cnce Lralned however Lhe demand ls
very greaL Cne of Lhe mosL dlfflculL parLs of breaklng lnLo Lhls lucraLlve lndusLry ls recelvlng Lhe requlslLe Lralnlng ?our
lncome poLenLlal wlll Lyplcally be deLermlned by your sklll level And sklll level wlll be a funcLlon of Lralnlng and
experlence unforLunaLely you wlll flnd LhaL mosL employers wlll be relucLanL Lo hlre lnexperlenced lndlvlduals 1he
learnlng curve can be qulLe sLeep and lL wlll be dlfflculL Lo flnd an employer LhaL ls wllllng Lo lnvesL Lhe Llme and money
necessary Lo Lraln a person

1here are a number of opporLunlLles Lo recelve Lhe lndepLh Lralnlng necessary Lo become a proflclenL Medlcal
1ranscrlpLlonlsL Many 1echnlcal Schools have fullLlme programs deslgned Lo provlde a baslc level of proflclency 1he
drawbacks wlLh Lhese programs ls LhaL Lhey Lend Lo be expenslve and Lhey generally requlre a fullLlme commlLmenL
whlch lnvolves qulLLlng a [ob and foregolng lncome durlng Lhe course of sLudy

An alLernaLlve Lo Lhese fullLlme classroom Lralnlng programs ls Lhe Pome SLudy Course Pome sLudy cerLalnly requlres a
more dlsclpllned aLLlLude buL Lhe cosL / beneflLs as well as Lhe ablllLy Lo work aL your own pace and ln your own home
are appeallng WlLh a Pome SLudy Course Lhere ls no need Lo qulL your presenL [ob unLll you have achleved a baslc sklll
level and are ready Lo begln your new career

lndeed lL ls ofLen posslble Lo begln your flrsL Medlcal 1ranscrlpLlon [ob on a parL Llme basls ln Lhe evenlngs followlng
compleLlon of Lhe home sLudy course whlle malnLalnlng your presenL employmenL 1hls earn whlle you learn approach
ls a good way Lo develop addlLlonal proflclency whlle sLlll reLalnlng Lhe safeLy neL of a full Llme [ob


-ormo/ Lob vo/ues



PLMA1CLCC? vALuLS
8ed 8lood Cell values
88C (Male) 42 36 M/L
88C (lemale) 38 31 M/L
88C (Chlld) 33 30 M/L
WhlLe 8lood Cell values
W8C (Male) 38 110 k / mm cubed
W8C (lemale) 38 110 k / mm cubed
W8C (Chlld) 30 100 k / mm cubed
Pemoglobln values
Pgb (Male) 14 18 g/dL
Pgb (lemale) 11 16 g/dL
Pgb (chlld) 10 14 g/dL
Pgb (newborn) 13 23 g/dL
PemaLocrlL values
PcL (Male) 39 34
PcL (lemale) 34 47
PcL (Chlld) 30 42
MCv 78 98 fL
MCP 27 33 pg
MCPC 31 37
neuLrophlls 30 81
8ands 1 3
LymphocyLes 14 44
MonocyLes 2 6
Loslnophlls 1 3
8asophlls 0 1
CA8ulAC MA8kL8S
1roponln l 0 01 ng/ml (onseL 46 hrs peak 1224 hrs reLurn Lo normal 47 days)
1roponln 1 0 02 ng/ml (onseL 34 hrs peak 1024 hrs reLurn Lo normal 1014 days)
Myoglobln (Male) 10 93 ng/ml (onseL 13 hrs peak 610 hrs reLurn Lo normal 1224 hrs)
Myoglobln (lemale) 10 63 ng/ml (onseL 13 hrs peak 610 hrs reLurn Lo normal 1224 hrs)
CLnL8AL CPLMlS18?
AceLone 03 20 mg
Albumln 33 30 gm/dL
Alkallne hosphaLase 32 110 u/L
Anlon gap 3 16 mLq/L
Ammonla 11 33 mol/L
Amylase 30 130 u/dL
AS1 SCC1 (Male) 7 21 u/L
AS1 SCC1 (lemale) 6 18 u/L
8lllrubln ulrecL 00 04 mg/dL
8lllrubln lndlrecL LoLal mlnus dlrecL
8lllrubln 1oLal 02 14 mg/dL
8un 6 23 mg/dL
Calclum (LoLal) 8 11 mg/dL
Carbon dloxlde 21 34 mLq/L
Carbon monoxlde sympLoms aL greaLer Lhan or equal Lo 10 saLuraLlon
Chlorlde 96 112 mLq/L
CreaLlne (Male) 02 06 mg/dL
CreaLlne (lemale) 06 10 mg/dL
CreaLlnlne 06 13 mg/dL
LLhanol 0 mg Coma greaLer Lhan or equal Lo 400 300 mg
lollc acld 20 21 ng/mL
Clucose 70 110 mg/dL (dluresls greaLer Lhan or equal Lo 180 mg/dL)
PuL (Male) 23 63 mg/dL
PuL (lemale) 38 94 mg/dL
lron 32 169 g/dL
lron blndlng capaclLy 246 433 g/dL
LacLlc acld 04 23 mLq/L
LacLaLe 03 23 mLq/L
Llpase 10 140 u/L
Magneslum 13 23 mg/dL
CsmolarlLy 276 293 mCsm/kg
araLhyrold hormone 12 68 pg/mL
hosphorus 22 48 mg/dL
oLassslum 33 33 mLq/L
roLeln (LoLal) 60 90 gm/dL
SC1 8 32 u/L
Sodlum 133 148 mLq/L
13 08 11 g/dL
1hyroglobulln Less Lhan 33 ng/mL
1hyroxlne (14) LoLal 3 13 g/dL
1oLal proLeln 3 9 gm/dL
1SP Less Lhan 9 u/mL
urea nlLrogen 8 23 mg/dL
urlc acld (Male) 33 77 mg/dL
urlc acld (lemale) 23 66 mg/dL
Lllu AnLL (AuuL1)
CholesLerol (LoLal) Less Lhan 200 mg/dL deslrable
CholesLerol (PuL) 30 73 mg/dL
CholesLerol (LuL) Less Lhan 130 mg/dL deslrable
1rlglycerldes (Male) CreaLer Lhan 40 170 mg/dL
1rlglycerldes (lemale) CreaLer Lhan 33 133 mg/dL
u8lnL vALuLS
Color SLraw
Speclflc CravlLy 1003 1040
pP 46 80
na 10 40 mLq/L
k Less Lhan 8 mLq/L
Cl Less Lhan 8 mLq/L
roLeln 1 13 mg/dL
CsmolallLy 80 1300 mCsm/L
24 PCu8 u8lnL vALuLS
Amylase 230 1100 lu / 24 hr
Calclum 100 230 mg / 24 hr
Chlorlde 110 230 mLq / 24 hr
CreaLlnlne 1 2 g / 24 hr
CreaLlne Clearance (Male) 100 140 mL / mln
CreaLlne Clearance (Male) 16 26 mg / kg / 24 hr
CreaLlne Clearance (lemale) 80 130 mL / mln
CreaLlne Clearance (lemale) 10 20 mg / kg / 24 hr
Magneslum 6 9 mLq / 24 hr
CsmolallLy 430 900 mCsm / kg
hosphorus 09 13 g / 24 hr
oLasslum 33 83 mLq / 24 hr
roLeln 0 130 mg / 24 hr
Sodlum 30 280 mLq / 24 hr
urea nlLrogen 10 22 gm / 24 hr
urlc acld 240 733 mg / 24 hr
CCACuLA1lCn
AC1 90 130 seconds
A11 21 33 seconds
laLeleLs 140000 430000 / ml
lasmlnogen 62 130
1 10 14 seconds
11 32 43 seconds
lS Less Lhan 10 g/dL
llbrlnogen 160 430 mg/dL
8leedlng Llme 3 7 mlnuLes
1hrombln Llme 11 13 seconds
CL8L88AL SlnAL lLulu
Appearance clear
Clucose 40 83 mg/dL
CsmolallLy 290 298 mCsm/L
ressure 70 180 mm/P2C
roLeln 13 43 mg/dL
1oLal cell counL 0 3 cells
W8Cs 0 6 / L
PLMCu?nAMlC A8AML1L8S
Cardlac lndex 23 42 L / mln / m squared
Cardlac CuLpuL 4 8 LM
LefL venLrlcular SLroke Work lndex 40 70 g / m squared / beaL
Mean ArLerlal ressure 70 103 mm Pg
ulmonary vascular 8eslsLance 133 233 dynes / sec / cm Lo Lhe negaLlve 3
ulmonary vaslular 8eslsLance lndex 233 283 dynes / sec / cm Lo Lhe negaLlve 3
8lghL venLrlcular SLroke Work lndex 7 12 g / m squared / beaL
SLroke volume 60 100 mL / beaL
SLroke volume lndex 40 83 mL / m squared / beaL
SysLemlc vascular 8eslsLance 900 1600 dynes / sec / cm Lo Lhe negaLlve 3
SysLemlc vascular 8eslsLance lndex 1970 2390 dynes / sec / cm Lo Lhe negaLlve 3
SysLollc ArLerlal ressure 90 140 mm Pg
ulasLollc ArLerlal ressure 60 90 mm Pg
CenLral venous ressure 2 6 mm Pg 23 12 cm P2C
L[ecLlon lracLlon 60 73
LefL ArLerlal ressure 4 12 mm Pg
ulmonary ArLery SysLollc 13 30 mm Pg
ulmonary ArLery ulasLollc 3 13 mm Pg
ulmonary ArLery ressure 10 20 mm Pg
ulmonary ArLery Wedge ressure 4 12 mm Pg
ulmonary ArLery Lnd ulasLollc ressure 8 10 mm Pg
8lghL ALrlal ressure 4 6 mm Pg
8lghL venLrlcular Lnd ulasLollc ressure 0 8 mm Pg
nLu8CLCClCAL vALuLS
Cerebral erfuslon ressure 70 90 mm Pg
lnLracranlal ressure 3 13 mm Pg or 3 10 cm P2C
A81L8lAL vALuLS
pP 733 743
aCC2 33 43 mm Pg
PCC3 22 26 mLq/L
C2 saL 96 100
aC2 83 100 mm Pg
8L 2 Lo +2 mmol/L
vLnCuS vALuLS
pP 731 741
aCC2 41 31 mm Pg
PCC3 22 29 mLq/L
C2 saL 60 83
aC2 30 40 mm Pg
8L 0 Lo +4 mmol/L


whot is Medico/ 1ermino/oqy?
Medlcal Lermlnology refers Lo Lhe words and phrases whlch have been developed Lo descrlbe Lhe procedures
medlcaLlons lnsLrumenLs anaLomlcal sLrucLures eLc used ln Lhe fleld of medlclne lL ls ln a very real sense Lhe
language of medlclne

Medlcal Lermlnology has a long and rlch hlsLory MosL medlcal Lerms derlve from LaLln or Creek So lf aL flrsL medlcal
Lermlnology appears Lo be a forelgn language well LhaLs because lL ls! 8uL donL despalr Llke any language Lhe
language of medlclne adheres Lo a seL of falrly slmple rules

lree lnfo on our recommended Medlcal 1ranscrlpLlon rogram leadlng Lo an exclLlng Pome 8ased Medlcal 1ranscrlpLlon
Career

1he SLrucLure of Medlcal 1ermlnology
lL may seem llke an lmposslble Lask Lo commlL Lhe spelllng and meanlng of 100000 dlfferenL medlcal Lerms Lo memory
and ln facL for mosL of us lL ls lorLunaLely lL ls noL necessary 1he facL ls LhaL mosL seemlngly complex medlcal Lerms
are slmply comblnaLlons of much smaller subseLs of word parLs 1hls ls a crlLlcally lmporLanL concepL Lo undersLand wlLh
medlcal Lermlnology

lL ls noL unreasonable Lo expecL Lo memorlze several hundred medlcal preflxes medlcal sufflxes and medlcal rooL words
ln a relaLlvely shorL perlod of Llme 1hen once Lhese word parLs are learned Lhey can be comblned Lo form llLerally
Lhousands of complex medlcal Lerms

Pow are Medlcal 1erms ConsLrucLed?
MosL medlcal Lerms conslsL of one or more parLs 1hese word parLs may lnclude one or more of Lhe followlng

8ooL Words
reflxes
Sufflxes
Comblnlng vowels
1o help you beLLer undersLand how Lhls works leLs look aL an example

Conslder Lhe word cholecysLecLomy AL flrsL glance Lhls word seems qulLe complex CholecysLecLomy whlch means
exclslon (removal) of Lhe gall bladder ls really a comblnaLlon of four dlfferenL word parLs LeLs break lL down lnLo lLs sub
parLs and see lf we can flgure ouL why lL means whaL lL means

chol e cysL ecLomy

chol ls a rooL word meanlng blle or gall
e ls a comblnlng vowel (descrlbed ln more deLall below)
cysL ls anoLher rooL word meanlng bladder
ecLomy ls a sufflx whlch LranslaLes Lo exclslon or surglcal removal

1herefore we can see LhaL cholecysLecLomy ls a comblnaLlon of words whlch LranslaLe Lo mean surglcal removal of Lhe
gall bladder

Lach of Lhese word parLs wlll be seen over and over ln medlcal language lor example Lhe sufflx ecLomy ls seen ln such
common Lerms as LonslllecLomy (removal of Lhe Lonslls) and appendecLomy (removal of Lhe appendlx) lL ls noL hard Lo
see LhaL as you begln Lo commlL Lhese subLerms Lo memory you wlll be able Lo declpher more complex Lerms because
you wlll recognlze and undersLand Lhelr componenL parLs

Medlcal Lerms always conLaln aL leasL one rooL word And as we saw wlLh cholecysLecLomy Lhey may have more Lhan
one rooL word 1he rooL ls Lhe parL of Lhe word LhaL comprlses Lhe prlmary meanlng of Lhe Lerm ln Lhe example of
LonslllecLomy Lhe rooL word ls Lonsll 1he sufflx ls ecLomy 1he rooL word Lonsll ls capable of sLandlng alone 1he sufflx
ecLomy (meanlng surglcal removal) requlres Lhe rooL word Lonsll Lo confer relevance reflxes and sufflxes cannoL sLand
alone Medlcal Lerms may have buL are noL requlred Lo have a preflx and/or a sufflx

Comblnlng vowels
Comblnlng vowels are someLlmes used Lo creaLe a more fluld LranslLlon beLween word parLs and Lo make medlcal Lerms
easler Lo pronounce lor example Lhe Lerm splenomegaly means enlargemenL of Lhe spleen lL ls a comblnaLlon of Lhe
rooL word splen meanlng spleen and Lhe sufflx megaly meanlng enlargemenL 1he C whlch follow Lhe rooL word splen
ls a comblnlng vowel whlch slmply makes Lhe word flow beLLer

1he vowel used mosL ofLen Lo comblne medlcal words ls C buL oLher vowels are also someLlmes used lL should be
noLed LhaL comblnlng vowels may be used beLween Lwo rooL words or beLween a rooL word and a sufflx buL Lhey are
never used beLween preflxes and rooL words



common/y Misspe//ed Medico/ words ond Medico/ 5ound 4/ikes

A
abscess
accommodaLlon
adolescenL
afferenL vs efferenL (Sound Allkes)
alopecla
Alzhelmer
analyze
aneurysm
anorexla
anuresls vs enuresls (Sound Allkes)
arrhyLhmla
asclLes
aphagla vs aphasla (Sound Allkes)
asphyxla
asysLole
asymmeLry
ausculLaLlon

8
basllar
barblLuraLes
brachlal
branchlal

C
callus (noun)
callous (ad[ecLlve)
caLheLer
caLheLerlzaLlon
Caucaslan
chalazlon
clrcumferenLlal
clrrhosls
chlckenpox
chlamydla
colosLrum vs clausLrum (Sound Allkes)
cord vs chord (Sound Allkes)
cor (hearL)
cureLLage

u
debrldemenL
decublLus
dependenL vs dependanL (Sound Allkes)
dlabeLes melllLus
dlaphoresls
dlaphragm
dllaLaLlon
dlphLherla
dyspareunla
dysphagla vs dysphasla (Sound Allkes)

L
eczema
effuslon
ellclL vs llllclL (Sound Allkes)
enuresls vs anuresls (Sound Allkes)
ellclL vs llllclL (Sound Allkes
epldldymls / epldldymlLls
eryLhemaLosus
exacerbaLed vs exasperaLed (Sound Allkes)

l
fascla
flaccld

C
gamma globulln
gases gassy gaseous
gallbladder
gangrene
gauge
gonorrhea

P
hemopLysls
hemorrhold
hlppocampus
homeosLasls
humerus
humeral vs humoral
hyglene

l
lcLerus
lleum vs lllum (Sound Allkes)
lnoculaLe
lnsufflaLe
lnLraocular
lnLussuscepLlon
lschemla

M
malacla
melanln
mensLruaLlon
mucus (noun) mucous (ad[ecLlve)
myxedema

C
occur occurrlng occurrence
oophorecLomy
CphLhalmology
orLhopnea


pacemaker
palllaLlve
palpaLe
palplLaLlon
paroxysmal
perfuslon vs profuslon (Sound Allkes)
perlneal vs peroneal (Sound Allkes)
perlneum
perlosLeum
perlLoneum
perslsLenL
peLechla
plane vs plaln (Sound Allkes)
pleural vs plural (Sound Allkes) pleurlsy
polyposls
prosLaLe vs prosLraLe (Sound Allkes)
prosLhesls
proLocol
prurlLus
pLeryglum

8
reglme vs reglmen vs reglmenL (Sound Allkes)
rhyLhm

S
saglLLal
scalene
scarrlng
seborrhelc
sedenLary
sequela
seroLonln
senlle
shoLLy lymph nodes
sleve
spleen
splenecLomy
supersede
suppuraLlon
symmeLry
syncope
syphllls

1
Lonslls
LonslllecLomy
Lrachea
Lrlcuspld
Lrochlear

v
veslcle vs veslcal
venLrlcle
verLlcal

x
xerosls
xlphold



Medico/ 1ronscription Line count uefinition ond Methodo/oqy

1lred of Lrylng Lo unravel Lhe medlcal LranscrlpLlon llne counL mysLery? lrusLraLed wlLh looklng for buL noL flndlng a
sLandard medlcal LranscrlpLlon llne counL deflnlLlon? Well youre noL alone ln facL lL Lurns ouL LhaL Lhls ls one of Lhe
mosL conLroverslal frusLraLlng mlsundersLood mlsused and abused concepLs ln Lhe medlcal LranscrlpLlon lndusLry

1he sad facL ls LhaL Lhe concepL of medlcal LranscrlpLlon llne counLs ls a concepL LhaL ls begglng for sLandardlzaLlon Why
hasnL lL been sLandardlzed Lo Lhls polnL? Cood quesLlon 1he shorL answer ls LhaL Lhere ls a loL of money lnvolved and
noL everyone would beneflL equally from M1 llne counL sLandardlzaLlon And lf hlsLory ls any lndlcaLlon lL wlll requlre a
greaL many more years of pollLlcal wrangllng Lo geL everyone on Lhe same page Cne of Lhe greaL lessons of Lconomlcs ls
LhaL power comes from Lhe assymeLry of lnformaLlon ln oLher words Lhe fuzzlness surroundlng Lhls lssue of whaL
consLlLuLes a medlcal LranscrlpLlon llne ls a source of greaL flnanclal beneflL for some medlcal LranscrlpLlon lndusLry
players and obvlously ls a source of consLernaLlon for oLhers

1he good news ls LhaL over Lhe pasL several years Lhere has been some modesL progress ln Lhe area of medlcal
LranscrlpLlon llne counLs We are seelng a slow buL unmlsLakable Lrend Loward sLandardlzaLlon

ueflnlLlons
LeLs sLarL wlLh a few baslc deflnlLlons LhaL have been adopLed by Lhe leadlng lndusLry medlcal LranscrlpLlon
organlzaLlons APul APlMA M1lA

1 Cross Medlcal 1ranscrlpLlon CharacLer ln counLlng medlcal LranscrlpLlon llnes any leLLer number symbol or
funcLlon key necessary for Lhe flnal appearance and conLenL of a medlcal LranscrlpLlon documenL lncludlng Lhe space
bar carrlage reLurn underscore bold and any characLer conLalned wlLhln a macro header or fooLer

2 neL Medlcal 1ranscrlpLlon CharacLer rlnLed characLers only noLe Lo converL Lo Cross CharacLers mulLlply neL
CharacLers by 12

3 neL Medlcal 1ranscrlpLlon Llne A deflned llne lengLh LhaL lncludes a predeLermlned number of gross characLers (33
60 63 70 73 eLc) noLe neL llnes are generally deLermlned by dlvldlng Lhe LoLal gross characLers ln a reporL by Lhe
deflned llne lengLh

4 Cross Medlcal 1ranscrlpLlon Llne Any prlnLed llne LhaL has one or more characLers noLe no dlsLlncLlon ls made
here beLween full and parLlal llnes (1o converL Cross Llnes Lo neL Llnes mulLlply Cross Llnes by 70)

3 Medlcal 1ranscrlpLlon keysLroke Lach sLroke of a key ls counLed lncludlng Lhe space bar carrlage reLurn
underscore bold eLc consLlLuLes a medlcal LranscrlpLlon keysLroke noLe macros become an lssue here Lechnlcally lf
a macro requlres Lhree keysLrokes Lhen for bllllng purposes Lhree keysLrokes would be bllled

6 neL Medlcal 1ranscrlpLlon Word A neL word ls deflned as flve (3) alpha/numerlc characLers plus one(1) space for a
LoLal of slx (6) characLers

7 8ecorded MlnuLe Cne recorded mlnuLe of medlcal LranscrlpLlon dlcLaLlon ls equal Lo an average of 777 gross
characLers for Medlcal 8ecords dlcLaLlon (lncludlng L8) and an average of 782 gross characLers for hyslclan racLlces
dlcLaLlon

Medico/ 1ronscription Line uefinition 1he /usive 5tondord
Cver Lhe years Lhe deflnlLlon of a medlcal LranscrlpLlon llne has varled slgnlflcanLly ln Lerms of gross characLers and
keysLrokes 1he range has Lyplcally been from 33 Lo 80 keysLrokes More recenLly a 63 keysLroke (gross characLer) llne
has emerged as someLhlng of an lndusLry sLandard alLhough a falr amounL of varlaLlon conLlnues Lo exlsL Powever
even as Lhls sLandard has emerged Lhere conLlnues Lo be slgnlflcanL conLroversy over gross characLers neL characLers
macro characLers eLc ln oLher words a 63 characLer llne can sLlll mean dlfferenL Lhlngs Lo dlfferenL people Some
companles acLually have Lwo ways of measurlng a llne one for bllllng purposes and one for wage paymenL purposes
1he ldea ls Lo creaLe a small spread blll for all keysLrokes whlle paylng only for hard characLers

1he 8llllng Conundrum
lL Lurns ouL LhaL Lhere ls a falr degree of flexlblllLy ln esLabllshlng medlcal LranscrlpLlon bllllng parameLers lL bolls down
Lo negoLlaLlng a raLe wlLh a prospecLlve cllenL Lven lf you deLermlne LhaL you wlll aLLempL Lo adhere Lo Lhe sLandards
provlded ln Lhe deflnlLlons above Lhere ls sLlll a falr amounL of laLLlLude LhaL derlves from Lhe sub[ecLlvlLy lnherenL ln Lhe
deflnlLlons lor example assume LhaL you declde Lo blll based on a 63 characLer llne WhaL abouL parLlal llnes? Agaln lL
depends on how Lhe conLracL ls wrlLLen Cn Lhe one hand you could sLrucLure Lhe conLracL Lo requlre LhaL all gross
characLers ln a glven reporL be added up and dlvlded by 63 Lo produce a LoLal blllable llne counL ln oLher words you are
baslng Lhe bllllng on Lhe deflnlLlon of a neL Llne above l personally llke Lhls meLhod lL ls clean and ls llkely Lo become
Lhe defacLo sLandard for bllllng large accounLs

lree lnfo on our recommended Medlcal 1ranscrlpLlon rogram leadlng Lo an exclLlng home based medlcal LranscrlpLlon
career

lor example

Assume LhaL for Lhe bllllng perlod your medlcal LranscrlpLlon llne counL sofLware calculaLes a LoLal of 3300000
Lranscrlbed gross characLers and LhaL your conLracL deflnes a blllable llne as 63 gross characLers Assume LhaL you have
negoLlaLed a prlce of 14 cenLs per blllable llne ?our blll would be calculaLed as follows

3300000 dlvlded by 63 33846 blllable llnes

33846 mulLlplled by 14 $733800


AlLernaLlvely you could dellver formaLLed medlcal LranscrlpLlon reporLs Lo Lhe cllenL LhaL are based on a 63 gross
characLer llne and Lhen counL all llnes lull and parLlal llnes would counL Lhe same for bllllng purposes (See Cross Llnes
deflnlLlon above) Conslder how Lhls mlghL affecL your blll for Lhe same bllllng perlod

uslng Lhe Cross Lo neL Llne converslon facLor shown above (mulLlply Cross Llnes by 70 Lo geL neL llnes or conversely
dlvlde neL Llnes by 70 Lo geL Cross llnes) we dlscover LhaL we have produced 76922 Cross Llnes lf we are bllllng for
gross llnes aL Lhe same bllllng raLe of 14 cenLs per llne Lhen our blll would read as follows

76922 mulLlplled by 14 $1076900

A slgnlflcanL dlfference ls noLed beLween Lhe Lwo bllls

1here ls noLhlng wrong wlLh negoLlaLlng a more favorable conLracL for yourself or your company as long as Lhlngs are
clearly spelled ouL ln advance And as lL Lurns ouL Lhls slmple facL ls prlmarlly responslble for Lhe bllllng varlaLlon LhaL
conLlnues Lo perslsL ln Lhe lndusLry Companles aLLempL Lo negoLlaLe Lerms LhaL favor Lhem by playlng wlLh characLer
and llne deflnlLlons

AnoLher facLor LhaL could be used Lo lnfluence medlcal LranscrlpLlon bllllng ls Lhe fonL slze of flnlshed formaLLed reporLs
A 12 polnL fonL wlLh a 1 lnch margln wlll yleld a very dlfferenL llne counL Lhan a 10 polnL fonL wlLh Lhe same 1 lnch
margln 1hese subLle dlfferences can mean blg money over Lhe llfe of a conLracL and should be LhoughL Lhrough
carefully Cbvlously a gross characLer deflnlLlon for a llne (63 gross characLers per llne for example) wlll ellmlnaLe Lhls
problem A gross characLer ls bllled Lhe same regardless of wheLher lL ls a 10 polnL or 12 polnL fonL whlch l belleve ls as
lL should be

8llllng by Lhe Medlcal 1ranscrlpLlon age
uependlng on Lhe average lengLh of Lhe reporLs you are Lranscrlblng bllllng mmedlcal LranscrlpLlon reporLs by Lhe page
can also make sense 1yplcally Lhls ls mosL beneflclal when deallng wlLh a hlgher quanLlLy of parLlal page reporLs 8llllng
by Lhe page for Lhese shorLer reporLs essenLlally guaranLees a mlnlmum llne counL for each reporL 1hls can be
lmporLanL as Lhe seLup and formaLLlng requlremenLs for Lhe larger volume of shorLer reporLs can become onerous lf
negoLlaLed properly bllllng by Lhe page can be yleld more lncome per llne of LranscrlpLlon Lhan bllllng for sLralghL llne
counLs Cbvlously cerLaln Lypes of accounLs lend Lhemselves more readlly Lo Lhls Lype of bllllng arrangemenL

lor example lf you charge $400 per page and Lhe average llne counL for Lhe cllenL ls 20 llnes per reporL Lhen you are
averaglng 20 cenLs per llne whlch may be more Lhan you would oLherwlse blll on a per llne basls

Line count uti/ities
A number of companles have developed sofLware Lechnology Lo faclllLaLe Lhe llne counLlng and bllllng process

1hese lnclude

Abacus Sorcerer SofLware

lnsLanL1exLro verslon lll 1exLware SoluLlons

Meden Lmmaus Meden

M CounL Lmmaus Meden

SlycounL ll Sylvan SofLware

SlycounL lv (MS Word) Sylvan SofLware

W CounL roducLlve erformance lnc

ln addlLlon MlcrosofL Word and oLher word processlng sofLware packages have Lhelr own bullL ln llne counLlng uLlllLy
whlch may prove adequaLe dependlng on your appllcaLlon 1he besL programs provlde Lhe opLlon of lncludlng or
excludlng spaces carrlage reLurns headers fooLers eLc 1hls allows for opLlmal flexlblllLy ln Lracklng and bllllng llne
counLs





common Medico/ 4bbreviotion

AbbrevlaLlon
Meanlng
A
1C
A AusculLaLlon and percusslon
A AnLerlor and posLerlor
Aflb ALrlal flbrlllaLlon
ac 8efore meals
A/a AlveolararLerlal oxygen gradlenL
AAA Abdomlnal aorLlc aneurysm
A8 / ab AborLlon
A8Cs Alrway breaLhlng clrculaLlon
A8C ArLerlal blood gas
A8C A sysLem of classlfylng blood groups
AC Acromloclavlcular
AC Abdomlnal Clrcumference
ACL AngloLensln converLlng enzyme
ACL AnLerlor cruclaLe llgamenL
ACLS Advanced Cardlac Llfe SupporL
AC1P AdrenocorLlcoLroplc hormone corLlcoLropln
Au Alzhelmers demenLla or dlsease
ad llb As deslred
AuP AnLldlureLlc hormone
AuL AcLlvlLles of dally llvlng
Al8 AcldfasL bacllll
AlL ALrlal fluLLer
Al AlphafeLoproLeln
Alv AmnloLlc fluld volume
Al ArLlflclal lnsemlnaLlon
Al Amnlolnfuslon
AluS Acqulred lmmunodeflclency syndrome
AkA Above knee ampuLaLlon
ALL AcuLe lymphocyLlc leukemla
AL1 Alanlne amlnoLransferase
AMA AgalnsL medlcal advlce
AnA AnLlnuclear anLlbody
A AnLeroposLerlor
appy AppendecLomy
A11 AcLlvaLed parLlal LhromboplasLln
AC WaLer
A8C AluSrelaLed complex
A8uS AdulL resplraLory dlsLress syndrome
A8l AcuLe renal fallure
ASA As soon as posslble
ASPu ALheroscleroLlc hearL dlsease
ASC AnLlsLrepLolyslnC
AS1 AsparLaLe amlnoLransferase
A1n AcuLe Lubular necrosls
A1nC ALraumaLlc normocephallc
Av ArLerlovenous aLrlovenLrlcular
Av8 ALrlovenLrlcular block
AvM ArLerlovenous malformaLlon
Avn ALrlovenLrlcular node
Av8 AorLlc valve replacemenL



orminq P/uro/s of Medico/ words
lormlng proper plurals of medlcal words can be one of Lhe more challenglng aspecLs of medlcal LranscrlpLlon 1he
problem ls exacerbaLed by Lhe facL LhaL even dlcLaLlng physlclans frequenLly have dlfflculLy wlLh plurals 1hey cannoL
always be counLed on Lo dlcLaLe Lhe correcL plural form 1hls pushes Lhe burden of ldenLlfylng and Lranscrlblng Lhe
proper plural sLralghL back on Lhe LranscrlpLlonlsL 1he good news ls LhaL plurals generally follow some baslc rules Cnce
you have masLered Lhese rules you wlll be able Lo qulckly form proper plurals for mosL medlcal Lerms LhaL you
encounLer 1he bad news ls LhaL for every rule Lhere ls an excepLlon 1hls means LhaL you wlll also need Lo memorlze (or
look up) Lhese excepLlons WlLh pracLlce you wlll become very famlllar wlLh all common plurals

1he charL below ls deslgned Lo provlde baslc rules of Lhumb for formlng plurals 8uL remember LhaL Lhere are excepLlons
Lo mosL of Lhese rules


osic ku/es of 1humb for orminq Medico/ P/uro/s

lf Lhe Slngular Lndlng ls Slngular Lxample 1he lural 8ule ls lural lorm
ls dlagnosls urop Lhe ls and add es dlagnoses
um lleum urop Lhe um and add a llea
us alveolus urop Lhe us and add l alveoll
a verLebra urop Lhe a and add ae verLebrae
lx appendlx urop Lhe lx and add lces appendlces
ex corLex urop Lhe ex and add lces corLlces
ax Lhorax urop Lhe x and add ces Lhoraces
ma sarcoma 8eLaln Lhe ma and add La sarcomaLa
on spermaLozoon urop Lhe on and add a spermaLozoa
nx larynx urop Lhe x and add ges larynges
y deformlLy urop Lhe y and add les deformlLles
yx calyx urop Lhe yx and add yces calyces
en foramen urop Lhe en and add lna foramlna

10 common xceptions to osic P/uro/ ku/es
1 SomeLlmes Lhe proper plural of a word endlng ln ls wlll be formed by dropplng Lhe ls and addlng ldes lor example
epldldymls becomes epldldymldes

2 SomeLlmes Lhe proper plural of a word endlng ln us wlll be formed by dropplng Lhe us and addlng era or ora lor
example vlscus becomes vlscera corpus becomes corpora

3 Some words endlng ln lx or ax have more Lhan one accepLable plural form lor example 1he plural of appendlx can
be elLher appendlces or appendlxes alLhough Lhe mosL common plural form would uLlllze Lhe lces endlng

4 1he proper plural for cerLaln words endlng ln lon can be formed slmply by addlng an s lor example chorlon
becomes chorlons

3 1he plural form of Lhe Lerm vas ls vasa

6 1he plural form of pons ls ponLes

7 1he plural form of Lhe dual meanlng word os ls ora when referrlng Lo mouLhs and ossa when referrlng Lo bones

8 1he plural form of Lhe Lerm femur ls femora

9 1he plural form of cornu ls cornua

10 1he plural form of parles ls parleLes



whot is nlP44?

1he ueparLmenL of PealLh and Puman Servlces has developed a serles of prlvacy regulaLlons known collecLlvely as Lhe
PealLh lnsurance orLablllLy and AccounLablllLy AcL of 1996 (PlAA) 1hese regulaLlons are deslgned Lo proLecL Lhe
prlvacy rlghLs of lndlvlduals wlLh regard Lo Lhelr confldenLlal medlcal records 1he acL greaLly resLrlcLs Lhe dlssemlnaLlon
and LransmlLLal of personal paLlenL lnformaLlon and wlll dramaLlcally affecL Lhe way healLhcare lnformaLlon ls handled

Who do Lhe PlAA 8egulaLlons Apply Lo?
PlAA regulaLlons have been crafLed Lo have broad appllcaLlon 1he provlslons of Lhe AcL exLend Lo all healLh care plans
healLh care provlders who LransmlL healLh records ln an elecLronlc formaL and healLh care clearlnghouses and bllllng
companles 1he blll refers Lo Lhese organlzaLlons as Covered LnLlLles ulLlmaLely however almosL everyone wlll be
affecLed ln one way or anoLher by Lhese regulaLlons whlch wlll lmpacL boLh consumers and provlders of healLh care
servlces

Are Medlcal 1ranscrlpLlon Servlces Consldered Covered LnLlLles?
MosL Medlcal 1ranscrlpLlon Servlces and Lhelr employees are noL consldered Covered LnLlLles under Lhe AcL unless
Lhelr organlzaLlon also engages ln servlces LhaL puL Lhem ln Lhe caLegory of Covered LnLlLy Medlcal 1ranscrlpLlon
Servlces are Lyplcally regarded under Lhe AcL as 8uslness AssoclaLes 1he AcL deflnes a 8uslness AssoclaLe as any
person or organlzaLlon LhaL performs a funcLlon or acLlvlLy on behalf of a Covered LnLlLy buL ls noL parL of Lhe Covered
LnLlLys workforce (employees volunLeers Lralnees and oLhers under Lhe Covered LnLlLys dlrecL conLrol regardless of
wheLher Lhey are pald by Lhe Covered LnLlLy 8e aware LhaL sLaLe regulaLlons may dlffer from naLlonal regulaLlons and
cerLaln SLaLes may deflne M1 Servlces as Covered LnLlLles

lree lnfo on our recommended Medlcal 1ranscrlpLlon rogram leadlng Lo an exclLlng home based medlcal LranscrlpLlon
career


As a 8uslness AssoclaLe a Medlcal 1ranscrlpLlon Servlce may noL be dlrecLly governed by PlAA regulaLlons Powever
8uslness AssoclaLes are governed lndlrecLly by vlrLue of Lhe facL LhaL Covered LnLlLles are requlred Lo obLaln wrlLLen
assurances from Lhe 8uslness AssoclaLes LhaL Lhey deal wlLh Lo ensure LhaL paLlenL ldenLlfylng lnformaLlon ls
approprlaLely safeguarded 1hese wrlLLen assurances musL be lncluded ln a wrlLLen conLracL beLween Lhe Covered LnLlLy
and Lhe 8uslness AssoclaLe

8ecause of Lhe sLrlcL requlremenLs of Lhe AcL relaLlng Lo Covered LnLlLles 8uslness AssoclaLes can expecL LhaL Lhe
Covered LnLlLles for whom Lhey perform servlces wlll be vlgllanL ln requlrlng evldence of compllance from Lhelr 8uslness
AssoclaLe parLners 1hls wlll llkely Lake dlfferenL forms from organlzaLlon Lo organlzaLlon Powever M1 Servlces should
plan Lo undersLand and lmplemenL Lhelr own acLlon plans and overslghL mechanlsms Lo ensure LhaL Lhey meeL Lhe
requlremenLs of Lhe AcL

lree lnfo on our recommended Medlcal 1ranscrlpLlon rogram leadlng Lo an exclLlng home based medlcal LranscrlpLlon
career


now does nlP44 4pp/y to lndependent Medico/ 1ronscriptionists?
Medlcal LranscrlpLlonlsLs who operaLe as lndependenL ConLracLors Lo Medlcal 1ranscrlpLlon Servlces (8uslness
AssoclaLes) and who have dlrecL access Lo paLlenL healLh lnformaLlon are referred Lo by Lhe AcL as 1hlrd arLles 1hlrd
arLles musL have a wrlLLen conLracL wlLh Lhe 8uslness AssoclaLe for whom Lhey provlde conLracL servlces Lo assure LhaL
paLlenL lnformaLlon conveyed Lo Lhem wlll be approprlaLely safeguarded and LhaL all elecLronlc daLa Lransmlsslons
beLween Lhe 1hlrd arLy and Lhe 8uslness AssoclaLe are conducLed ln accordance wlLh Lhe approved naLlonal sLandard
1hls conLracL should be slmllar ln naLure and scope Lo Lhe conLracL beLween Lhe 8uslness AssoclaLe and Lhe Covered
LnLlLy

When does PlAA 8ecome LffecLlve?
1he rules became offlclally effecLlve on Aprll 14 2001 Powever Lhe AcL provlded for a perlod of Llme before compleLe
compllance was mandaLed Small healLh care plans for example had unLll Aprll 14 2004 Lo become compleLely
compllanL All oLher covered enLlLles were requlred Lo become fully compllanL by Aprll 14 2003

lree lnfo on our recommended Medlcal 1ranscrlpLlon rogram leadlng Lo an exclLlng home based medlcal LranscrlpLlon
career


uoes Lhe AcL Covern Lhe 1ransmlLLal of LlecLronlc aLlenL lnformaLlon?
1he AcL calls for Lhe sLandardlzaLlon of elecLronlc documenL LransmlLLal 1he naLlonal sLandard whlch has been
prescrlbed by PlAA for elecLronlc healLh record LransmlLLal ls AnSl x12 1hls naLlonal sLandard governs boLh Lhe
conLenL and Lhe formaL of paLlenL lnformaLlon LhaL ls senL elecLronlcally beLween Lwo organlzaLlons

WhaL are Lhe CLher key rovlslons of Lhe AcL?
1he prlmary focus of Lhe AcL ls Lo resLrlcL Lhe dlssemlnaLlon of paLlenL healLh care lnformaLlon 1he condlLlons under
whlch lnformaLlon can be conveyed are spelled ouL very expllclLly lf Lhe AcL does noL speclflcally allow for healLh care
lnformaLlon Lo be shared ln a cerLaln manner or under a cerLaln seL of condlLlons lL ls prohlblLed

1he rules speclflcally perLaln Lo healLh lnformaLlon LhaL ls LransmlLLed or malnLalned ln any form (oral paper elecLronlc
eLc) and whlch conLalns paLlenL ldenLlfylng lnformaLlon aLlenL ldenLlfylng lnformaLlon lncludes such Lhlngs as name
address soclal securlLy number phone number and any oLher lnformaLlon whlch could be used Lo ldenLlfy an
lndlvldual

ln order Lo be compllanL covered enLlLles musL lmplemenL measures Lo ensure LhaL paLlenL lnformaLlon ls proLecLed ln
accordance wlLh Lhe provlslons of Lhe AcL Speclflcally

WrlLLen noLlflcaLlon musL be glven Lo lndlvlduals Lelllng Lhem how lnformaLlon wlll be used and Lo whom lL wlll be
dlssemlnaLed (lnsurance and bllllng companles or oLher healLh care pracLlLloners for example)

WrlLLen consenL musL be obLalned from Lhe lndlvldual allowlng for Lhe use and malnLenance of personal lnformaLlon as
provlded for by Lhe AcL

ulsclosure or use of lnformaLlon for any oLher purpose or Lo any oLher organlzaLlon requlres speclflc auLhorlzaLlon from
Lhe lndlvldual
8easonable efforLs musL be made by covered enLlLles Lo mlnlmlze Lhe dlspersal of paLlenL lnformaLlon
PealLh lnformaLlon can be conveyed Lo 8uslness AssoclaLes (8uslness AssoclaLes ls a Lerm LhaL Lyplcally lncludes
Medlcal 1ranscrlpLlon Servlce rovlders and Lhelr employees) only afLer wrlLLen assurance ls provlded Lo guaranLee Lhe
proLecLlon of Lhe lnformaLlon

rlvacy offlclals musL be appolnLed by each covered enLlLy Lo develop lmplemenL and oversee prlvacy pollcy for Lhe
covered organlzaLlon A prlmary conLacL person musL also be deslgnaLed Lo handle complalnLs and lnqulrles abouL Lhe
organlzaLlons pollcy

All employees of Lhe covered enLlLy musL recelve formal Lralnlng Lo ensure LhaL Lhey undersLand Lhe requlremenLs of Lhe
prlvacy AcL as Lhey perLaln Lo Lhelr speclflc duLles

Covered enLlLles musL esLabllsh adequaLe admlnlsLraLlve Lechnlcal and physlcal safeguards Lo ensure LhaL all prlvacy
requlremenLs are upheld wlLhln Lhe organlzaLlon

WhaL are Lhe enalLles for nonCompllance?
Covered enLlLles whlch fall Lo comply wlLh Lhe flnal regulaLlons by Lhe mandaLed compllance daLe may lncur sLlff
penalLles lncludlng Lhe paymenL of a flne ln cerLaln cases crlmlnal charges may be broughL agalnsL Lhe noncompllanL
enLlLy


rommor ku/es
osic rommor uefinitions ond usoqe

Ak1S CI SLLCn

l nCunS
A Common nouns

Common nouns are used Lo name a general person place or Lhlng

Lxamples man baby clLy monLh

8 roper nouns

roper nouns are used Lo name a speclflc person place or Lhlng

noLe roper nouns are generally caplLallzed

Lxamples !ohn Chloe Mlaml AugusL

C CollecLlve nouns

CollecLlve nouns are used Lo name groups of people places or Lhlngs
Lxamples Leam herd flock gaggle prlde

u lural lorms of nouns

Ceneral rules

ln mosL cases an s ls added Lo Lhe end of Lhe noun Lo form Lhe plural

Lxamples bananas cars

SomeLlmes es ls added Lo Lhe end of Lhe noun Lo form Lhe plural 1hls generally occurs when Lhe noun ends ln s z ch
or sh

Lxamples bushes glasses porches

LxcepLlons

1 nouns LhaL end ln a vowel plus o add s

Lxamples paLlos radlos

2 nouns LhaL end wlLh a consonanL plus o add es

Lxample poLaLoes

3 nouns LhaL end ln f or fe change Lhe f Lo v and add es

Lxample calf / calves

4 CerLaln noun plural forms are lrregular and musL be memorlzed

Lxample mouse / mlce ox / oxen goose / geese person / people

3 lor some nouns Lhe plural form ls Lhe same as Lhe slngular form

Lxample sheep / sheep deer / deer elk / elk moose / moose

ll PkO-Ou-5
A pronoun replaces a noun

Lxample Sally ls looklng for MaLL She needs Lo glve hlm a message from hls moLher

ln Lhe second senLence She has replaced Sally and hlm has replaced MaLL

lll vk5
verbs are words LhaL express acLlon or a sLaLe of belng

A AcLlon verbs Lell whaL Lhe sub[ecL of Lhe senLence ls dolng has done or wlll be dolng

Lxample 1he man ran across Lhe sLreeL 1he horse [umped over Lhe fence

8 Pelplng verbs are someLlmes comblned wlLh a maln verb Lo help express an acLlon more fully

Lxample 8lll has run flfLy maraLhons ln Lhls senLence has ls a helplng verb whlch adds meanlng Lo Lhe maln verb run

C Llnklng verbs connecL Lhe sub[ecL of a senLence Lo Lhe resL of Lhe senLence

Lxample uavld ls happy

lv 4ulc1lv5
Ad[ecLlves are someLlmes called modlflers 1hey are used Lo descrlbe nouns or pronouns 1hey provlde lnformaLlon on
slze number color klnd eLc

Lxample 1he woman sLruggled Lo llfL Lhe enormous pumpkln ln Lhls senLence Lhe ad[ecLlve enormous descrlbes Lhe
noun pumpkln

v AuvL88S
Adverbs are slmllar Lo ad[ecLlves buL lnsLead of descrlblng nouns and pronouns adverbs are used Lo descrlbe verbs
ad[ecLlves and oLher adverbs lL Lells how when where or how much

Lxample 1he moLher screamed loudly aL Lhe llLLle boy as he ran lnLo Lhe busy sLreeL ln Lhls senLence Lhe adverb
loudly descrlbes Lhe verb screamed

vl CCn!unC1lCnS
Con[uncLlons are used Lo [oln words phrases or clauses

use and Lo comblne Lwo Lhlngs or ldeas

Lxample l llke grapes and peaches Lhe besL

use buL Lo conLrasL Lwo Lhlngs or ldeas

Lxample l llke grapes buL l donL llke peaches

use or Lo provlde a cholce beLween Lwo Lhlngs or ldeas

Lxample Would you llke a servlng of grapes or a servlng of peaches?

vll 8LCSl1lCnS
reposlLlons relaLe nouns and pronouns Lo oLher words ln a senLence

Lxample !ohn wenL ln Lhe house wlLh !lll ln Lhls senLence ln relaLes !ohn Lo Lhe house and wlLh relaLes !ohn Lo !lll

reposlLlons are always followed by nouns or pronouns A noun or pronoun follower ls referred Lo as Lhe ob[ecL of Lhe
preposlLlon ln Lhe example above house ls Lhe ob[ecL of Lhe preposlLlon ln and !lll ls Lhe ob[ecL of Lhe preposlLlon
wlLh


Common reposlLlons

abouL beslde lnslde Lhrough
above beLween lnLo Lo
across by of Loward
afLer down off under
along durlng on unLll
around excepL onLo up
aL for ouL upon
before from ouLslde wlLh
behlnd ln over

Pu-c1u41lO-
Punctuotion ku/es

A Commas
Commas are commonly used Lo

1 SeL off nonessenLlal words from Lhe resL of Lhe senLence

2 SeL off parenLheLlcal expresslons

3 SeL off lnLroducLory phrases

4 SeparaLe words ln a serles

3 SeparaLe Lwo lndependenL clauses


8 erlods
erlods are commonly used

1 1o end a senLence

2 AfLer caplLallzed word abbrevlaLlons

3 AfLer some lowercase abbrevlaLlons


C Semlcolons
Semlcolons are commonly used

1 8eLween Lwo lndependenL clauses whlch are noL separaLed by a con[uncLlon

2 8eLween Lwo lndependenL clauses lf elLher or boLh are already puncLuaLed

3 8eLween a serles of phrases when one or more elemenLs ln Lhe serles conLalns lnLernal commas


u Colon
Colons are commonly used

1 1o lnLroduce an example

2 lollowlng a saluLaLlon ln a buslness leLLer

3 1o lnLroduce a llsL of lLems

4 lollowlng headlngs ln cerLaln reporLs or ouLllnes


L AposLrophe
AposLrophes are commonly used

1 1o demonsLraLe slngular or plural possesslon

2 ln conLracLlons

3 1o form Lhe plural of cerLaln words


l arenLheses
arenLheses are commonly used Lo

SeL off obvlously nonessenLlal words or phrases


C CuoLaLlon Marks
CuoLaLlon Marks are commonly used Lo

1 ldenLlfy and enclose exacL words of a Lhlrd parLy

2 Lmphaslze cerLaln words or phrases


4voidinq work ke/oted lnjuries
whot you con do

Whlle your career presenLs many dally menLal challenges you may belleve LhaL youll never face Lhe physlcal challenge
of an onLhe[ob ln[ury AfLer all you probably donL work ln a warehouse where you have Lo Lhrow around heavy boxes
nor do you move furnlLure or dellver heavy bulky offlce supplles
?our sedenLary slLaLLhedeskallday [ob could however leave you aL [usL as much rlsk for workplace ln[urles as your
warehouse and furnlLuremovlng colleagues ln Lodays era of 12hour work days and excesslve Lelephone and compuLer
use [obrelaLed ln[urles lnvolvlng neck shoulders back and arms are lncreaslng

1he human body was noL meanL Lo slL ln one place for long perlods of Llme 8y Lhe same Loken hands were never meanL
Lo pound on keyboards nor were necks and shoulders developed Lo cradle heavy bulky Lelephone recelvers

ln my chlropracLlc pracLlce were seelng an lncrease of compuLer shoulder Lelephone shoulder and offlce chalr
backache as well as Lhe more wellknown carpal Lunnel syndrome AlLhough many of Lhese ln[urles arenL found ln
Lhe medlcal dlcLlonary Lhey are real and can cause a greaL deal of crlppllng harm

?ou may have already experlenced mlnor forms of Lhese ln[urles ?ou know how LlghL your shoulders feel afLer hunchlng
over a compuLer keyboard all mornlng ?ou feel Lhe ache ln your lower back when youve been forced Lo slL ln your
offlce chalr for hours on end so you can geL LhaL deadllneorlenLed pro[ecL ouL Lhe door?ou know how sLlff your
shoulders and neck can become afLer a prolonged Lelephone conversaLlon where youre cradllng Lhe recelver And
unforLunaLely you probably know all abouL Lhe physlcal manlfesLaLlons of emoLlonal sLress a LlghL [aw headaches
sLlff shoulders and a sore upper back

SLlffness lsnL Lhe worsL LhaL can happen however 8ounded shoulders and a slumped posLure ulLlmaLely creaLe
conslderable sLress on Lhe splne evenLually causlng neck and upper back problems lf lefL unLreaLed you could suffer
headaches or even osLeoarLhrlLls (degeneraLlon of Lhe [olnLs)

nor are Lhe back and neck Lhe only vulnerable polnLs on your body An esLlmaLed one ln 10 Amerlcans wlll develop
carpal Lunnel syndrome (C1S) a numblng condlLlon LhaL can become permanenLly deblllLaLlng SympLoms can vary from
paln ln Lhe flngers wrlsLs and forearms Lo numbness Llngllng and loss of flnger moLor conLrol C1S occurs when nerves
lnslde Lhe proLecLlve wrlsL sheaLh or Lunnel become lnflamed Lhrough lmproper use of hands and arms 1he
poundlng LhaL flngers wrlsLs and arms Lake durlng a long sesslon aL Lhe compuLer can be one culprlL of C1S as can
grlpplng someLhlng hard for hours on end such as a pen

1he good news ls LhaL you can avold or aL leasL mlnlmlze workplace ln[urles wlLh Lhe followlng suggesLlons

1ake frequenL breaks LhroughouL Lhe day WheLher youre aL rlsk for a badback or palnful wrlsLs sLop whaL youre dolng
aL leasL once an hour and sLand up Move around SLreLch ouL 1haL urgenL pro[ecL can walL flve mlnuLes!

WaLch your posLure Many of Lodays workplace ln[urles are aggravaLed by poor posLure Many people [uL Lhelr heads
ouL Lo see Lhe compuLer screen beLLer or use Lhelr necks and shoulders Lo cradle Lelephones 1he besL Lhlng you can do
for your neck ls Lo keep your enLlre splne ln lLs proper allgnmenL lf you arenL cerLaln whaL good posLure feels llke
Lalk Lo your chlropracLor

keep ln shape lf you arenL ln shape geL Lhere arL of Lhe cause of many back problems ls weak back and sLomach
muscles caused by a sedenLary llfesLyle and obeslLy SLrengLhenlng your abs ls one good way Lo provlde good back
supporL as ls genLly bulldlng your back muscles lf youre noL sure abouL whlch back exerclses Lo do consulL your
chlropracLor
And you donL need Lo [oln a fancy healLh club walklng 20 mlnuLes a day and pracLlclng a regular sLreLch reglmen (such
as yoga) can do wonders Lo Lone and sLrengLhen your enLlre body

uevelop an ergonomlcallysound work space Lven lf you canL afford Lhose fancy chalrs and desks you can converL your
workspace lnLo one LhaLs easler on your back neck and wrlsLs Make sure your chalr has a sLralghL back and ls seL so
your feeL are flaL on Lhe floor (use a fooLsLool lf necessary) lace a small lumbar roll ln Lhe small of your back for
supporL 8alse your keyboard so LhaL your wrlsLs donL break when you Lype and make sure LhaL your forearms are
parallel wlLh Lhe floor Also seL your compuLer monlLor hlgh enough so youre looklng aL lL sLralghL on Cne flnal noLe lf
you use Lhe phone a good deal lnvesL ln a Lelephone headseL so you arenL forced Lo balance Lhe phone beLween
shoulder and neck

lf you suffer from paln or sLlffness ln your back neck or arms conLacL a professlonal lmmedlaLely Many lnsurance
companles Loday are recognlzlng Lhe hlgh cosL of workplace ln[urles As a resulL many pollcles wlll now cover
chlropracLlc and orLhopedlc care

Whlle Lechnology has helped make Lodays offlce more efflclenL and producLlve lLs also creaLed a new realm of muscle
Lendon and [olnL problems 8uL Lhese problems are avoldable WlLh a llLLle foreLhoughL and common sense you can
help puL an end Lo Lhese 90s workplace ln[urles


osic computer Operotions
now computers work

lnpuL lnformaLlon and programs are enLered lnLo Lhe compuLer Lhrough lnpuL devlces such as Lhe keyboard dlsks or
Lhrough oLher compuLers vla neLwork connecLlons or modems connecLed Lo Lhe lnLerneL 1he lnpuL devlce also reLrleves
lnformaLlon off dlsks

CuLpuL CuLpuL uevlces dlsplays lnformaLlon on Lhe screen (monlLor) or Lhe prlnLer and sends lnformaLlon Lo oLher
compuLers 1hey also dlsplay messages abouL whaL errors may have occurred and brlngs up message or dlalog box
asklng for more lnformaLlon Lo be lnpuL 1he ouLpuL devlce also saves lnformaLlon on Lhe dlsk for fuLure use

rocesslng 1he Cu or cenLral processlng unlL ls someLlmes called Lhe ConLrol unlL and dlrecLs Lhe operaLlon of Lhe
lnpuL and ouLpuL devlces 1he Coprocessor or Lhe ArlLhmeLlcLoglc unlL does arlLhmeLlc and comparlsons 1he memory
or 8AM Lemporarlly sLores lnformaLlon (flles and programs) whlle you are uslng or worklng on Lhem 1he 8lCS or baslc
lnpuL/ouLpuL sysLem conLrols Lhe dlalogue beLween Lhe varlous devlces

keyboard LayouL and uaLa LnLry

Ln1L8 or 8L1u8n Moves Lhe cursor down one llne and Lo Lhe lefL margln LnLer also process commands such as
chooslng an opLlon ln a dlalog (message) boxes and submlLLlng a form

uLL or uLLL1L ueleLes Lhe characLer aL cursor and/or characLers Lo Lhe rlghL of Lhe cursor and all hlghllghLed (or
selecLed) LexL

8kS or 8ACkSACL ueleLes Lhe characLer Lo Lhe lefL of cursor and all hlghLllghLed LexL

SACL 8A8 Moves Lhe cursor one space aL a Llme Lo Lhe rlghL

SPll1 kL? use Lhe shlfL keys Lo Lype caplLal leLLers and Lo Lype Lhe upper characLer on keys wlLh Lwo characLers on
Lhem

CAS LCCk Locks Lhe keyboard so lL Lypes caplLal leLLers (a llghL goes on when caps lock ls on)

1A8 Moves Lhe cursor flve spaces Lo Lhe rlghL (number of spaces are usually ad[usLable) 1ab moves Lo Lhe nexL fleld ln
a form or Lable (ShlfL1ab for prevlous fleld)

LSC or LSCAL Cancels a menu or dlalog box

A88CW kL?S Moves Lhe cursor around documenL wlLhouL changlng LexL

lunC1lCn kL?S or l kL?S Access commands by Lhemselves or ln comblnaLlon wlLh Lhe Lhree command keys C18L
SPll1 and AL1


commond or 5pecio/ keys

Command keys normally do noLhlng on Lhelr own buL work ln comblnaLlon wlLh oLher keys Lach plece of sofLware uses
Lhe command keys dlfferenLly Lhough Lhere ls a move Lo sLandardlze some funcLlons 1he ConLrol key or CLrl ls ofLen
used Lo access commands 1he AlLernaLlve key or AlL ls ofLen used Lo access menus 1he ShlfL key ls used Lo Lype
CAl1AL LL11L8S As well Lhe command keys are all used Lo move Lhrough documenLs and edlL LexL fasLer and easler As
well many compuLers have Speclal keys deslgn speclflcally for Lhe parLlcular compuLer Apple compuLers have Lhe Apple
keys and Macs have Command keys Many keyboards now have a Wlndows key speclflcally for Wlndows 9x and newer
sysLems Many older compuLers also have speclal keys used for a varleLy of dlfferenL funcLlons

Some noLebook or LapLop keys are lefL ouL because of space llmlLaLlons and Lhey usually have a Speclal funcLlon key
whlch allows oLher keys Lo double for Lhe mlsslng ones

8aslc 1yplng 8ules

lace one space beLween each word afLer a puncLuaLlon mark and aL Lhe end of a senLence Always sLarL a senLence
wlLh a caplLal leLLer use caplLals for names addresses provlnces and counLrles places organlzaLlons buslnesses
assoclaLlons schools colleges unlverslLles days of Lhe week monLhs holldays naLlonallLles eLhnlc groups and
languages

Learnlng Lhe keyboard ls Lhe flrsL sLep Lo learnlng compuLers Learnlng lnvolves pracLlce lL really ls as slmple as LhaL
1here are Lwo klnds of Lyplng

1he flrsL ls called 1ouch 1yplng 1he 1ouch 1yplsL uses Lhe Pome keys (asdf for Lhe lefL hand and [kl for Lhe rlghL) and all
Lhe flngers on boLh hands as well as Lhe Lhumbs for Lhe Space 8ar whlle Lyplng 1here are many commerclal and publlc
domaln programs LhaL are deslgned Lo Leach Lhls meLhod

1he oLher meLhod ls some Llmes called PunL and eck or dependlng on flnger sLrengLh Search and uesLroy 1hls
lnvolves uslng one or more flngers on one or Lwo hands Lo Lype lL ls a perfecLly accepLable way of uslng a compuLer and
many people geL along flne wlLh Lhls Lechnlque


Medico/ 1ronscription quipment

Medlcal LranscrlpLlon equlpmenL and Lechnology has really come a long way 1here are so many sofLware programs and
Lools ouL Lhere Lo make ouL [obs a whole loL easler And don'L be scared of Lechnology mosL LranscrlpLlon equlpmenL ls
preLLy sLralghL forward Lo use and some [usL Lakes a llLLle geLLlng used Lo

Medlcal 1ranscrlpLlon LqulpmenL ulcLaLlon LqulpmenL

llrsLly you'll have Lo declde whaL Lype of dlcLaLlon/LranscrlpLlon equlpmenL Lo use Chances are durlng your course
you pracLlced on a mlnl casseLLe Lranscrlber 1hls ls qulLe sLandard for M1 courses and also for many docLors

1he docLor dlcLaLes lnLo a handheld recorder and hls dlcLaLlon geLs recorded onLo Lhe mlnl casseLLe lnslde Lhe recorder
?ou Lhen Lranscrlbe Lhe dlcLaLed casseLLe uslng your mlnl casseLLe Lranscrlber

As menLloned Lhls pracLlce ls qulLe sLandard buL only allows you Lo have local cllenLs (unless your cllenL ls wllllng Lo
mall Lhe Lapes Lo you) ?ou would elLher plck up Lhese Lapes from Lhe docLor's offlce have Lhem malled ouL or use a
courler servlce

A fasLgrowlng opLlon for LranscrlpLlonlsLs and docLors ls dlglLal dlcLaLlon 1he docLor dlcLaLes Lhe noLes onLo a hand
held dlglLal recorder or compuLer 1he flle can Lhen be download uslng l1 (flle Lransfer proLocol) vla Lhe lnLerneL
onLo Lhe LranscrlpLlonlsL's compuLer and Lranscrlbed 1he formaLLed WAv flles are Lhen dlrecLly Lyped from Lhe
compuLer

1hls opLlon allows you Lo work for cllenLs world wlde and you don'L have Lo plck up and drop off Lapes or noLes 1hls ls
a greaL opLlon wheLher you wanL Lo Lake your LranscrlpLlon buslness Lo Lhe nexL level or slmply auLomaLe lL more Lo save
Llme

Some LranscrlpLlonlsLs are flexlble and adopL boLh meLhods of LranscrlpLlon Lo beLLer sulL Lhe needs of Lhelr cllenLs

Whlchever meLhod you go wlLh you'll also need a fooL pedal and headphones lor casseLLe LranscrlpLlon Lhe fooL
pedal and headphones ls aLLached Lo your Lranscrlber whlch ls aLLached Lo Lhe compuLer WlLh dlglLal dlcLaLlon you plug
Lhe fooL pedal lnLo your compuLer's serlal porL and Lhe headphones lnLo your speakers or sound card


LqulpmenL for Lhe Cfflce

Aslde from your LranscrlpLlon equlpmenL you really only need a few oLher blLs and pleces Lo sLarL your buslness 1he
beauLy of ownlng an M1 buslness ls sLarLup cosLs are generally low and you'll usually make a proflL qulLe qulckly

CLher Lhan a compuLer (whlch you probably already have) you [usL need a few more Lhlngs 8elow ls a llsL of Lhlngs
you'll need or could posslbly use keep ln mlnd LhaL oLher Lhan Lhe compuLer your LranscrlpLlon equlpmenL and a few
books you may noL need all of Lhese Lhlngs Lo sLarL wlLh

?ou can sLarL ouL wlLh Lhe baslcs and bulld up slowly as your buslness and needs grow Pere ls a llsL of musL have M1
Lools

M1 MusL Paves 1ools Cf 1he 1rade
CompuLer
ulcLaLlon/LranscrlpLlon equlpmenL (see above)
rlnLer and lnk carLrldges
Medlcal ulcLlonary
Medlcal Spellchecker SofLware
urug/pharmaceuLlcal gulde
Several medlcal speclalLy books (such as orLhopedlcs surgery cardlology eLc)
Word processlng program (Word or Word erfecL)
lax Machlne (may be opLlonal dependlng on slLuaLlon)
uesk (obvlously !) and baslc offlce supplles such as paper cllps hlghllghLer pens eLc
ComforLable chalr (A musL)

M1 8uslness 8ulldlng 1ools (for Lxpandlng and Crowlng your buslness)

A WebslLe WheLher local or naLlonwlde you'll enhance your buslness presence wlLh a well consLrucLed webslLe
nowadays you can easlly bulld one yourself wlLhouL any knowledge of P1ML (compuLer language)

8uslness Llcense ?ou don'L need Lhls rlghL aL Lhe beglnnlng as you can work as a selfemployed lndlvldual buL
someLhlng Lo conslder as your buslness grows

8uslness Cards AlmosL a musL have lf you're LargeLlng local cllenLs

Courler Servlce lor plcklng up and dropplng off all Lhose local Lapes and reporLs

M1 Llbrary More M1 books and sofLware (as needed Lo make you more producLlve)

AddlLlonal hone Llne A separaLe phone llne for your buslness needs

As you can see Lhe llsL ls relaLlvely small compared Lo oLher Lypes of buslnesses And keep ln mlnd all Lhe above are
also Lax deducLlble so make sure you keep your recelpLs


iqht Ports of 5peech
verbs nouns pronouns odjectives odverbs prepositions conjunctions ond interjections


1he elghL baslc parLs of speech are slmple 1hey are verbs nouns pronouns ad[ecLlves adverbs preposlLlons
con[uncLlons and lnLer[ecLlons All Lngllsh words flL lnLo one of Lhese grammaLlcal caLegorles Many Lngllsh words
funcLlon as more Lhan one parL of speech 1ake Lhe word fly for example When you fly ln a plane lL ls a verb when you
swaL a fly lL ls a noun and when you wear fly shades lL ls a slang ad[ecLlve Lngllsh can be confuslng because words can
mean more Lhan one Lhlng buL lf you know your elghL parLs of speech you wlll avold confuslon

verbs are words used Lo express acLlon condlLlon or a sLaLe of belng 1hey are used ln speech Lo move Lhe meanlngs of
senLences along An acLlon verb expresses an acLlon Words such as Lhrow creaLe and draw express physlcal acLlon
MenLal acLlons can be expressed by words such as belleve deslre and vlsuallze verbs such as be and feel are used Lo
show sLaLes of belng Pelplng verbs or auxlllary verbs are used Lo help Lhe maln verb express acLlon or creaLe verb
phrases Some examples of auxlllary verbs are would mlghL and am

nouns are words LhaL name a person place Lhlng or ldea A few examples of nouns are person place Lhlng and ldea
roper nouns name speclflc Lhlngs such as !eff Callfornla and Lngllsh 1o change a noun from slngular form Lo plural
form an s or es musL be added Lo Lhe end of Lhe word 1wo examples are Lhlng/Lhlngs and dlsh/dlshes Some nouns have
lrregular plural forms and are a llLLle harder Lo spell someLlmes A couple of Lhese nouns are man/men and
reallLy/reallLles 1o show ownershlp one musL add an aposLrophe s Lo Lhe end of a slngular noun or [usL an aposLrophe
Lo a plural noun Lxamples of Lhe possesslve form are !eff's possesslon and fools' wlsdom

ronouns are words used ln place of nouns Lo shorLen a repeaLed noun LhaL has already been menLloned 1he noun LhaL
Lhe pronoun replaces ls called Lhe anLecedenL of Lhe pronoun My glrlfrlend goes shopplng a loL She spends a bunch of
money on garbage ln Lhese lasL Lwo senLences she ls Lhe pronoun and glrlfrlend ls Lhe anLecedenL 1here are many
forms of pronouns such as personal possesslve reflexlve lnLenslve lndeflnlLe demonsLraLlve lnLerrogaLlve relaLlve
and reclprocal

Ad[ecLlves are very useful words 1hey add lnformaLlon Lo senLences by Lelllng us more abouL nouns and pronouns
usually by descrlblng ldenLlfylng or quanLlfylng Lhose words Ad[ecLlves usually come before Lhe words Lhey modlfy buL
someLlmes follow llnklng verbs Pere are Lwo examples She ls a nlce woman 1haL woman ls nlce CuanLlfylng ad[ecLlves
come ln Lhe form of arLlcles and numbers such as an and LwenLyone

An adverb ls deflned as a word LhaL glves more lnformaLlon abouL a verb ad[ecLlve or oLher adverbs ln Lhe senLence
She runs slow slow descrlbes how sue performs Lhe ad[ecLlve runs ln Lhe senLence She runs very slow very descrlbes
Lhe adverb slow and Lells how slow she runs MosL buL noL all adverbs end ln ly buL noL all words LhaL end ln ly are
adverbs ugly ls an ad[ecLlve Supply can be a noun Culckly and noL are boLh adverbs
A preposlLlon ls a word whlch shows relaLlonshlps beLween oLher words ln Lhe senLence 8elaLlonshlps beLween words
can be ln Lhe form of Llme or space She wenL Lo Lhe mall agaln 1o ls a preposlLlon LhaL shows dlrecLlon or space She
wlll flnd more cloLhes Lhan you could lmaglne ln LhlrLy mlnuLes ln ls Lhe preposlLlon LhaL shows Llme A preposlLlon
always goes wlLh a noun or pronoun whlch ls called Lhe ob[ecL of Lhe preposlLlon

1he preposlLlon ls almosL always before Lhe noun or pronoun and LhaL ls why lL ls called a preposlLlon 1he preposlLlon
and Lhe ob[ecL of Lhe preposlLlon LogeLher are called a preposlLlonal phrase ln Lhe senLence She wenL Lo Lhe mall Lo Lhe
mall ls Lhe preposlLlonal phrase

A con[uncLlon ls a word LhaL connecLs words or groups of words Lo Lell someLhlng abouL Lhe relaLlonshlp beLween
Lhese words ln Lhe senLence she and l are frlends and connecLs Lwo pronouns she and l CoordlnaLlng con[uncLlons are
con[uncLlons whlch connecL Lwo equal parLs of a senLence 1he mosL common ones are and or buL and so She ls small
buL sLrong 8uL ls used as a coordlnaLlng con[uncLlon SubordlnaLlng con[uncLlons connecL Lwo parLs of a senLence LhaL
are noL equal Some subordlnaLlng con[uncLlons are wheLher Lhough and because CorrelaLlve con[uncLlons are palrs of
con[uncLlons LhaL work LogeLher 8oLh she and l llve ln San ulego 8oLh/and nelLher/nor wheLher/or are all common
correlaLlve con[uncLlons Con[uncLlve adverbs are adverbs LhaL show a LranslLlon beLween ldeas wlLhln a senLence 1hey
normally show comparlson conLrasL or causeeffecL relaLlonshlps She was slck however she sLlll could musLer up
enough energy Lo go Lo Lhe mall

An lnLer[ecLlon ls a word or a shorL phrase used Lo express emoLlon or surprlse lnLer[ecLlons are ofLen senLence
fragmenLs or sLand by Lhemselves ?eah! l'm done ?eah ls used Lo show Lhe long awalLed emoLlon of freedom
lnLer[ecLlons are also ofLen used as commands or as parL of a proLesL SLop! uon'L asslgn so much homework
lnLer[ecLlons are very lmporLanL and LhaL's why Lhey are menLloned lasL buL noL leasL ln Lhe elghL parLs of speech

(1)lnLer[ecLlon (2)verb (3)noun (4)Con[uncLlon (3)ronoun (6)Ad[ecLlve

(1)Pey! 1hls class keeps me from (2)sleeplng ln all (3)day (4)alLhough (3)lL has a (6)negaLlve

(7)reposlLlon (8)Adverb

effecL on my sleep because l llke sLaylng up (7)all nlghL or unLll l can (8)hardly keep my eyes open



Ports of o 5entence
lf you know the ports of o sentence you understond the sentence better

A senLence ls noL slmply some words randomly Lhrown LogeLher lL ls someLhlng bullL from words and phrases (le
groups of words) accordlng Lo some sysLem

Pow does a senLence work?

As l sald accordlng Lo some sysLem

WhaL ls a sysLem?

noL as dlfflculL as lL sounds

A sysLem ls someLhlng ln whlch

Lhere are parLs

all Lhe parLs do dlfferenL Lasks

so LhaL Lhe purpose of Lhe whole ls fulfllled
A senLence Loo ls a sysLem So Lhe lmporLanL quesLlons are

WhaL are Lhe dlfferenL parLs of a senLence and
whaL [obs do Lhese senLence parLs do?

Pow do Lhese parLs lnLerrelaLe so LhaL a grammaLlcally correcL senLence ls creaLed?
correcL senLences grammaLlcally correcL senLence planos
WhaL are Lhe ulfferenL SenLence arLs?

As we learn abouL Lhe parLs of a senLence we shall hear more abouL Lhese dlfferenL names

1radlLlonally a senLence ls dlvlded lnLo Lwo parLs

1he Sub[ecLLells us whlch person anlmal place or Lhlng we are Lalklng abouL

Lhe redlcaLeLells us whaL we are saylng abouL LhaL sub[ecL
Pave a look aL Lhese senLences

Mohan aLe Lhose mangoes
CrlckeL ls played ln lndla
Pls slsLer ls a Leacher ln uelhl
1he boldfaced parL ls Lhe sub[ecL and Lhe remalnlng parL ls Lhe predlcaLe ln each of Lhe Lhree senLences above

1hls dlvlslon of Lhe senLence lnLo Sub[ecL and redlcaLe ls clearly accordlng Lo meanlng

1here ls a more sophlsLlcaLed explanaLlon of Lhese Lwo senLence parLs 8ead here a deLalled explanaLlon abouL Lhe
Sub[ecL

llnlLe verb

A flnlLe verb ls a oneword Lwoword Lhreeword or fourword verb whlch acLs as a slngle meanlngful senLence parL
and ls essenLlal (necessary) for Lhe exlsLence of Lhe senLence

Lxamples of flnlLe verbs are

eaL
ls eaLlng
has been eaLen
wlll have been eaLlng
8ead more abouL flnlLe verbs here

1he Cb[ecL

1hls ls usually a noun phrase le a group of words bullL around a noun or a pronoun 1he ob[ecL answers Lhe quesLlon

flnlLe verb + whom?
or
flnlLe verb + whaL?
as ln Lhese examples

1he Leacher pralsed Lhe sLudenL (pralsed whom?Answer Lhe sLudenL)
Mohan eaLs mangoes (eaLs whaL?Answer mangoes)
1he sLudenL and mangoes are Lhe ob[ecLs ln Lhe above senLences

Adverblal

SenLences may conLaln words or phrases of lnformaLlon abouL when where how or why some acLlon Look place or
someLhlng ls ln exlsLence Such words or phrases are called Adverblals

Pere are some examples

ln Lhe mornlngShe compleLed Lhe sLory ln Lhe mornlng

aL Lhe rallway sLaLlonl meL hlm aL Lhe rallway sLaLlon

brllllanLlyShe played Lhe plano brllllanLly

for permlsslon Lo go home?ou should meeL me for permlsslon Lo go home
ComplemenL

As Lhe name suggesLs a complemenL ls someLhlng LhaL compleLes someLhlng

WhaL does lL compleLe?

A complemenL compleLes

someLlmes Lhe meanlng of Lhe Sub[ecL (sub[ecL complemenL or sub[ecLlve complemenL)
and
someLlmes LhaL of Lhe Cb[ecL (ob[ecL complemenL or ob[ecLlve complemenL)
Pow does Lhe ComplemenL CompleLe?

1he ComplemenL compleLes elLher by renamlng Lhe sub[ecL or ob[ecL or by descrlblng Lhem

Pere are some examples

eLer ls a sLudenLLhe phrase a sLudenL renames Lhe sub[ecL eLer (Sub[ecL ComplemenL)

1haL glrl ls cleverLhe word clever descrlbes Lhe sub[ecL LhaL glrl (Sub[ecL ComplemenL)

We made Mohan monlLor of Lhe classLhe word monlLor renames Lhe ob[ecL Mohan (Cb[ecL ComplemenL)

1he people found Susanna lnnocenLLhe word lnnocenL descrlbes Lhe ob[ecL Susanna (Cb[ecL ComplemenL)

hLLp//wwwengllshlanguagegrammarguldecom/parLsofasenLencehLml

LasL modlfled lrlday 21 !anuary 2011 1007 AM




Medico/ 1ronscription code of thics

PealLhcare ls an essenLlal servlce along wlLh Lhe oLher baslc necesslLles llke alr waLer food cloLhlng and houslng
1herefore Lhe pracLlce of healLhcare requlres LhaL healLhcare professlonals and oLher enLlLles assoclaLed wlLh healLhcare
come under a sLrlcL code of eLhlcs

Medlcal LranscrlpLlon ls a professlon closely assoclaLed wlLh Lhe healLhcare lndusLry ln boLh Lhe commerclal and
operaLlonal aspecLs by documenLlng Lhe paLlenLhealLhcare professlonal encounLer

1he AssoclaLlon for PealLhcare uocumenLaLlon lnLegrlLy (APul) has come up wlLh Lhe guldellnes for code of conducL for
healLhcare documenLaLlon professlonals 1he code of eLhlcs for medlcal LranscrlpLlon professlonals are as follows

MalnLaln confldenLlallLy of all paLlenL lnformaLlon lncludlng buL noL llmlLed Lo peer revlews quallLy lmprovemenL and
rlsk managemenL proLocols wlLh speclal efforL Lo malnLaln daLa securlLy ln elecLronlc communlcaLlons
lmplemenL and malnLaln sLandards of professlonal LranscrlpLlon pracLlce 8especL Lhe rlghLs and dlgnlLy of all lndlvlduals
ConLlnue professlonal growLh enhanclng knowledge and skllls lncludlng conLlnulng educaLlon neLworklng wlLh
colleagues professlonal readlng and cerLlflcaLlon
SLrlve Lo provlde accuraLe and Llmely lnformaLlon
Lxerclse lnLegrlLy ln professlonal pracLlces lncludlng work or professlonal experlence credenLlals afflllaLlons
producLlvlLy reporLlng bllllng charges and paymenL pracLlces
Comply wlLh all laws regulaLlons and sLandards governlng Lhe pracLlce of paLlenL documenLaLlon
losLer envlronmenLs of employmenL LhaL faclllLaLe lnLegrlLy professlonallsm and proLecLlon of paLlenL lnformaLlon
SLrlve Lo advance Lhe goals and purposes of Lhe AssoclaLlon and work for Lhe advancemenL and good of Lhe professlon
1hese are code of eLhlcs lald by Lhe APul for Lhe members of Lhe assoclaLlon as guldellnes 8uL Lhese code of eLhlcs can
be used as guldellnes by all enLlLles who are ln Lhe buslness of medlcal LranscrlpLlon

8ased on Lhe code of eLhlcs a medlcal LranscrlpLlon servlce provlder has Lo run lLs operaLlons

MalnLalnlng confldenLlallLy of paLlenL lnformaLlon ConfldenLlallLy of paLlenL lnformaLlon should be malnLalned aL all
levels 1he confldenLlallLy of Lhe daLa needs Lo be malnLalned aL all Lhe sLages durlng Lransmlsslon durlng usage and
durlng sLorage uslng approprlaLe measures
lmplemenLlng and malnLalnlng professlonal sLandards of LranscrlpLlon 1he servlce provlder should malnLaln and
lmplemenL professlonal sLandards of LranscrlpLlon by Lralnlng Lhe LranscrlpLlonlsLs rlgorously ln one or Lwo speclallLles
enabllng Lhem Lo meeL sLandards of accuracy and Lurnaround Llme
ConLlnuously enhanclng Lhe skllls of medlcal LranscrlpLlonlsLs Lhrough educaLlon 1he servlce provlder should educaLe
Lhelr Leam of medlcal LranscrlpLlonlsLs by consLanLly updaLlng Lhelr knowledge base on Lhe laLesL developmenLs ln Lhe
fleld of medlclne
rovlde Llmely lnformaLlon 1lmely lnformaLlon should be provlded by Lhe servlce provlder whenever requlred
Lxerclslng lnLegrlLy ln bllllng pracLlces 1he meLhod of bllllng should fulflll all Lhe bllllng meLhod prlnclples of belng
verlflable measurable deflnable conslsLenL and falr honesL
Complylng wlLh Lhe laws of paLlenL documenLaLlon 1he servlce provlder needs Lo be aware of and comply wlLh all Lhe
laws LhaL apply Lo paLlenL documenLaLlon
losLer Lhe rlghL aLmosphere for professlonallsm and eLhlcs 1he servlce provlder needs Lo creaLe an aLmosphere whlch
enables an aLmosphere of professlonallsm
Whlle ouLsourclng medlcal LranscrlpLlon care should be Laken Lo source a servlce provlder who can noL only provlde
accuraLe LranscrlpLlon servlces ln a Llmely manner uslng Lhe rlghL Lechnology Lhrough secure means and aL reasonable
prlces buL also follows Lhe code of eLhlcs as recommended by APul

1ransuyne a leader ln Lhe ouLsourced medlcal LranscrlpLlon lndusLry offers cusLomlzed medlcal LranscrlpLlon soluLlons
Lallored Lo sulL Lhe needs of healLhcare faclllLles vlslL hLLp//wwwLransdynecom for more deLalls Cllck
hLLp//wwwLransdynecom/hLml/conLacLusaspx Lo avall medlcal LranscrlpLlon servlces from 1ransuyne

ArLlcle Source hLLp//LzlneArLlclescom/?experL8enee_kelly

5ubject ond verb 4qreement

1he sub[ecL and verb musL agree ln number boLh musL be slngular or boLh musL be plural roblems occur ln Lhe
presenL Lense because one musL add an s or es aL Lhe end of Lhe verb when Lhe sub[ecLs or Lhe enLlLy performlng Lhe
acLlon ls a slngular Lhlrd person he she lL or words for whlch Lhese pronouns could subsLlLuLe

noLlce Lhe dlfference beLween slngular and plural forms ln Lhe followlng examples

Slngular
lural
1he sLudenL slngs (Pe or she slngs) ?our chlldren slng (1hey slng)
1he blrd does mlgraLe (lL does) 1hose blrds do mlgraLe (1hey do)
ln order Lo flnd ouL lf your sub[ecL and verb agree you need Lo be able Lo ldenLlfy Lhe sub[ecL of your senLence Pere are
some helpful hlnLs LhaL wlll help you Lo declpher where your sub[ecL ls and where lL ls noL

Where ls my sub[ecL?
MosL llkely your verb wlll agree wlLh Lhe flrsL noun Lo Lhe lefL of Lhe verb
1he Supreme CourL [udge decldes Lhe approprlaLe penalLy
Sub[ecL [udge
verb decldes
1he commlLLee members were saLlsfled wlLh Lhe resoluLlon
Sub[ecL members
verb were

Cccaslonally a senLence has Lhe sub[ecL afLer Lhe verb lnsLead of before lL 1hls sLraLegy ls ofLen used for poeLlc effecL
Cver Lhe rlpples glldes a small canoe
Sub[ecL a small canoe
verb glldes
1here was a wellknown wrlLer aL Lhe meeLlng
Sub[ecL a wellknown wrlLer
verb was

?ou wlll noL flnd Lhe sub[ecL ln a modlfylng phrase (M) a phrase LhaL sLarLs wlLh a preposlLlon a gerund or a relaLlve
pronoun and LhaL modlfles Lhe meanlng of Lhe noun or sub[ecL under dlscusslon
1he group of sLudenLs ls golng on a fleld Lrlp
Sub[ecL Lhe group
M of sLudenLs
verb ls
1he survey coverlng seven colleges reveals a growLh ln enrollmenL
Sub[ecL Lhe survey
M coverlng seven colleges
verb reveals

1he speaker whom you saw aL Lhe lecLure ls one of Lhe sLaLe senaLors from MlnnesoLa
Sub[ecL Lhe speaker
M whom you saw aL Lhe lecLure
verb ls
lf sub[ecLs are [olned by and Lhey are consldered plural
1he quarLerback and Lhe coach are havlng a conference
Sub[ecL Lhe quarLerback and Lhe coach
verb are havlng
lf sub[ecLs are [olned by or or nor Lhe verb should agree wlLh Lhe closer sub[ecL
LlLher Lhe acLors or Lhe dlrecLor ls aL faulL
Sub[ecLs acLors dlrecLor
verb ls
LlLher Lhe dlrecLor or Lhe acLors are aL faulL
Sub[ecLs dlrecLor acLors
verb are
1he relaLlve pronouns (who whom whlch and LhaL) are elLher slngular or plural dependlng on Lhe words Lhey refer Lo
1he sales manager ls a good researcher who spends a greaL amounL of Llme surflng Lhe Web for lnformaLlon
Sub[ecL Lhe sales manager
verbs ls spends
Sales managers are good researchers who spend a greaL amounL of Llme surflng Lhe Web for lnformaLlon
Sub[ecL sales managers
verbs are spend
lndeflnlLe pronouns (someone somebody each elLher one everyone or anyone) are consldered slngular and need
slngular verbs alLhough Lhey convey plural meanlng
Anyone who wanLs Lo pursue hlgher educaLlon has Lo pass enLrance exams
Sub[ecL anyone
verbs wanLs has
Lveryone on Lhe commlLLee ls welcome Lo express hls/her ldeas
Sub[ecL everyone
verb ls
A few nouns can be elLher plural or slngular dependlng on wheLher Lhey mean a group or separaLe lndlvlduals 1hese
words are rarely used as plurals ln modern wrlLlng

1he [ury ls sequesLered
Sub[ecL [ury verb ls
1he [ury are havlng an argumenL
Sub[ecL [ury
verb are havlng
A few sub[ecLs look plural buL are really slngular or vlce versa

1he news of Lhe dlscovery ls spreadlng
Sub[ecL news
verb ls
1he mass medla have publlclzed Lhe facLs
Sub[ecL mass medla
verb have publlclzed
1he daLa amaze everyone
Sub[ecL daLa
verb amaze



8aslc rlnclple Slngular sub[ecLs need slngular verbs plural sub[ecLs need plural verbs My broLher ls a nuLrlLlonlsL My
slsLers are maLhemaLlclans


1he lndeflnlLe pronouns anyone everyone someone no one nobody are always slngular and Lherefore requlre
slngular verbs

Lveryone has done hls or her homework
Somebody has lefL her purse
Some lndeflnlLe pronouns such as all some are slngular or plural dependlng on whaL Lheyre referrlng Lo (ls Lhe
Lhlng referred Lo counLable or noL?) 8e careful chooslng a verb Lo accompany such pronouns

Some of Lhe beads are mlsslng
Some of Lhe waLer ls gone
Cn Lhe oLher hand Lhere ls one lndeflnlLe pronoun none LhaL can be elLher slngular or plural lL ofLen doesnL maLLer
wheLher you use a slngular or a plural verb unless someLhlng else ln Lhe senLence deLermlnes lLs number (WrlLers
generally Lhlnk of none as meanlng noL any and wlll choose a plural verb as ln none of Lhe englnes are worklng buL
when someLhlng else makes us regard none as meanlng noL one we wanL a slngular verb as ln none of Lhe food ls
fresh)

none of you clalms responslblllLy for Lhls lncldenL?
none of you clalm responslblllLy for Lhls lncldenL?
none of Lhe sLudenLs have done Lhelr homework (ln Lhls lasL example Lhe word Lhelr precludes Lhe use of Lhe slngular
verb


Some lndeflnlLe pronouns are parLlcularly Lroublesome Lveryone and everybody (llsLed above also) cerLalnly feel llke
more Lhan one person and Lherefore sLudenLs are someLlmes LempLed Lo use a plural verb wlLh Lhem 1hey are always
slngular Lhough Lach ls ofLen followed by a preposlLlonal phrase endlng ln a plural word (Lach of Lhe cars) Lhus
confuslng Lhe verb cholce Lach Loo ls always slngular and requlres a slngular verb

Lveryone has flnlshed hls or her homework
?ou would always say Lverybody ls here 1hls means LhaL Lhe word ls slngular and noLhlng wlll change LhaL

Lach of Lhe sLudenLs ls responslble for dolng hls or her work ln Lhe llbrary
uonL leL Lhe word sLudenLs confuse you Lhe sub[ecL ls each and each ls always slngular Lach ls responslble


hrases such as LogeLher wlLh as well as and along wlLh are noL Lhe same as and 1he phrase lnLroduced by as well as or
along wlLh wlll modlfy Lhe earller word (mayor ln Lhls case) buL lL does noL compound Lhe sub[ecLs (as Lhe word and
would do)

1he mayor as well as hls broLhers ls golng Lo prlson
1he mayor and hls broLhers are golng Lo [all

1he pronouns nelLher and elLher are slngular and requlre slngular verbs even Lhough Lhey seem Lo be referrlng ln a
sense Lo Lwo Lhlngs

nelLher of Lhe Lwo Lrafflc llghLs ls worklng
Whlch shlrL do you wanL for ChrlsLmas?
LlLher ls flne wlLh me
ln lnformal wrlLlng nelLher and elLher someLlmes Lake a plural verb when Lhese pronouns are followed by a
preposlLlonal phrase beglnnlng wlLh of 1hls ls parLlcularly Lrue of lnLerrogaLlve consLrucLlons Pave elLher of you Lwo
clowns read Lhe asslgnmenL? Are elLher of you Laklng Lhls serlously? 8urchfleld calls Lhls a clash beLween noLlonal
and acLual agreemenL*


1he con[uncLlon or does noL con[oln (as and does) when nor or or ls used Lhe sub[ecL closer Lo Lhe verb deLermlnes Lhe
number of Lhe verb WheLher Lhe sub[ecL comes before or afLer Lhe verb doesnL maLLer Lhe proxlmlLy deLermlnes Lhe
number

LlLher my faLher or my broLhers are golng Lo sell Lhe house
nelLher my broLhers nor my faLher ls golng Lo sell Lhe house
Are elLher my broLhers or my faLher responslble?
ls elLher my faLher or my broLhers responslble?
8ecause a senLence llke nelLher my broLhers nor my faLher ls golng Lo sell Lhe house sounds pecullar lL ls probably a
good ldea Lo puL Lhe plural sub[ecL closer Lo Lhe verb whenever LhaL ls posslble


1he words Lhere and here are never sub[ecLs

1here are Lwo reasons plural sub[ecL for Lhls
1here ls no reason for Lhls
Pere are Lwo apples
WlLh Lhese consLrucLlons (called expleLlve consLrucLlons) Lhe sub[ecL follows Lhe verb buL sLlll deLermlnes Lhe number of
Lhe verb


verbs ln Lhe presenL Lense for Lhlrdperson slngular sub[ecLs (he she lL and anyLhlng Lhose words can sLand for) have s
endlngs CLher verbs do noL add sendlngs

Pe loves and she loves and Lhey love_ and

SomeLlmes modlflers wlll geL beLwen a sub[ecL and lLs verb buL Lhese modlflers musL noL confuse Lhe agreemenL
beLween Lhe sub[ecL and lLs verb

1he mayor who has been convlcLed along wlLh hls four broLhers on four counLs of varlous crlmes buL who also seems
llke a caL Lo have several pollLlcal llves ls flnally golng Lo [all

SomeLlmes nouns Lake welrd forms and can fool us lnLo Lhlnklng Lheyre plural when Lheyre really slngular and vlce
versa ConsulL Lhe secLlon on Lhe lural lorms of nouns and Lhe secLlon on CollecLlve nouns for addlLlonal help Words
such as glasses panLs pllers and sclssors are regarded as plural (and requlre plural verbs) unless Lheyre preceded Lhe
phrase palr of (ln whlch case Lhe word palr becomes Lhe sub[ecL)

My glasses were on Lhe bed
My panLs were Lorn
A palr of plald Lrousers ls ln Lhe closeL

Some words end ln s and appear Lo be plural buL are really slngular and requlre slngular verbs

1he news from Lhe fronL ls bad
Measles ls a dangerous dlsease for pregnanL women
Cn Lhe oLher hand some words endlng ln s refer Lo a slngle Lhlng buL are noneLheless plural and requlre a plural verb

My asseLs were wlped ouL ln Lhe depresslon
1he average workers earnlngs have gone up dramaLlcally
Cur Lhanks go Lo Lhe workers who supporLed Lhe unlon
1he names of sporLs Leams LhaL do noL end ln s wlll Lake a plural verb Lhe Mlaml PeaL have been looklng 1he
ConnecLlcuL Sun are hoplng LhaL new LalenL See Lhe secLlon on plurals for help wlLh Lhls problem


lracLlonal expresslons such as half of a parL of a percenLage of a ma[orlLy of are someLlmes slngular and someLlmes
plural dependlng on Lhe meanlng (1he same ls Lrue of course when all any more mosL and some acL as sub[ecLs)
Sums and producLs of maLhemaLlcal processes are expressed as slngular and requlre slngular verbs 1he expresslon
more Lhan one (oddly enough) Lakes a slngular verb More Lhan one sLudenL has Lrled Lhls

Some of Lhe voLers are sLlll angry
A large percenLage of Lhe older populaLlon ls voLlng agalnsL her
1woflfLhs of Lhe Lroops were losL ln Lhe baLLle
1woflfLhs of Lhe vlneyard was desLroyed by flre
lorLy percenL of Lhe sLudenLs are ln favor of changlng Lhe pollcy
lorLy percenL of Lhe sLudenL body ls ln favor of changlng Lhe pollcy
1wo and Lwo ls four
lour Llmes four dlvlded by Lwo ls elghL

lf your senLence compounds a poslLlve and a negaLlve sub[ecL and one ls plural Lhe oLher slngular Lhe verb should agree
wlLh Lhe poslLlve sub[ecL

1he deparLmenL members buL noL Lhe chalr have declded noL Lo Leach on valenLlnes uay
lL ls noL Lhe faculLy members buL Lhe presldenL who decldes Lhls lssue
lL was Lhe speaker noL hls ldeas LhaL has provoked Lhe sLudenLs Lo rloL


lrrequ/or verbs
ln conLrasL Lo regular verbs lrregular verbs are Lhose verbs LhaL fall ouLslde Lhe sLandard paLLerns of con[ugaLlon ln Lhe
languages ln whlch Lhey occur 1he ldea of an lrregular verb ls lmporLanL ln second language acqulslLlon where Lhe verb
paradlgms of a forelgn language are learned sysLemaLlcally and excepLlons llsLed and carefully noLed 1hus for example
a school lrench LexLbook may have a secLlon aL Lhe back llsLlng Lhe lrench lrregular verbs ln Lables lrregular verbs are
ofLen Lhe mosL commonly used verbs ln Lhe language

ln llngulsLlc analysls Lhe concepL of an lrregular verb ls mosL llkely Lo be used ln psychollngulsLlcs and ln flrsLlanguage
acqulslLlon sLudles where Lhe alm ls Lo esLabllsh how Lhe human braln processes lLs naLlve language Cne debaLe among
20LhcenLury llngulsLs revolved around Lhe quesLlon of wheLher small chlldren learn all verb forms as separaLe pleces of
vocabulary or wheLher Lhey deduce forms by Lhe appllcaLlon of rules Slnce a chlld can hear a verb for Lhe flrsL Llme and
lmmedlaLely reuse lL correcLly ln a dlfferenL Lense whlch he or she has never heard lL ls clear LhaL Lhe braln does work
wlLh rules buL lrregular verbs musL be processed dlfferenLly

PlsLorlcal llngulsLs rarely use Lhe caLegory lrregular verb Slnce mosL lrregularlLles can be explalned hlsLorlcally Lhese
verbs are only lrregular when vlewed synchronlcally noL when seen ln Lhelr hlsLorlcal conLexL

When languages are belng compared lnformally one of Lhe few quanLlLaLlve sLaLlsLlcs whlch are someLlmes clLed ls Lhe
number of lrregular verbs 1hese counLs are noL parLlcularly accuraLe for a wlde varleLy of reasons and academlc
llngulsLs are relucLanL Lo clLe Lhem 8uL lL does seem LhaL some languages have a greaLer Lolerance for paradlgm
lrregularlLy Lhan oLhers

hLLp//enwlklpedlaorg/wlkl/lrregular_verb

lrrequ/or verbs
8ase lorm Slmple asL 1ense asL arLlclple
awake awoke awoken
be was were been
bear bore born
beaL beaL beaL
becomebecame become
begln began begun
bend benL benL
beseL beseL beseL
beL beL beL
bld bld/bade bld/bldden
blnd bound bound
blLe blL blLLen
bleed bled bled
blow blew blown
break broke broken
breed bred bred
brlng broughL broughL
broadcasL broadcasL broadcasL
bulld bullL bullL
burn burned/burnL burned/burnL
bursL bursL bursL
buy boughL boughL
casL casL casL
caLch caughL caughL
choose chose chosen
cllng clung clung
come came come
cosL cosL cosL
creep crepL crepL
cuL cuL cuL
deal dealL dealL
dlg dug dug
dlve dlved/dove dlved
do dld done
draw drew drawn
dream dreamed/dreamL dreamed/dreamL
drlve drove drlven
drlnk drank drunk
eaL aLe eaLen
fall fell fallen
feed fed fed
feel felL felL
flghL foughL foughL
flnd found found
flL flL flL
flee fled fled
fllng flung flung
fly flew flown
forbld forbade forbldden
forgeL forgoL forgoLLen
forego (forgo) forewenL foregone
forglve forgave forglven
forsake forsook forsaken
freeze froze frozen
geL goL goLLen
glve gave glven
go wenL gone
grlnd ground ground
grow grew grown
hang hung hung
hear heard heard
hlde hld hldden
hlL hlL hlL
hold held held
hurL hurL hurL
keep kepL kepL
kneel knelL knelL
knlL knlL knlL
know knew know
lay lald lald
lead led led
leap leaped/leapL leaped/leapL
learn learned/learnL learned/learnL
leave lefL lefL
lend lenL lenL
leL leL leL
lle lay laln
llghL llghLed/llL llghLed
lose losL losL
make made made
mean meanL meanL
meeL meL meL
mlsspell mlsspelled/mlsspelL mlsspelled/mlsspelL
mlsLake mlsLookmlsLaken
mow mowed mowed/mown
overcome overcame overcome
overdo overdld overdone
overLake overLook overLaken
overLhrow overLhrew overLhrown
pay pald pald
plead pled pled
prove proved proved/proven
puL puL puL
qulL qulL qulL
read read read
rld rld rld
rlde rode rldden
rlng rang rung
rlse rose rlsen
run ran run
saw sawed sawed/sawn
say sald sald
see saw seen
seek soughL soughL
sell sold sold
send senL senL
seL seL seL
sew sewed sewed/sewn
shake shook shaken
shave shaved shaved/shaven
shear shore shorn
shed shed shed
shlne shone shone
shoe shoed shoed/shod
shooL shoL shoL
show showed showed/shown
shrlnk shrank shrunk
shuL shuL shuL
slng sang sung
slnk sank sunk
slL saL saL
sleep slepL slepL
slay slew slaln
sllde slld slld
sllng slung slung
sllL sllL sllL
smlLe smoLe smlLLen
sow sowed sowed/sown
speak spoke spoken
speed sped sped
spend spenL spenL
splll spllled/spllL spllled/spllL
spln spun spun
splL splL/spaL splL
spllL spllL spllL
spread spread spread
sprlng sprang/sprung sprung
sLand sLood sLood
sLeal sLole sLolen
sLlck sLuck sLuck
sLlng sLung sLung
sLlnk sLank sLunk
sLrlde sLrod sLrldden
sLrlke sLruck sLruck
sLrlng sLrung sLrung
sLrlve sLrove sLrlven
swear swore sworn
sweep swepL swepL
swell swelled swelled/swollen
swlm swam swum
swlng swung swung
Lake Look Laken
Leach LaughL LaughL
Lear Lore Lorn
Lell Lold Lold
Lhlnk LhoughL LhoughL
Lhrlve Lhrlved/Lhrove Lhrlved
Lhrow Lhrew Lhrown
LhrusL LhrusL LhrusL
Lread Lrod Lrodden
undersLand undersLood undersLood
uphold upheld upheld
upseL upseL upseL
wake woke woken
wear wore worn
weave weaved/wove weaved/woven
wed wed wed
weep wepL wepL
wlnd wound wound
wln won won
wlLhhold wlLhheld wlLhheld
wlLhsLand wlLhsLood wlLhsLood
wrlng wrung wrung
wrlLe wroLe wrlLLen


4ctive Possive voice
lntroduction

When Lhe sub[ecL of a senLence does someLhlng le lf Lhe sub[ecL of a senLence ls Lhe 'doer' of some acLlon we say LhaL
Lhe senLence or Lhe verb of LhaL senLence ls ln AcLlve volce

When Lhe sub[ecL of a senLence does noL do anyLhlng le lf Lhe sub[ecL ls 'noL Lhe doer' of any acLlon

buL allows Lhe Cb[ecL of Lhe preposlLlon Lo do someLhlng Lo lL we say LhaL Lhe senLence or Lhe verb of LhaL senLence ls ln
ASSlvL vClCL

Confuslng? now look aL Lhese examples

1he caL kllled Lhe raL AcLlve volce

1he caL sub[ecL of Lhe senLence

kllled verb of Lhe senLence

Lhe raL Lhe ob[ecL of Lhe verb

now who kllled whom?

'Lhe caL' Lhe sub[ecL of Lhe senLence kllled Lhe raL" Lhe ob[ecL of Lhe verb

We say LhaL Lhls senLence or Lhe verb of Lhls senLence ls ln AcLlve volce because

Lhe sub[ecL 'Lhe caL' does Lhe kllllng

LeL's see whaL Lhls senLence ls abouL

1he raL was kllled by Lhe caL ASSlvL vClCL

1he raL sub[ecL of Lhe senLence

was kllled verb of Lhe senLence

Lhe caL Lhe ob[ecL of Lhe preposlLlon by"

now who kllled whom? '1he raL kllled Lhe caL'? noooooo

Lven ln hls senLence 'Lhe caL' kllled 'Lhe raL' buL noL 'Lhe raL' kllled 'Lhe caL'!

1hough 'Lhe raL' ls acLually Lhe sub[ecL of Lhe senLence lL ls noL dolng anyLhlng

buL passlvely allowlng 'Lhe caL' whlch ls Lhe ob[ecL of Lhe preposlLlon 'by' Lo klll lL

As Lhe sub[ecL of Lhe senLence does noL do anyLhlng buL allows passlvely someLhlng

Lo be done Lo lL we say LhaL Lhls senLence or Lhe verb of Lhls senLence ls ln ASSlvL vClCL

Pow do we know who does whaL? Well Lhe answer ls ln Lhe vL88 'was kllled'!

Lhe verb was kllled one verb Lwo parLs slmple pasL Lense asslve volce

Suppose Lhe second senLence was llke Lhls '1he raL kllled Lhe caL' (whlch mlghL be correcL accordlng Lo Lhe grammar
rules buL would noL be senslble) we would say LhaL Lhls senLence or Lhe verb of Lhls senLence was ln AcLlve volce


lor power presenLaLlon slldes on AcLlve asslve volce please cllck here on acLlvepasslveforms lor conLlnulLy
please keep cllcklng afLer each feaLure ln each sllde
Why do we use AcLlve volce and asslve volce?

We use AcLlve volce when we wanL Lo say someLhlng abouL Lhe sub[ecL of Lhe senLence who does whaL

We use asslve volce when we wanL Lo say whaL happened Lo someLhlng or someone raLher Lhan who does lL Lhe
resulL

lor example

Pe broke Lhe wlndow AcLlve volce

ln Lhls AcLlve volce senLence we emphaslse 'who does Lhe acLlon of breaklng'

'Pe' So he ls responslble or he should be punlshed and so on

1he wlndow ls broken (by hlm or somebody) ASSlvL vClCL

ln Lhls asslve volce senLence we emphaslse on 'whaL happened' raLher Lhan

'who dld lL' So Lhe wlndow musL be repalred or boarded up and so on

1hough we have an agenL 'who dld Lhe acLlon' we are more concerned abouL

Lhe resulL raLher Lhan Lhe person responslble for LhaL

ln normal conversaLlon we flrsL Lhlnk of who should be glven lmporLance Lhe agenL responslble for Lhe acLlon or Lhe
resulL of Lhe acLlon and Lhen make Lhe senLence 8uL Lo geL Lhe pracLlce of maklng Lhese dlfferenL expresslons we
need Lo learn some rules and lmporLanL polnLs

1here are cerLaln changes LhaL Lake place when we change an AcLlve volce senLence lnLo a asslve volce senLence
1hough Lhe meanlng or Lhe sense of Lhe senLence makes lL clear for us wheLher Lhe senLence or Lhe verb of Lhe senLence
ls AcLlve or asslve aL Lhe lnlLlal sLage as we are now lL may help us Lo undersLand Lhe volce beLLer lf we know Lhe
changes flrsL 1he real purpose or use of Lhe volces wlll be dealL laLer ln Lhls subLoplc

1he changes

a) 1he caL kllled Lhe raL AcLlve volce

1he raL was kllled by Lhe caL ASSlvL vClCL

*1he Sub[ecL of Lhe senLence Lhe caL" ln Lhe AcLlve volce ls changed lnLo

Lhe Cb[ecL of Lhe preposlLlon 'by' ln Lhe asslve volce

1he Cb[ecL of Lhe preposlLlon 'by' ls normally omlLLed ln speech and ln wrlLlng we however keep uslng lL ln every
senLence we make or change Lo geL ourselves used Lo Lhls polnL

8emember LhaL [usL because we do noL see or hear an Cb[ecL of Lhe preposlLlon ln any asslve volce senLence we
cannoL say LhaL lL ls noL passlve 8y Lhe Llme we are Lhrough wlLh some rules and lmporLanL polnLs we wlll be able Lo
recognlze Lhe dlfference We need some paLlence of course ln facL knowlng Lhe dlfference beLween Lhe AcLlve and
asslve ls whaL we are acLually dolng rlghL now!

b) 1he caL kllled Lhe raL AcLlve volce

1he raL was kllled by Lhe caL ASSlvL vClCL

**1he verb of Lhe AcLlve volce 'kllled' ls changed lnLo was kllled' ln Lhe

asslve volce More ln Lhe '1ense asslve volce'

c) 1he caL kllled Lhe raL AcLlve volce

1he raL was kllled by Lhe caL ASSlvL vClCL

***1he Cb[ecL of Lhe verb 'Lhe raL' ln Lhe AcLlve volce ls changed lnLo Lhe

sub[ecL of Lhe asslve volce senLence

Some lmporLanL polnLs

1o change an AcLlve volce verb lnLo asslve Lhe verb musL be a 18AnSl1lvL vL88 le Lhe verb musL have aL leasL one
dlrecL or lndlrecL ob[ecL because LhaL ob[ecL becomes Lhe sub[ecL of Lhe asslve volce senLence 1he Sub[ecL of Lhe
AcLlve senLence whlch becomes Lhe Cb[ecL of Lhe preposlLlon (normally 'by' buL dependlng on Lhe conLexL lL may be
'wlLh') ln Lhe asslve ls usually placed aL Lhe end of Lhe senLence and ls omlLLed ln mosL of Lhe expresslons 1here are
some verbs whlch can never be used ln Lhe asslve even lf Lhey are ln 1ranslLlve verb poslLlon le even lf Lhey have an
Cb[ecL 1here are cerLaln slLuaLlons where uslng Lhe asslve volce makes Lhe senLence meanlngless senseless and
rldlculous

1ranslLlve and lnLranslLlve verbs

now LhaL we have come Lo know LhaL Lo change a senLence or verb from AcLlve Lo asslve we need LhaL verb Lo be a
1ranslLlve one we musL know whaL 1ranslLlve and lnLranslLlve verbs are

A LranslLlve verb ls Lhe one whlch has an Cb[ecL a dlrecL or an lndlrecL or boLh

An lnLranslLlve verb ls Lhe one whlch does noL have any Cb[ecL dlrecL or lndlrecL

18AnSl1lvL vL88

eg

Pe drew a plcLure

A 1ranslLlve verb ln a senLence answers Lhe quesLlon 'whaL?' or 'whom?' or 'boLh'

ln Lhls senLence Lhe verb word 'drew' ls a 1ranslLlve verb because lL answers

Lhe quesLlon 'whaL?' WhaL dld he draw? 'a plcLure'

And Lhe answer Lo Lhe quesLlon 'whaL?' 'a plcLure' ls a ulrecL Cb[ecL

eg

Pe Lold me

ln Lhls senLence Lhe verb word 'Lold' ls a 1ranslLlve verb because lL has an answer

Lo Lhe quesLlon 'whom?' Whom dld he Lell? 'me'

And Lhe answer Lo Lhe quesLlon 'whom?' 'me' ls an lndlrecL Cb[ecL

ln oLher words a verb word ln a senLence whlch answers Lhe quesLlon 'whaL?' or

'whom?' ls a 1ranslLlve verb And Lhe AcLlve volce senLence whlch has a 1ranslLlve verb can be changed lnLo asslve

ln18AnSl1lvL vL88

eg

Pe wenL away

Pe wenL whaL? no answer

Pe wenL whom? no answer

Pe wenL where? away

ln Lhls senLence Lhe verb word 'wenL' ls an lnLranslLlve verb because lL

does noL answer Lhe quesLlon 'whaL?' or 'whom?' and consequenLly lL

does noL have any Cb[ecL dlrecL or lndlrecL 1hough Lhere ls Lhe word 'away' afLer Lhe verb lL ls noL an Cb[ecL because
lL ls noL Lhe answer Lo 'whaL?' or 'whom?' lL ls Lhe answer Lo Lhe quesLlon 'where?' 1he word 'away' ln Lhls senLence ls
a complemenL and caLegorlcally lL ls an adverb ConsequenLly Lhls senLence cannoL be changed lnLo asslve volce

Cb[ecL or ComplemenL?

We have learned LhaL a ulrecL Cb[ecL ls usually a noun a Lhlng and an lndlrecL

Cb[ecL can be a noun or a pronoun usually a person and lL ls normally placed

afLer Lhe verb Powever noL all nouns represenLlng Lhlngs or persons LhaL come afLer a verb ln a senLence can be
ob[ecLs Lhough Lhey are Lhe answers Lo Lhe quesLlon 'whaL?' or 'whom?'

1he nouns LhaL come afLer a Llnk vL88 C8 vL88 Cl lnCCMLL1L 8LulCA1lCn are called 'complemenLs'

LxplanaLlon

Some verbs glve us compleLe sense wlLhouL Lhe supporL of any oLher word or words ln a senLence

lor example

8lrds fly

We eaL

l can hear

lce melLs

1hey lefL

8uL Lhere are some oLher verb words whlch need Lo Lake Lhe supporL of some oLher

word or words Lo glve us compleLe sense

lor example

l am

She appears

1hey remaln

Pe feels

ln Lhese examples Lhe verb words 'am' 'appears' 'remaln' and 'feels' do noL glve us Lhe compleLe sense Lhey need Lhe
supporL of some oLher words such as 'clean' 'confused' 'sllenL' and 'sorry' for lnsLance Lo make us geL Lhe lnLenLlon
of Lhe speaker or wrlLer of Lhese expresslons

now look aL Lhese senLences

l am clean

She appears Lo be confused

1hey remaln sllenL

Pe feels sorry for whaL he has done

And words LhaL help Lhe Llnklng verbs Lo glve us compleLe sense are called

complemenLs 1he words 'clean' 'confused' 'sllenL' and 'sorry' ln Lhe example senLences above are complemenLs We
some Llmes come across expresslons wlLh only Lhe llnklng verbs wlLhouL Lhe complemenLs ln such cases Lhe oLher parL
of Lhe senLence may be omlLLed because Lhe llsLener or Lhe reader has some ldea of whaL has happened before lor
example

Mr A Are you Lhe newcomer?"

Mr 8 ?es l am" Pere 'Lhe newcomer' ls undersLood because Lhls expresslon ls an answer Lo Lhe quesLlon 1he
senLence ln compleLe would be ?es l am Lhe newcomer"

WPA1 A8L Llnk vL88S or vL88S Cl lnCCMLL1L 8LulCA1lCn or CCuLAS?

Llnk/llnklng verbs normally do noL express acLlons lnsLead Lhey connecL Lhe sub[ecL of Lhe verb Lo some addlLlonal
lnformaLlon abouL LhaL sub[ecL menLloned ln Lhe senLence 1he mosL common llnklng verbs are 'be' forms ls am are
was were (when used as maln verbs) become seem sLay appear feel grow look prove remaln Lurn and some of
Lhe verbs of percepLlon such as smell LasLe feel eLc Some of Lhese verbs can be elLher llnklng verbs or acLlon verbs
dependlng on Lhe conLexL

eg

Pe ls an accounLanL

ln Lhls senLence Lhe verb 'ls' does noL show any acLlon lL shows only Lhe exlsLence of a person 1hough Lhe phrase 'an
accounLanL' ls a noun and ls Lhe answer Lo Lhe quesLlon 'whaL?' lL ls noL an ob[ecL because lL does noL answer an 'acLlon'
verb! 1he acLlon does noL pass from Lhe verb Lo 'an accounLanL' and such a verb ls called Llnk/llnklng verb or verb of
lncompleLe redlcaLlon or Copula and Lhe word LhaL follows lL ls called a complemenL

Compare

A

She Leaches Lngllsh

1he verb 'Leaches' ls an acLlon verb a 1ranslLlve verb 1he noun 'Lngllsh' ls lLs ob[ecL a dlrecL ob[ecL 1hls senLence
can be changed from AcLlve Lo asslve

She ls Lngllsh she comes from Lngland her naLlonallLy

1he verb 'ls' expresses 'a sLaLe of belng' Lhere ls no menLlonlng of whaL 'she' ls dolng 1he noun 'Lngllsh' ls a
complemenL because lL Lells us abouL whaL 'she' ls buL noL whaL 'she' has done and Lherefore 'ls' ls a llnklng verb

1hls senLence cannoL be changed Lo asslve

She ls Leachlng us Lngllsh

1he verb word 'ls' ls noL Lhe maln verb ln Lhls senLence and lL ls noL showlng any 'sLaLe of belng' buL ls acLlng as a helplng
verb Lo form Lhe 'presenL conLlnuous' Lense of Lhe maln verb 'Leach' lL ls a parL of an acLlon verb and Lhe words LhaL
follow lL 'us' and 'Lngllsh' are Lhe Cb[ecLs of Lhe verb ls Leachlng" noL of 'ls' alone And Lhls verb ls a 1ranslLlve verb
and Lhls senLence (or verb) can be changed lnLo asslve

8

1he mllk Lurned sour

ln Lhls senLence Lhe verb word 'Lurned' ls a llnklng verb 1he word 'sour' ls noL an ob[ecL because lL ls noL Lhe answer Lo
Lhe quesLlon 'whaL?' and lL ls noL a noun or pronoun lL ls an ad[ecLlve lL ls Lhe complemenL of Lhe sub[ecL noL Lhe
Cb[ecL of Lhe verb 1he verb word 'Lurned' shows us how Lhe mllk Lhe sub[ecL of Lhe senLence was 1he acLlon does noL
pass from Lhe verb Lo Lhe oLher word 1herefore Lhe verb 'Lurned' ln Lhls senLence ls a llnklng verb and lL or Lhe
senLence cannoL be changed lnLo asslve

1he Leacher Lurned suddenly Lowards Lhe boy who dozed off

ln Lhls senLence Lhe verb word 'Lurned' ls lnLranslLlve whlch means lL does noL have an ob[ecL 1he word 'suddenly' ls
an adverb Lhe word 'Lowards' ls a preposlLlon and Lhe phrase 'Lhe boy' Lhough a noun ls noL Lhe ob[ecL of Lhe verb buL
lL ls Lhe ob[ecL of Lhe preposlLlon 'Lowards'

1herefore Lhe word 'Lurned' ln Lhls senLence ls an lnLranslLlve verb and so Lhls senLence cannoL be changed lnLo
asslve

Pe Lurned Lhe plcLure upslde down

ln Lhls senLence Lhe acLlon verb word 'Lurned' ls 1ranslLlve whlch means lL has an ob[ecL '1he plcLure' a noun phrase ls
Lhe ulrecL Cb[ecL of Lhe verb because lL ls Lhe answer Lo Lhe quesLlon 'whaL?' 1herefore Lhe word 'Lurned' ln Lhls
senLence ls a 1ranslLlve verb and so Lhls senLence can be changed lnLo asslve

SCML MC8L LxAMLLS

Pe seems Llred 'seems' llnklng verb 'Llred' complemenL

She looks charmlng 'looks' llnklng verb 'charmlng' complemenL

Pls cloLhes smelled awful 'smelled' llnklng verb 'awful' complemenL

1hls medlclne LasLes sweeL 'LasLes' llnklng verb 'sweeL' complemenL

Pls Lheory was proved wrong

'was proved' llnklng verb 'wrong' complemenL

My boss felL annoyed when l gave hlm an lncompleLe reporL

'felL' llnklng verb 'annoyed' complemenL

My elder broLher grew Laller Lhan our faLher

'grew' llnklng verb 'Laller' complemenL

We sLayed lndoors Lhe whole day

'sLayed' llnklng verb 'lndoors' complemenL

A CCMLLMLn1 C8 An C8!LC1?

1 Pe was my Leacher complemenL

Pe Lold my Leacher ob[ecL

2 She grew a garden ob[ecL

She grew pale complemenL

3 1hey looked up Lhe number ob[ecL

1hey looked dlsappolnLed complemenL

4 Pe was a professor complemenL

Pe was examlnlng a professor ob[ecL

3 ?ou are Lhe resldenL complemenL

?ou are guldlng Lhe resldenL ob[ecL
__________________________________

1ense Possive voice

lntroduction

1 Slmple asL

2 asL conLlnuous

3 asL erfecL

4 asL erfecL ConLlnuous

1 Slmple resenL

2 resenL ConLlnuous

3 resenL erfecL

4 presenL erfecL conLlnuous

1 Slmple luLure

2 fuLure conLlnuous

3 luLure erfecL

4 luLure erfecL ConLlnuous

1here are only LlCP1 1LnSLS ln asslve volce

1he 'asL erfecL ConLlnuous' 'resenL erfecL ConLlnuous' 'luLure ConLlnuous' and Lhe 'luLure erfecL ConLlnuous'
1enses are noL used ln asslve volce ln modern Lngllsh 1he AcLlve volce senLences havlng Lhese four 1enses are noL
changed lnLo asslve volce

1he Maln verb ln any 1ense ln asslve volce Lakes only Lhe asL arLlclple v3 form!

AS1

1 Slmple asL

formula was/were + Lhe pasL parLlclple v3 form of Lhe Maln verb

go/goes wenL gone golng

walk/walks walked walked walklng

eg

(l) Pe bullL a large house 'bullL' slmple pasL acLlve volce

A large house was bullL by hlm 'was bullL' slmple pasL passlve volce

(ll) 1hey flew several klLes 'flew' slmple pasL acLlve volce

Several klLes were flown by Lhem

'were flown' slmple pasL passlve volce

2 asL ConLlnuous

formula was/were + belng + Lhe pasL parLlclple v3 form of Lhe Maln verb

eg

(l) She was cooklng dlnner 'was cooklng' pasL conLlnuous acLlve volce

ulnner was belng cooked by her

'was belng cooked' pasL conLlnuous passlve volce

(ll) 1hey were palnLlng some aLLracLlve plcLures on Lhe wall

'were palnLlng' pasL conLlnuous acLlve volce

Some aLLracLlve plcLures were belng palnLed on Lhe wall by Lhem

'were belng palnLed' pasL conLlnuous passlve volce

3 asL erfecL

formula had + been + Lhe asL arLlclple v3 form of Lhe Maln verb

eg

(l) She had posLed Lhe leLLer before she goL Lhe phone call

'had posLed' pasL perfecL acLlve volce and ln Lhls senLence goL" ln Lhe second parL ls beLLer kepL ln Lhe acLlve volce

1he leLLer had been posLed (by her) before she goL Lhe phone call

'had been posLed' pasL perfecL passlve volce

(ll) Mac had answered flve quesLlons before Lhe flnal bell wenL

'had answered' pasL perfecL acLlve volce

llve quesLlons had been answered (by Mac) before Lhe flnal bell wenL

'had been answered' pasL perfecL passlve volce

4 asL erfecL ConLlnuous

no passlve volce for Lhls Lense

8LSLn1

1 Slmple resenL

formula ls/am/are + Lhe asL arLlclple v3 form of Lhe Maln verb

eg

(l) 1he grocer sells fresh vegeLables 'sells' slmple presenL acLlve volce

lresh vegeLables are sold by Lhe grocer

'are sold' slmple presenL passlve volce

(ll) Pe glves me an expenslve waLch

'glves' slmple presenL acLlve volce

1he verb 'glves' ln Lhls senLence has Lwo ob[ecLs 'me' and 'an expenslve waLch' and so Lhls senLence can be changed ln
Lwo ways

*(a) l am glven an expenslve waLch by hlm 'am glven' slmple presenL passlve volce

*(b) An expenslve waLch ls glven Lo me by hlm

'ls glven' slmple presenL passlve volce

2 resenL ConLlnuous

formula ls/am/are + belng + Lhe asL arLlclple v3 form of Lhe Maln verb

eg

(l) My boss ls glvlng many asslgnmenLs

'ls glvlng' presenL conLlnuous acLlve volce

Many asslgnmenLs are belng glven by my boss

'are belng glven' presenL conLlnuous passlve volce

(ll) She ls glvlng some lecLure

'ls glvlng' presenL conLlnuous acLlve volce

Some lecLure ls belng glven by her

'ls belng glven' presenL conLlnuous passlve volce

3 resenL erfecL

formula has/have + been + Lhe pasL parLlclple v3 form of Lhe Maln verb

eg

(l) l have Laken hlm ouL 'have Laken' presenL perfecL acLlve volce

Pe has been Laken ouL by me

'has been Laken' presenL perfecL passlve volce

(ll) She has shown Lhem an lnLeresLlng book

'has shown' presenL perfecL acLlve volce

*a) 1hey have been shown an lnLeresLlng book by her

'have been shown' presenL perfecL passlve volce

*b) An lnLeresLlng book has been shown Lo Lhem by her

'has been shown' presenL perfecL passlve volce

4 resenL erfecL ConLlnuous

no passlve volce for Lhls Lense

luLure

1 Slmple luLure

formula wlll/shall + be + Lhe asL arLlclple v3 form of Lhe Maln verb

eg

l wlll glve you a presenL 'wlll glve' slmple presenL acLlve volce

*a) ?ou shall be glven a presenL by me

'wlll be glven' slmple fuLure passlve volce

*b) A presenL wlll be glven Lo you by me

'wlll be glven' slmple fuLure passlve volce

2 luLure ConLlnuous

no passlve volce for Lhls Lense

3 luLure erfecL

formula

wlll/shall + have + been + Lhe asL arLlclple v3 form of Lhe Maln verb

eg

1he docLor shall have examlned Len paLlenLs by 10 C'clock

'shall have examlned' fuLure perfecL acLlve volce

1en paLlenLs wlll have been examlned by 10 C'clock by Lhe docLor

'wlll have been examlned' fuLure perfecL passlve volce

4 luLure erfecL ConLlnuous

no passlve form for Lhls Lense

******************************

8ound up of 1enses AcLlve asslve


verb


Lense


volce


parLs

glve slmple presenL acLlve one verb one parL
ls glven slmple presenL passlve one verb Lwo parLs

am glvlng presenL conLlnuous acLlve one verb Lwo parLs
am belng glven presenL conLlnuous passlve one verb Lhree parLs
has glven presenL perfecL acLlve one verb Lwo parLs

has been glven presenL perfecL passlve one verb Lhree parLs
gave slmple pasL acLlve one verb one parL
was glven slmple pasL passlve one verb Lwo parLs
was glvlng pasL conLlnuous acLlve one verb Lwo parLs
was belng glven pasL conLlnuous passlve one verb Lhree parLs
had glven pasL perfecL acLlve one verb Lwo parLs
had been glven pasL perfecL passlve one verb Lhree parLs
wlll glve slmple fuLure acLlve one verb Lwo parLs
wlll be glven slmple fuLure passlve one verb Lhree parLs

wlll have glven fuLure perfecL acLlve one verb Lhree parLs

wlll have been glven fuLure perfecL passlve one verb four parLs
A SLClAL nC1L Cn 1PL vL88 WC8u LL1"

1he verb word 'leL' has no passlve form and Lherefore AcLlve senLences wlLh 'leL' would Lake allowed" or permlLLed"
ln asslve

lor example

She dldn'L leL her chlldren go ouL alone AcLlve volce

1he chlldren were noL allowed (or permlLLed) Lo go ouL alone by her asslve volce

A8Cu1 1PL uSL Cl 1PL AC1lvL Anu ASSlvL

Learnlng how Lhe dlfferenL asslve forms are consLrucLed may be easy once we undersLand Lhe rules buL whaL ls ofLen
dlfflculL Lo undersLand ls when lL ls proper Lo use an AcLlve volce senLence and when lL ls approprlaLe Lo use a asslve
volce senLence

We musL remember LhaL AcLlve and asslve forms are ofLen noL equlvalenL and we cannoL use elLher of Lhem Lo sulL a
parLlcular conLexL

Lucklly for us Lhere are some clearcuL cases such as

uocLor WhaL's Lhe maLLer?"

aLlenL l broke my arm" AcLlve volce

8uL noL

aLlenL My arm was broken by me" asslve volce

lL would be rldlculous uslng asslve ln Lhls expresslon!

**************************************************************************************************
Use a per|od at the end of a sentence that makes a statement 1here ls no space beLween Lhe lasL leLLer and Lhe
perlod use one space beLween Lhe perlod and Lhe flrsL leLLer of Lhe nexL senLence 1hls goes agalnsL Lhe graln for
people uslng Lhe Lypography lnsLllled by generaLlons of oldfashloned LypewrlLer users buL modern wordprocessors
nlcely accommodaLe Lhe spaclng afLer a perlod and doublespaclng afLer a perlod can only serve Lo dlscombobulaLe Lhe
good lnLenLlons of ones sofLware

use a perlod aL Lhe end of a command

Pand ln Lhe posLer essays no laLer Lhan noon on lrlday
ln case of Lremors leave Lhe bulldlng lmmedlaLely
use a perlod aL Lhe end of an lndlrecL quesLlon

1he Leacher asked why Marla had lefL ouL Lhe easy exerclses
My faLher used Lo wonder why LgberLs ears were so blg
use a perlod wlLh abbrevlaLlons

ur Lsplnoza arrlved from WashlngLon uC aL 6 pm
noLlce LhaL when Lhe perlod endlng Lhe abbrevlaLlon comes aL Lhe end of a senLence lL wlll also sufflce Lo end Lhe
senLence Cn Lhe oLher hand when an abbrevlaLlon ends a quesLlon or exclamaLlon lL ls approprlaLe Lo add a quesLlon
mark or exclamaLlon mark afLer Lhe abbrevlaLlonendlng perlod

uld you en[oy llvlng ln WashlngLon uC?
Cccaslonally a sLaLemenL wlll end wlLh a quesLlon When LhaL happens lL ls approprlaLe Lo end Lhe senLence wlLh a
quesLlon mark

We can geL Lo 8osLon qulcker canL we lf we Lake Lhe lnLersLaLe?
Pls quesLlon was can we end Lhls sLaLemenL wlLh a quesLlon mark?
She ended her remarks wlLh a resoundlng why noL?
Acronyms (abbrevlaLlons usually made up of Lhe flrsL leLLer from a serles of words whlch we pronounce as words noL a
serles of leLLers) usually do noL requlre perlods nA1C nCW vlS1A LASL8 SCu8A 8AuA8 AbbrevlaLlons we
pronounce by spelllng ouL Lhe leLLers may or may noL use perlods and you wlll have Lo use a dlcLlonary Lo be sure l8l
nAAC nCAA uSA unlCLl eLc


Use a quest|on mark ? at the end of a d|rect quest|on lL ls consldered bad form Lo use a quesLlon mark ln
comblnaLlon wlLh oLher marks alLhough LhaL ls ofLen done ln lnformal prose ln an aLLempL Lo convey complex Lones Pe
Lold you whaL!? 1haL comblnaLlon (or slmllar comblnaLlon) of puncLuaLlon marks ls someLlmes called an lnLerrobang buL
Lhe lnLerrobang currenLly has no role ln academlc prose*

A Lag quesLlon ls a devlce used Lo Lurn a sLaLemenL lnLo a quesLlon lL nearly always conslsLs of a pronoun a helplng
verb and someLlmes Lhe word noL AlLhough lL beglns as a sLaLemenL Lhe Lag quesLlon prevalls when lL comes Lo Lhe
endmark use a quesLlon mark noLlce LhaL when Lhe sLaLemenL ls poslLlve Lhe Lag quesLlon ls expressed ln Lhe
negaLlve when Lhe sLaLemenL ls negaLlve Lhe Lag quesLlon ls poslLlve (1here are a few excepLlons Lo Lhls frequenLly
expresslng an elemenL of surprlse or sarcasm So youve made your flrsL mllllon have you? Ch LhaLs your plan ls
lL?) 1he followlng are more Lyplcal Lag quesLlons

Pe should qulL smoklng shouldnL he?
Pe shouldnL have qulL hls dleL should he?
1heyre noL dolng very well are Lhey?
Pe flnlshed on Llme dldnL he?
She does a beauLlful [ob doesnL she?
Parold may come along mlghLnL he?
1here were Loo many people on Lhe dock werenL Lhere?
(8e careful of Lhls lasL one lLs noL werenL Lhey?)
8e careful noL Lo puL a quesLlon mark aL Lhe end of an lndlrecL quesLlon

1he lnsLrucLor asked Lhe sLudenLs whaL Lhey were dolng
l asked my slsLer lf she had a daLe
l wonder lf Cheney wlll run for vlce presldenL agaln
l wonder wheLher Cheney wlll run agaln
8e careful Lo dlsLlngulsh beLween an lndlrecL quesLlon (above) and a quesLlon LhaL ls embedded wlLhln a sLaLemenL
whlch we do wanL Lo end wlLh a quesLlon mark

We can geL Lo 8osLon qulcker canL we lf we Lake Lhe lnLersLaLe?
Pls quesLlon was can we end Lhls sLaLemenL wlLh a quesLlon mark?
She ended her remarks wlLh a resoundlng why noL?
l wonder wlll Cheney run for offlce agaln?
uL a quesLlon mark aL Lhe end of a senLence LhaL ls ln facL a dlrecL quesLlon (SomeLlmes wrlLers wlll slmply forgeL)
8heLorlcal quesLlons (asked when an answer ls noL really expecLed) by Lhe way are quesLlons and deserve Lo end wlLh a
quesLlon mark

Pow else should we end Lhem afLer all?
WhaL lf l sald Lo you ?ouve goL a real problem here? (noLlce LhaL Lhe quesLlon mark here comes afLer Lhe quoLaLlon
mark and Lhere ls no perlod aL Lhe end of Lhe sLaLemenL)
SomeLlmes a quesLlon wlll acLually end wlLh a serles of brlef quesLlons When LhaL happens especlally when Lhe brlef
quesLlons are more or less followup quesLlons Lo Lhe maln quesLlon each of Lhe llLLle quesLlons can begln wlLh a
lowercase leLLer and end wlLh a quesLlon mark

Who ls responslble for execuLlng Lhe plan? Lhe coach? Lhe coachlng sLaff? Lhe players?
lf a quesLlon mark ls parL of an lLallclzed or underllned LlLle make sure LhaL Lhe quesLlon mark ls also lLallclzed

My favorlLe book ls Where uld Pe Co?
(uo noL add a perlod afLer such a senLence LhaL ends wlLh Lhe LlLles quesLlon mark 1he quesLlon mark wlll also sufflce
Lo end Lhe senLence) lf Lhe quesLlon mark ls noL parL of a senLenceendlng LlLle donL lLallclze Lhe quesLlon mark

uld he slng Lhe lrench naLlonal anLhem la Marselllalse?
When a quesLlon ends wlLh an abbrevlaLlon end Lhe abbrevlaLlon wlLh a perlod and Lhen add Lhe quesLlon mark

uldnL he use Lo llve ln WashlngLon uC?
When a quesLlon consLlLuLes a pollLe requesL lL ls usually noL followed by a quesLlon mark 1hls becomes more Lrue as
Lhe requesL becomes longer and more complex

Would everyone ln Lhe room who hasnL recelved an lu card please move Lo Lhe fronL of Lhe llne


Use an exc|amat|on po|nt ! at the end of an emphat|c dec|arat|on |nter[ect|on or command
No! he yelled uo lL now!
An exclamaLlon mark may be used Lo close quesLlons LhaL are meanL Lo convey exLreme emoLlon as ln

WhaL on earLh are you dolng! SLop!
An exclamaLlon mark can be lnserLed wlLhln parenLheses Lo emphaslze a word wlLhln a senLence

We have some really(!) lowprlced rugs on sale Lhls week
noLe LhaL Lhere ls no space beLween Lhe lasL leLLer of Lhe word so emphaslzed and Lhe parenLheses 1hls devlce should
be used rarely lf ever ln formal LexL

An exclamaLlon mark wlll ofLen accompany mlmeLlcally produced sounds as ln

All nlghL long Lhe dogs woof! ln my nelghbors yard and

1he bear wenL Crr! and l wenL lefL
lf an exclamaLlon mark ls parL of an lLallclzed or underllned LlLle make sure LhaL Lhe exclamaLlon mark ls also lLallclzed or
underllned

My favorlLe book ls Ch Lhe laces ?oull Co!
(uo noL add a perlod afLer such a senLence LhaL ends wlLh Lhe LlLles exclamaLlon mark 1he exclamaLlon mark wlll also
sufflce Lo end Lhe senLence) lf Lhe exclamaLlon mark ls noL parL of a senLenceendlng LlLle donL lLallclze Lhe
exclamaLlon mark

lve asked you noL Lo slng la Marselllalse!
ln academlc prose an exclamaLlon polnL ls used rarely lf aL all and ln newspaper wrlLlng Lhe exclamaLlon polnL ls
vlrLually nonexlsLenL


Use a co|on before a ||st or an exp|anat|on that |s preceded by a clause LhaL can sLand by lLself 1hlnk of Lhe colon as
a gaLe lnvlLlng one Lo go on

1here ls only one Lhlng lefL Lo do now confess whlle you sLlll have Llme
1he charLer revlew commlLLee now lncludes Lhe followlng people
Lhe mayor
Lhe chlef of pollce
Lhe flre chlef
Lhe chalr of Lhe Lown councll
?ou nearly always have a sense of whaL ls golng Lo follow or be on Lhe oLher slde of Lhe colon (Compare Lhe funcLlon of
a semlcolon ln Lhls regard) ?ou wlll flnd dlfferlng advlce on Lhe use of a colon Lo lnLroduce a verLlcal or dlsplay llsL See
uslng numbers and CreaLlng LlsLs

We wlll ofLen use a colon Lo separaLe an lndependenL clause from a quoLaLlon (ofLen of a raLher formal naLure) LhaL Lhe
clause lnLroduces

1he acLlng dlrecLor ofLen used her favorlLe quoLaLlon from Shakespeares 1empesL We are such sLuff as dreams are
made on and our llLLle llfe ls rounded wlLh a sleep
WlLh Lodays sophlsLlcaLed wordprocesslng programs (whlch know how much space Lo puL afLer puncLuaLlon marks) we
lnserL only one space (hlL Lhe spacebar only once) afLer a colon

lL mlghL be useful Lo say also when we donL use a colon 8emember LhaL Lhe clause LhaL precedes Lhe mark (where
youre conslderlng a colon) oughL Lo be able Lo sLand on lLs own as an lndependenL clause lLs purpose mlghL be sLrlcLly
Lo lnLroduce Lhe clause LhaL follows so lL mlghL feel raLher lncompleLe by lLself buL grammaLlcally lL wlll have boLh a
sub[ecL and a predlcaLe ln oLher words we would noL use a colon ln slLuaLlons llke Lhe followlng

Per reclpe for gunpowder lncluded salLpeLer dry oaLmeal and groundup charcoal brlqueLs (no colon afLer lncluded)
Pls favorlLe breakfasL cereals were 8lce krlsples Cheerlos and WheaLles (no colon afLer were)
Per usual advlce l remember was keep your head up as you push Lhe ball up Lhe courL (no colon afLer was)
Cne of Lhe mosL frequenLly asked quesLlons abouL colons ls wheLher we should begln an lndependenL clause LhaL comes
afLer a colon wlLh a caplLal leLLer lf Lhe lndependenL clause comlng afLer Lhe colon ls a formal quoLe begln LhaL quoLed
language wlLh a caplLal leLLer

WhlLehead had Lhls Lo say abouL wrlLlng sLyle SLyle ls Lhe ulLlmaLe morallLy of mlnd
lf Lhe explanaLory sLaLemenL comlng afLer a colon conslsLs of more Lhan one senLence begln Lhe lndependenL clause
lmmedlaLely afLer Lhe colon wlLh a caplLal leLLer

1here were Lwo reasons for a drop ln aLLendance aL n8A games Lhls season llrsL Lhere was no supersLar Lo Lake Lhe
place of Mlchael !ordan Second fans were dlslllusloned abouL Lhe mlsbehavlor of several promlnenL players
lf Lhe lnLroducLory phrase precedlng Lhe colon ls very brlef and Lhe clause followlng Lhe colon represenLs Lhe real
buslness of Lhe senLence begln Lhe clause afLer Lhe colon wlLh a caplLal leLLer

8emember Many of Lhe promlnenL famllles of Lhls new Lngland sLaLe were slaveholders prlor Lo 1830
lf Lhe funcLlon of Lhe lnLroducLory clause ls slmply Lo lnLroduce and Lhe funcLlon of Lhe second clause (followlng Lhe
colon) ls Lo express a rule begln LhaL second clause wlLh a caplLal

LeL us noL forgeL Lhls polnL ApposlLlve phrases have an enLlrely dlfferenL funcLlon Lhan parLlclplal phrases and musL noL
be regarded as dangllng modlflers
1here ls some dlsagreemenL among wrlLlng reference manuals abouL when you should caplLallze an lndependenL clause
followlng a colon MosL of Lhe manuals advlse LhaL when you have more Lhan one senLence ln your explanaLlon or when
your senLence(s) ls a formal quoLaLlon a caplLal ls a good ldea 1he n?L WrlLers Culde urges conslsLency wlLhln a
documenL Lhe Chlcago Manual of SLyle says you may begln an lndependenL clause wlLh a lowercase leLLer unless lLs one
of Lhose Lwo Lhlngs (a quoLaLlon or more Lhan one senLence) 1he AA ubllcaLlon Manual ls Lhe mosL exLreme lL
advlses us Lo always caplLallze an lndependenL clause followlng a colon 1he advlce glven above ls conslsLenL wlLh Lhe
Cregg 8eference Manual

We also use a colon afLer a saluLaLlon ln a buslness leLLer

uear SenaLor uodd

lL has come Lo our aLLenLlon LhaL
and when we deslgnaLe Lhe speaker wlLhln a play or ln courL LesLlmony

8lll Pe had Lhe wrong dreams All all wrong
PA? (almosL ready Lo flghL 8lff) uonL say LhaL!
8lll Pe never knew who he was

Use a sem|co|on to he|p sort out a monster ||st
1here were clLlzens from 8angor Malne ParLford ConnecLlcuL 8osLon MassachuseLLs and newporL 8hode lsland
C8
We had four professors on our commlLLee eLer WursLhorn rofessor of MaLhemaLlcs 8onald epln rofessor of
Lngllsh CynLhla CreenblaLL rofessor of LducaLlon and nada LlghL rofessor of nurslng

Lo separaLe closely relaLed lndependenL clauses
My grandmoLher seldom goes Lo bed Lhls early shes afrald shell mlss ouL on someLhlng
1he semlcolon allows Lhe wrlLer Lo lmply a relaLlonshlp beLween nlcely balanced ldeas wlLhouL acLually sLaLlng LhaL
relaLlonshlp (lnsLead of saylng because my grandmoLher ls afrald shell mlss ouL on someLhlng we have lmplled Lhe
because 1hus Lhe reader ls lnvolved ln Lhe developmenL of an ldeaa clever subllmlnal way of engaglng Lhe readers
aLLenLlon)

lL ls rare buL cerLalnly posslble LhaL you wlll wanL a semlcolon Lo separaLe Lwo lndependenL clauses even when Lhose
Lwo lndependenL clauses are connecLed by a coordlnaLlng con[uncLlon 1hls ls especlally Lrue when Lhe lndependenL
clauses are complex or lengLhy and when Lhere are commas wlLhln Lhose lndependenL clauses ?ou mlghL conslder
breaklng Lhose Lwo lndependenL clauses lnLo separaLe senLences when Lhls happens

Coach Aurlemma reallzed LhaL hls nexL recrulLlng class conLalned Lwo superb guards a flne posL player and a power
forward buL as of Lhe end of Lhe sprlng recrulLlng season he was sLlll pushlng Lo dlscover beLLer flrsLyear players for
Lhe lnLerlor poslLlons

AlLhough smarL wordprocessors seem Lo have Laken over Lhe [ob of hyphenaLlng broken words aL Lhe rlghLhand end of
our llnes and spellcheckers can revlew our use of hyphens ln oLher places Lhese Lechnologlcal marvels are by no means
lnfalllble MlcrosofL Word for example flags as mlsspelled almosL any word wlLh an unhyphenaLed preflx
anLldlscrlmlnaLlon and cogeneraLlon for example are marked as mlsspelled words and reslgn cobra evergreen and
beloved are marked as correcLly hyphenaLed words by LhaL sofLware* Cenerally lL ls a good ldea noL Lo use [usLlfled
LexL ln academlc papers LhaL wlll cuL down on a loL of declslons abouL hyphenaLlng 1he AA ubllcaLlon Manual ln facL
lnslsLs LhaL you noL break words aL llneendlngs ln any case buL LhaL can lead Lo llnes LhaL are Loo brlef and aesLheLlcally
unbalanced

1he rules for hyphenaLlng aL llne endlngs are so compllcaLed LhaL no one can be expecLed Lo keep Lrack of Lhem lf
youre ever ln a slLuaLlon where you have Lo hyphenaLe aL llnebreaks go Lo a dlcLlonaryunless you can explaln why
you would break experlence beLween Lhe e and Lhe r LhaL ls and Lhen you can do whaLever you wanL 8emember LhaL lf
you ad[usL one llnebreak for aesLheLlc reasons LhaL may well affecL subsequenL llnebreaks ln Lhe LexL

robably Lhe besL reference LexL for Lhese declslons (nexL Lo looklng up everyLhlng ln a dlcLlonary LhaL ls) ls 1he Chlcago
Manual of SLyle An excellenL onllne resource on hyphen use ls Lhe LdlLlng Workshop by Sonla !affe 8obblns aL new ?ork
unlverslLy 1om LlLLle volces a dlssenLlng oplnlon ln 1he CreaL PyphenaLlon Poax whlch seeks Lo free wrlLers of Lhe
lnnumerable rules and lmponderable Lables of Lhe Chlcago Manual of SLyle

nyphens have other uses
creaLlng compound words parLlcularly modlflers before nouns (Lhe wellknown acLor my slxyearold daughLer Lhe ouL
ofdaLe currlculum
wrlLlng numbers LwenLyone Lo nlneLynlne and fracLlons (flveelghLhs onefourLh)
creaLlng compounds onLhefly for flybynlghL organlzaLlons
addlng cerLaln preflxes Lo words When a preflx comes before a caplLallzed word or Lhe preflx ls caplLallzed use a
hyphen (nonLngllsh Aframe lformaLlon) 1he preflxes self all and ex nearly always requlre a hyphen (exhusband
alllncluslve selfconLrol) and when Lhe preflx ends wlLh Lhe same leLLer LhaL beglns Lhe word you wlll ofLen use a
hyphen (anLllnLellecLual deemphaslze) buL noL always (unnaLural coordlnaLe cooperaLe) 8y all means use a good
dlcLlonary when ln doubL! lor furLher lnformaLlon abouL compound nouns and compound modlflers see Lhe separaLe
secLlon on Compound Words
1here ls no space beLween a hyphen and Lhe characLer on elLher slde of lL

Suspended Compounds
WlLh a serles of nearly ldenLlcal compounds we someLlmes delay Lhe flnal Lerm of Lhe flnal Lerm unLll Lhe lasL lnsLance
allowlng Lhe hyphen Lo acL as a klnd of place holder as ln

1he Lhlrd and fourLhgrade Leachers meL wlLh Lhe parenLs
8oLh full and parLLlme employees wlll geL ralses Lhls year
We donL see many 3 4 and 3yearold chlldren around here
8e careful noL Lo overuse Lhls feaLure of Lhe hyphen readers have Lo walL unLll LhaL flnal lnsLance Lo know whaL youre
Lalklng abouL and LhaL can be annoylng


Use a dash (or two hyphens on o|dfash|oned typewr|ters) or dashes as a supercomma or set of super
commas Lo seL off parenLheLlcal elemenLs especlally when Lhose elemenLs conLaln lnLernal forms of puncLuaLlon

All four of Lhem8ob !effrey !ason and 8reLLdld well ln college
ln mosL wordprocessors Lhe dash ls creaLed by holdlng down Lhe opLlon key and hlLLlng Lhe key LhaL has Lhe underllne
mark above Lhe hyphen 1hls can vary Lhough from program Lo program usually you geL an en dash (see below) wlLh
Lhe opLlon + hyphen key and you geL Lhe larger em dash (used more frequenLly) wlLh opLlon + shlfL + hyphen keys

uo noL use dashes Lo seL aparL maLerlal when commas would do Lhe work for you usually Lhere are no spaces beLween
Lhe dash and Lhe leLLers on elLher slde of a dash alLhough Lhe dash ls frequenLly shown LhaL way ln documenLs prepared
for Lhe World Wlde Web and emall for Lypographlcal and aesLheLlc reasons (because Lhe WWW auLhorlng and emall
cllenLs have llLLle conLrol over llnebreaks)

ln wrlLlng dlalogue Lhe dash ls used Lo show breaks ln LhoughL and shlfLs ln Lone

Pow many Llmes have l asked you noL Lo !aslon suddenly sLopped Lalklng and looked ouL Lhe wlndow

noL Lo do whaL? l prompLed

noL Lo Ch heck l forgeL!

A dash ls someLlmes used Lo seL off concludlng llsLs and explanaLlons ln a more lnformal and abrupL manner Lhan Lhe
colon We seldom see Lhe dash used Lhls way ln formal academlc prose

Modern word processors provlde for Lwo klnds of dashes Lhe regular dash or em dash (whlch ls Lhe same wldLh as Lhe
leLLer M ) and Lhe en dash (whlch ls abouL half Lhe wldLh Lhe same as Lhe leLLer n ) We use Lhe em dash for
mosL purposes and keep lLs smaller broLher Lhe en dash for marklng Lhe space beLween daLes ln a chronologlcal range
kennedys presldency (19611963) marked an exLraordlnary era ln Llme 630843 pm and beLween numbers
and leLLers ln an lndexlng scheme Lable 13C C1 SLaLuLe 144A

1he en dash ls also used Lo [oln compound modlflers made up of elemenLs LhaL are Lhemselves elLher open compounds
(frequenLly Lwoword proper nouns) or already hyphenaLed compounds Lhe uerLo 8lcanunlLed SLaLes collaboraLlon
Lhe new ?orknew !ersey border posLuarwlnlanprelreudlan Lheorems 1he Cregg 8eference Manual and Lhe
Chlcago Manual of SLyle boLh recommend uslng Lhe en dash whenever a compound modlfler ls comblned wlLh a
parLlclple as ln a lrank Lloyd WrlghLdeslgned bulldlng a WhlLe Pousebacked proposal and a forelgn exchanged
relaLed lssue A sLrlng of modlflers ln a slngle compound Lhough ls [olned wlLh hyphens hllarlous neverLobe
forgoLLen momenLs lf you are uslng an oldfashloned LypewrlLer LhaL cannoL creaLe an en dash you can denoLe Lo your
LypeseLLer or edlLor LhaL a hyphen ls Lo be converLed Lo an en dash by uslng a hyphen and handwrlLlng Lhe leLLer n
above lL

Some reference manuals are urglng edlLors and publlshers Lo geL rld of Lhe en dash alLogeLher and Lo use Lhe em dash
excluslvely buL en and em are sLlll handy words Lo know when youre Lrylng Lo geL rld of Lhose exLra es aL Lhe end of a
Scrabble game llnally we use whaL ls called a 3em dash (or slx LypewrlLer hyphens) when were showlng LhaL
someones name or a word has been omlLLed (perhaps for legal reasons or lssues of LasLe)

Use parentheses ( ) to |nc|ude mater|a| that you want to deemphas|ze or that wou|dnt norma||y f|t |nto the f|ow of
your LexL buL you wanL Lo lnclude noneLheless lf Lhe maLerlal wlLhln parenLheses appears wlLhln a senLence do noL use
a caplLal leLLer or perlod Lo puncLuaLe LhaL maLerlal even lf Lhe maLerlal ls lLself a compleLe senLence (A quesLlon mark
or exclamaLlon mark however mlghL be approprlaLe and necessary) lf Lhe maLerlal wlLhln your parenLheses ls wrlLLen
as a separaLe senLence (noL lncluded wlLhln anoLher senLence) puncLuaLe lL as lf lL were a separaLe senLence

1hlrLyflve years afLer hls deaLh 8oberL lrosL (we remember hlm aL kennedys lnauguraLlon) remalns Amerlcas favorlLe
poeL
1hlrLyflve years afLer hls deaLh 8oberL lrosL (do you remember hlm?) remalns Amerlcas favorlLe poeL
1hlrLyflve years afLer hls deaLh 8oberL lrosL remalns Amerlcas favorlLe poeL (We remember hlm aL kennedys
lnauguraLlon)
lf Lhe maLerlal ls lmporLanL enough use some oLher means of lncludlng lL wlLhln your LexLeven lf lL means wrlLlng
anoLher senLence noLe LhaL parenLheses Lend Lo deemphaslze LexL whereas dashes Lend Lo make maLerlal seem even
more lmporLanL

Use brackets |n the fo||ow|ng s|tuat|ons

?ou can use Lhem Lo lnclude explanaLory words or phrases wlLhln quoLed language

Lew erklns Lhe ulrecLor of ALhleLlc rograms sald LhaL umlLa Lsplnoza Lhe new soccer coach aL noLre uame
Academy ls golng Lo be a real wlnner
lf you are quoLlng maLerlal and youve had Lo change Lhe caplLallzaLlon of a word or change a pronoun Lo make Lhe
maLerlal flL lnLo your senLence enclose LhaL changed leLLer or word(s) wlLhln brackeLs

Lsplnoza charged her former employer wlLh falslflcaLlon of her coachlng record
See Lhe descrlpLlon of Lhe elllpsls for lnformaLlon on uslng brackeLs Lo seL off an elllpsls LhaL you have used Lo lndlcaLe
omlLLed language ln a quoLaLlon

Also wlLhln quoLaLlons you could enclose slc wlLhln brackeLs (we lLallclze buL never underllne Lhe word slc and we do
noL lLallclze Lhe brackeLs Lhemselves) Lo show LhaL mlsspelled words or lnapproprlaLely used words are noL your own
Lypos or blunders buL are parL of an accuraLely rendered quoLaLlon

8eporLers found Lhree mlspellngs slc ln Lhe reporL
(lL ls bad manners however Lo use Lhls devlce Lo show LhaL anoLher wrlLer ls a lousy speller or oLherwlse unleLLered
Also use lL only when lL ls lmporLanL Lo malnLaln Lhe orlglnal spelllng for some reason lf you can edlL (remove) Lhe error
wlLhouL vlolaLlng some scholarly or eLhlcal prlnclple do so) noLe also LhaL Lhe word slc means Lhus or LhaLs how lL
was and ls noL an abbrevlaLlon Lhus no perlod

lf you have lLallclzed or underllned words wlLhln quoLed language LhaL was noL lLallclzed or underllned ln Lhe orlglnal
you can noLe LhaL change ln brackeLs lncluded wlLhln Lhe senLence or paragraph

lL was Lhe aLmosphere of Lhe gym LhaL Lhrllled !acobs noL Lhe elghL champlonshlp banners hanglng from Lhe beams
lLallcs added
(lLallcs mlne or emphasls added would be oLher accepLable phrases)

?ou can use brackeLs Lo lnclude parenLheLlcal maLerlal lnslde parenLheLlcal maLerlal

Chernwell was poeL laureaLe of 8ermuda (a largely honorary poslLlon unpald) for Len years
8e klnd Lo your reader however and use Lhls devlce sparlngly


An e|||ps|s proves to be a handy dev|ce when youre quot|ng mater|a| and you want to om|t some words 1he
e|||ps|s conslsLs of Lhree evenly spaced doLs (perlods) wlLh spaces beLween Lhe elllpsls and surroundlng leLLers or oLher
marks LeLs Lake Lhe senLence 1he ceremony honored Lwelve brllllanL aLhleLes from Lhe Carlbbean who were vlslLlng
Lhe uS and leave ouL from Lhe Carlbbean who were

1he ceremony honored Lwelve brllllanL aLhleLes vlslLlng Lhe uS
lf Lhe omlsslon comes afLer Lhe end of a senLence Lhe elllpsls wlll be placed afLer Lhe perlod maklng a LoLal of four doLs
See how LhaL works? noLlce LhaL Lhere ls no space beLween Lhe perlod and Lhe lasL characLer of Lhe senLence

1he elllpsls can also be used Lo lndlcaLe a pause ln Lhe flow of a senLence and ls especlally useful ln quoLed speech

!uan LhoughL and LhoughL and Lhen LhoughL some more
lm wonderlng !uan sald bemused
noLe carefully Lhe spaclng of Lhe elllpsls marks and Lhe surroundlng characLers ln Lhe examples above ln mldsenLence
a space should appear beLween Lhe flrsL and lasL elllpsls marks and Lhe surroundlng leLLers lf a quoLaLlon ls meanL Lo
Lrall off (as ln !uans bemused LhoughL) leave a space beLween Lhe lasL leLLer and Lhe flrsL elllpsls mark buL do noL
lnclude a perlod wlLh Lhe elllpsls marks

lf words are lefL off aL Lhe end of a senLence and LhaL ls all LhaL ls omlLLed lndlcaLe Lhe omlsslon wlLh elllpsls marks
(preceded and followed by a space) and Lhen lndlcaLe Lhe end of Lhe senLence wlLh a perlod lf one or more senLences
are omlLLed end Lhe senLence before Lhe elllpsls wlLh a perlod and Lhen lnserL your elllpsls marks wlLh a space on boLh
sldes As ln Lhls example A coded elllpsls (used ln Lhe consLrucLlon of Lhls page) wlll appear LlghLer (wlLh less of a
space beLween Lhe doLs) Lhan Lhe use of perlodspaceperlodspaceperlod

When words aL Lhe beglnnlng of a quoLed senLence are omlLLed lL ls noL necessary Lo use an elllpsls Lo lndlcaLe LhaL
words have been lefL ouL when LhaL fragmenL can flL lnLo Lhe flow of your LexL An excepLlon ln a blockquoLed fragmenL
use an elllpsls Lo lndlcaLe an omlsslon

Accordlng Lo Culrk and Creenbaum Lhe dlsLlncLlons are unlmporLanL for counL nouns wlLh speclflc reference Lo
deflnlLe and lndeflnlLe pronouns
Powever lf Lhe maLerlal quoLed can be read as a compleLe senLence slmply caplLallze Lhe flrsL word of Lhe maLerlal and
leave ouL Lhe elllpsls marks

1hls prlnclple ls descrlbed by Culrk and Creenbaum
1he dlsLlncLlons for counL nouns wlLh speclflc reference Lo deflnlLe and lndeflnlLe pronouns remaln unlmporLanL
When a lengLhy quoLaLlon beglns wlLh a compleLe senLence and ends wlLh a compleLe senLence do noL use an elllpsls aL
elLher Lhe end or Lhe beglnnlng of Lhe quoLaLlon unless lL ls for some reason lmporLanL Lo emphaslze LhaL some
language has been omlLLed*

1he elllpsls should be regarded as one unlL and should noL be broken aL Lhe end of a llne 1oward LhaL end lL ls useful Lo
know Lhe code LhaL wlll creaLe an unbroken and unbreakable elllpsls for you on Lhe wordprocesslng program you are
uslng Cn mosL machlnes lLs a slmple maLLer of holdlng down Lhe opLlon key and hlLLlng Lhe semlcolon buL Lhls varles
from program Lo program 1o avold problems when you reformaL a paper (change marglns fonL slzes eLc) Lhe spaces
LhaL surround Lhe elllpsls should also be creaLed as nonbreaklng spaces

1he MLA Pandbook recommends uslng square brackeLs on elLher slde of Lhe elllpsls polnLs Lo dlsLlngulsh beLween an
elllpsls LhaL youve added and Lhe elllpses LhaL mlghL have been ln Lhe orlglnal LexL Such a brackeLed elllpsls ln a
quoLaLlon would look llke Lhls

8ohr used Lhe analogy of parallel sLalrways (SmlLh 33)
(CLher research manuals Lhe AA ubllcaLlon Manual and Lhe Chlcago Manual of SLyle do noL address Lhls use of
brackeLed elllpses)

1he plural of elllpsls ls elllpses (handy Lo remember when youre playlng Scrabble) buL Lhe polnLs Lhemselves (Lhe doLs
LhaL make up Lhe elllpsls) are called elllpsls polnLs or elllpsls marks

Je use an apostrophe ' to create possess|ve forms contract|ons and some p|ura|s (see be|ow) 1he apostrophe
shows where a leLLer or leLLers have been lefL ouL of a conLracLed verb

l am lm you are youre she ls shes lL ls lLs
do noL donL she would shed he would have he wouldve
leL us leLs who ls whos she wlll shell Lhey had Lheyd

WheLher or noL conLracLlons are approprlaLe ln academlc prose ls a maLLer of personal LasLe and debaLe See Lhe secLlon
on 1one for a dlscusslon of conLracLlons Also ask your lnsLrucLor before uslng conLracLlons ln a paper LhaL wlll be
graded

1hls Culde has an enLlre secLlon devoLed Lo a descrlpLlon of possesslves ?ou can cllck PL8L Lo go Lo LhaL secLlon (and
accompanylng qulzzes) or read Lhls summary

ln possesslves Lhe placemenL of Lhe aposLrophe depends on wheLher Lhe noun LhaL shows possesslon ls slngular or
plural Cenerally lf Lhe noun ls slngular Lhe aposLrophe goes before Lhe s 1he wlLchs broom lf Lhe noun ls plural Lhe
aposLrophe goes afLer Lhe s 1he wlLches brooms Powever lf Lhe word ls plurallzed wlLhouL an s Lhe aposLrophe
comes before Lhe s Pe enLered Lhe mens room wlLh an armload of chlldrens cloLhlng lf you creaLe a possesslve wlLh a
phrase llke of Lhe wlLches you wlll use no aposLrophe Lhe brooms of Lhe wlLches

8emember LhaL lLs means lL ls or lL has Confuslng lLs wlLh lLs Lhe possesslve of lL ls perhaps Lhe mosL common error ln
wrlLlng 8emember Loo LhaL Lhere ls no approprlaLe conLracLlon for Lhere are uonL confuse Lheyre whlch means
Lhey are wlLh Lhere are (whlch can sound llke Lherre or some such seL of rumbllng rs ln casual speech)

An aposLrophe ls also used Lo form some plurals especlally Lhe plural of leLLers and dlglLs 8aoul goL four As lasL Lerm
and hls slsLer goL four 6s ln Lhe lceskaLlng compeLlLlon 1hls ls parLlcularly useful when Lhe leLLer belng plurallzed ls ln
Lhe lower case mlndlng ones ps and qs or uonL forgeL Lo doL your ls (ln a conLexL ln whlch Lhe plural ls clear
aposLrophes afLer uppercase leLLers are noL necessary Pe goL four As Lwo 8s and Lhree Cs) lL ls no longer
consldered necessary or even correcL Lo creaLe Lhe plural of years or decades or abbrevlaLlons wlLh an aposLrophe

Pe wroLe several novels durlng Lhe 1930s
1here are flfLeen hus on our faculLy
My slsLer and l have ldenLlcal lCs
(lf you wroLe hu wlLh perlods you would add an aposLrophe before Lhe plurallzlng s hus) lf Lhe abbrevlaLlon or
acronym ends ln S lLs a good ldea Lo separaLe Lhls flnal S from Lhe plurallzlng s wlLh an aposLrophe SCSs


Use quotat|on marks " " to set off mater|a| that represents quoted or spoken |anguage uotat|on marks a|so set
off Lhe LlLles of Lhlngs LhaL do noL normally sLand by Lhemselves shorL sLorles poems and arLlcles usually a quoLaLlon
ls seL off from Lhe resL of Lhe senLence by a comma however Lhe Lypography of quoLed maLerlal can become qulLe
compllcaLed Pere ls one slmple rule Lo remember

ln Lhe unlLed SLaLes perlods and commas go lnslde quoLaLlon marks regardless of loglc Cllck PL8L for an explanaLlon
(sorL of)
ln Lhe unlLed klngdom Canada and lslands under Lhe lnfluence of 8rlLlsh educaLlon puncLuaLlon around quoLaLlon
marks ls more apL Lo follow loglc ln Amerlcan sLyle Lhen you would wrlLe My favorlLe poem ls 8oberL lrosLs ueslgn
8uL ln Lngland you would wrlLe My favorlLe poem ls 8oberL lrosLs ueslgn 1he placemenL of marks oLher Lhan perlods
and commas follows Lhe loglc LhaL quoLaLlon marks should accompany (be rlghL nexL Lo) Lhe LexL belng quoLed or seL
aparL as a LlLle 1hus you would wrlLe (on elLher slde of Lhe ALlanLlc)

WhaL do you Lhlnk of 8oberL lrosLs ueslgn? and
l love ueslgn however my favorlLe poem was wrlLLen by Lmlly ulcklnson
lurLher puncLuaLlon around quoLed speech or phrases depends on how lL flLs lnLo Lhe resL of your LexL lf a quoLed word
or phrase flLs lnLo Lhe flow of your senLence wlLhouL a break or pause Lhen a comma may noL be necessary

1he phrase lovely dark and deep beglns Lo suggesL omlnous overLones
lollowlng a form of Lo say however youll almosL always need a comma

My faLher always sald 8e careful whaL you wlsh for
lf Lhe quoLed speech follows an lndependenL clause yeL could be parL of Lhe same senLence use a colon Lo seL off Lhe
quoLed language

My moLhers favorlLe quoLe was from Shakespeare 1hls above all Lo Lhlne own self be Lrue
When an aLLrlbuLlon of speech comes ln Lhe mlddle of quoLed language seL lL aparL as you would any parenLheLlcal
elemenL

l donL care she sald whaL you Lhlnk abouL lL
8e careful Lhough Lo begln a new senLence afLer Lhe aLLrlbuLlon lf sense calls for lL

l donL care she sald WhaL do you Lhlnk?
ConvenLlon normally lnslsLs LhaL a new paragraph beglns wlLh each change of speaker

l donL care whaL you Lhlnk anymore she sald [aunLlly Losslng back her halr and looklng askance aL Ldward
WhaL do you mean? he replled
WhaL do you mean WhaL do l mean? AlberLa snlffed She was becomlng lmpaLlenL and wlshed LhaL she were
elsewhere
?ou know darn well whaL l mean! Ldward huffed
Pave lL your way AlberLa added lf LhaLs how you feel
ln proofreadlng and edlLlng your wrlLlng remember LhaL quoLaLlon marks always Lravel ln palrs! Well almosL always
When quoLed dlalogue carrles from one paragraph Lo anoLher (and Lo anoLher and anoLher) Lhe closlng quoLaLlon mark
does noL appear unLll Lhe quoLed language flnally ends (alLhough Lhere ls a beglnnlng quoLaLlon mark aL Lhe sLarL of each
new quoLed paragraph Lo remlnd Lhe reader LhaL Lhls ls quoLed language) Also ln parenLheLlcal documenLaLlon (see Lhe
Culde Lo WrlLlng 8esearch apers) Lhe perlod comes afLer Lhe parenLheLlcal clLaLlon whlch comes afLer Lhe quoLaLlon
mark (uarllng 333)

ln reporLlng sllenL speechnoLlng LhaL language ls sald buL lnLernally and noL spoken ouL loudwrlLers are on Lhelr
own WrlLers can puL quoLaLlon marks around lL or noL

Ch whaL a beauLlful mornlng Curly sald Lo hlmself
Ch whaL a beauLlful mornlng! Curly sald Lo hlmself
Some wrlLers wlll seL such unspoken language ln lLallcs or lndenL lL ln order Lo seL lL off from oLher regular language
1haLs probably noL a good ldea lf Lhere ls a loL of lL because Lhe lndenLs can be confuslng and lLallcs can become
Llresome Lo read afLer a whlle 1he declslon wlll probably depend on Lhe amounL of sllenL speech wlLhln Lhe LexL
robably Lhe besL way Lo handle sllenL speech ls Lo flnd an auLhor whom you llke who does a loL of LhlsCraham SwlfL
ln hls novel LasL Crders for lnsLanceand copy LhaL auLhors sLyle ConslsLency of course ls very lmporLanL

8e careful noL Lo use quoLaLlon marks ln an aLLempL Lo emphaslze a word (Lhe klnd of Lhlng you see ln grocery sLore
wlndows8lg Sale 1oday!) underllne or lLallclze LhaL word lnsLead (1he quoLaLlon marks wlll suggesL Lo some people
LhaL you are uslng LhaL word ln a speclal or pecullar way and LhaL you really mean someLhlng elseor LhaL your sale ls
enLlrely bogus)

1he Amerlcan Medlcal AssoclaLlon Manual of SLyle (9Lh ed 1998) calls mlsused quoLaLlon marks llke Lhls ApologeLlc
CuoLaLlon Marks and says

CuoLaLlon marks used around words Lo glve speclal effecL or Lo lndlcaLe lrony are usually unnecessary When lrony or
speclal effecL ls lnLended sklllful preparaLlon can Lake Lhe place of uslng Lhese quoLes 8esorL Lo apologeLlc quoLaLlon
marks or quoLaLlon marks used Lo express lrony only afLer such aLLempLs have falled keeplng ln mlnd LhaL Lhe besL
wrlLlng does noL rely on apologeLlc quoLaLlon marks (p 220)
8efer Lo CaplLals Culde for WrlLlng 8esearch apers and especlally Lhe Lngllsh faculLys SuggesLlons for WrlLlng apers
for LlLeraLure Courses for furLher help ln handllng quoLaLlons

We do noL enclose lndlrecL quoLaLlons ln quoLaLlon marks An lndlrecL quoLaLlon reporLs whaL someone says buL noL ln
Lhe exacL orlglnal language lndlrecL quoLaLlons are noL heard ln Lhe same way LhaL quoLed language ls heard

1he resldenL sald LhaL nAl1A would evenLually be a boon Lo small buslnesses ln boLh counLrles
rofessor vllla Lold her sLudenLs Lhe LexLbooks were noL yeL ln Lhe booksLore
uouble uncLuaLlon wlLh CuoLaLlons

Cccaslonally very occaslonally we hope we come across a senLence LhaL seems Lo demand one klnd of puncLuaLlon
mark wlLhln quoLaLlon marks and anoLher klnd of puncLuaLlon mark ouLslde Lhe quoLaLlon marks A klnd of pecklng
order of puncLuaLlon marks Lakes over oLher marks are sLronger Lhan a perlod and an exclamaLlon mark ls usually
sLronger Lhan a quesLlon mark lf a sLaLemenL ends ln a quoLed quesLlon allow Lhe quesLlon mark wlLhln Lhe quoLaLlon
marks sufflce Lo end Lhe senLence

Malcolm x had Lhe courage Lo ask Lhe younger generaLlon of Amerlcan blacks WhaL dld we do who preceded you?
Cn Lhe oLher hand lf a quesLlon ends wlLh a quoLed sLaLemenL LhaL ls noL a quesLlon Lhe quesLlon mark wlll go ouLslde
Lhe closlng quoLaLlon mark

Who sald lame means when your compuLer modem ls broken Lhe repalr guy comes ouL Lo your house a llLLle fasLer?
lf a quesLlon ends wlLh a quoLaLlon conLalnlng an exclamaLlon mark Lhe exclamaLlon mark wlll supersede Lhe quesLlon
and sufflce Lo end Lhe senLence

WasnL lL Malcolm x who declared Why LhaLs Lhe mosL hypocrlLlcal governmenL slnce Lhe world began!
A slngle quesLlon mark wlll sufflce Lo end a quoLed quesLlon wlLhln a quesLlon

uldnL he ask WhaL dld we do who preceded you? querled !ohnson
AuLhorlLy for Lhls secLlon new ?ork ubllc Llbrary WrlLers Culde Lo SLyle and usage ParperColllns new ?ork 1994 277
ClLed wlLh permlsslon examples our own

S|ng|e uotat|on Marks
ln Lhe unlLed SLaLes we use slngle quoLaLlon marks ' ' Lo enclose quoLed maLerlal (or Lhe LlLles of poems sLorles
arLlcles) wlLhln oLher quoLed maLerlal

ueslgn ls my favorlLe poem he sald
uld she ask WhaLs golng on?
8alph Llllson recalls Lhe Colden Age of !azz Lhls way lL was lLself a LexLure of fragmenLs repeLlLlve nervous noL fully
formed lLs melodlc llnes underground secreL and LaunLlng lLs rlffs [eerlngSalL peanuLs! SalL peanuLs!
8rlLlsh pracLlce agaln ls qulLe dlfferenL ln facL slnglequoLe marks and doublequoLe marks are apL Lo be reversed ln
usage lnsLrucLors ln Lhe uS should probably Lake Lhls lnLo accounL when readlng papers submlLLed by sLudenLs who
have gone Lo school ln oLher parLs of Lhe globe

ln newspapers slngle quoLaLlon marks are used ln headllnes where double quoLaLlon marks would oLherwlse appear

Congress Crles Shame!
ln some flelds key Lerms may be seL aparL wlLh slnglequoLe marks ln such cases perlods and commas go ouLslde Lhe
slnglequoLe marks

SarLres LreaLmenL of belng as opposed Lo hls LreaLmenL of nonbelng has been Lhoroughly descrlbed ln kaufmanns
book
When Lhe Lerm ls casesenslLlve caplLallzaLlon remalns unchanged desplLe placemenL ln Lhe senLence

Lx_send deLermlnes wheLher Lhe slgnal wlll be ouLpuL Lhrough 1x CuLpuL orL
lf Lhe consLanL 8LC_8LSL1 ls seL Lhen reseLs wlll be reglsLered

/A s|ash or s|ant or so||dus or v|rgu|e ] (take your p|ck of names) |s used to |nd|cate a cho|ce between the words |t
separates

uslng Lhe pass/fall opLlon backflred on her she couldve goLLen an A
1he slash can be LranslaLed as or and should noL be used where Lhe word or could noL be used ln lLs place 1o avold
gender problems wlLh pronouns some wrlLers use he/she hls/her and hlm/her Many auLhorlLles desplse LhaL
consLrucLlon and urge wrlLers elLher Lo plurallze when posslble and approprlaLe (Lo Lhey Lhelr Lhem) or Lo use he or
she eLc lnsLead noLlce Lhere ls no space beLween Lhe slash and Lhe leLLers on elLher slde of lL

1here ls however a space when Lhe slash ls used Lo lndlcaLe a llnebreak ln quoLed poeLry 1he woods are lovely dark
and deep / buL l have promlses Lo keep (1hls way of quoLlng poeLry ls llmlLed Lo four or flve llnes of verse wlLhln Lhe
normal flow of LexL)

When uslng slashes ln a unlform 8esource LocaLor (u8L) for a World Wlde Web address
(hLLp//wwwccccommneLedu/grammar/) be especlally sure noL Lo lnclude spaces and noL Lo confuse Lhe slash wlLh lLs
backward cousln used as a paLh separaLor ln Wlndows (for example cprogram fllesAdobe)
Use a comma to separate the e|ements |n a ser|es (three or more th|ngs) |nc|ud|ng the |ast two ne h|t the ba||
dropped Lhe baL and ran Lo flrsL base ?ou may have learned LhaL Lhe comma before Lhe and ls unnecessary whlch ls
flne lf youre ln conLrol of Lhlngs Powever Lhere are slLuaLlons ln whlch lf you donL use Lhls comma (especlally when
Lhe llsL ls complex or lengLhy) Lhese lasL Lwo lLems ln Lhe llsL wlll Lry Lo glom LogeLher (llke macaronl and cheese) uslng
a comma beLween all Lhe lLems ln a serles lncludlng Lhe lasL Lwo avolds Lhls problem 1hls lasL commaLhe one
beLween Lhe word and and Lhe precedlng wordls ofLen called Lhe serlal comma or Lhe Cxford comma ln newspaper
wrlLlng lncldenLally you wlll seldom flnd a serlal comma buL LhaL ls noL necessarlly a slgn LhaL lL should be omlLLed ln
academlc prose

use a comma + a llLLle con[uncLlon (and buL for nor yeL or so) Lo connecL Lwo lndependenL clauses as ln Pe hlL Lhe
ball well buL he ran Loward Lhlrd base

ConLendlng LhaL Lhe coordlnaLlng con[uncLlon ls adequaLe separaLlon some wrlLers wlll leave ouL Lhe comma ln a
senLence wlLh shorL balanced lndependenL clauses (such as we see ln Lhe example [usL glven) lf Lhere ls ever any doubL
however use Lhe comma as lL ls always correcL ln Lhls slLuaLlon

Cne of Lhe mosL frequenL errors ln comma usage ls Lhe placemenL of a comma afLer a coordlnaLlng con[uncLlon We
cannoL say LhaL Lhe comma wlll always come before Lhe con[uncLlon and never afLer buL lL would be a rare evenL
lndeed LhaL we need Lo follow a coordlnaLlng con[uncLlon wlLh a comma When speaklng we do someLlmes pause afLer
Lhe llLLle con[uncLlon buL Lhere ls seldom a good reason Lo puL a comma Lhere

use a comma Lo seL off lnLroducLory elemenLs as ln 8unnlng Loward Lhlrd base he suddenly reallzed how sLupld he
looked

lL ls permlsslble Lo omlL Lhe comma afLer a brlef lnLroducLory elemenL lf Lhe omlsslon does noL resulL ln confuslon or
heslLancy ln readlng lf Lhere ls ever any doubL use Lhe comma as lL ls always correcL lf you would llke some addlLlonal
guldellnes on uslng a comma afLer lnLroducLory elemenLs cllck PL8L

use a comma Lo seL off parenLheLlcal elemenLs as ln 1he lounders 8rldge whlch spans Lhe ConnecLlcuL 8lver ls falllng
down 8y parenLheLlcal elemenL we mean a parL of a senLence LhaL can be removed wlLhouL changlng Lhe essenLlal
meanlng of LhaL senLence 1he parenLheLlcal elemenL ls someLlmes called added lnformaLlon 1hls ls Lhe mosL dlfflculL
rule ln puncLuaLlon because lL ls someLlmes unclear whaL ls added or parenLheLlcal and whaL ls essenLlal Lo Lhe
meanlng of a senLence

ApposlLlves are almosL always LreaLed as parenLheLlcal elemenLs

Calhouns amblLlon Lo become a goalle ln professlonal soccer ls wlLhln hls reach
Lleanor hls wlfe of LhlrLy years suddenly declded Lo open her own buslness
SomeLlmes Lhe apposlLlve and Lhe word lL ldenLlfles are so closely relaLed LhaL Lhe comma can be omlLLed as ln Pls
wlfe Lleanor suddenly declded Lo open her own buslness We could argue LhaL Lhe name Lleanor ls noL essenLlal Lo
Lhe meanlng of Lhe senLence (assumlng he has only one wlfe) and LhaL would suggesL LhaL we can puL commas boLh
before and afLer Lhe name (and LhaL would lndeed be correcL) 8uL hls wlfe and Lleanor are so close LhaL we can
regard Lhe enLlre phrase as one unlL and leave ouL Lhe commas WlLh Lhe phrase Lurned around however we have a
more deflnlLe parenLheLlcal elemenL and Lhe commas are necessary Lleanor hls wlfe suddenly declded Lo open her
own buslness Conslder also Lhe dlfference beLween College resldenL lra 8ubenzahl voLed Lo resclnd Lhe wlLhdrawal
pollcy (ln whlch we need Lhe name lra 8ubenzahl or Lhe senLence doesnL make sense) and lra 8ubenzahl Lhe
college presldenL voLed Lo resclnd Lhe wlLhdrawal pollcy (ln whlch Lhe senLence makes sense wlLhouL hls LlLle Lhe
apposlLlve and we LreaL Lhe apposlLlve as a parenLheLlcal elemenL wlLh a palr of commas)

As polnLed ouL above (8ule #3) an adverblal clause LhaL beglns a senLence ls seL off wlLh a comma

AlLhough CueasybreaLh had spenL several years ln AnLarcLlca he sLlll bundled up warmly ln Lhe brlsk auLumns of Chlo
8ecause 1ashonda had learned Lo sLudy by herself she was able Lo pass Lhe enLrance exam
When an adverblal clause comes laLer on ln Lhe senLence however Lhe wrlLer musL deLermlne lf Lhe clause ls essenLlal
Lo Lhe meanlng of Lhe senLence or noL A because clause can be parLlcularly Lroublesome ln Lhls regard ln mosL
senLences a because clause ls essenLlal Lo Lhe meanlng of Lhe senLence and lL wlll noL be seL off wlLh a comma

1he Ckles had Lo leave Lhelr farms ln Lhe mldwesL because Lhe droughL condlLlons had rulned Lhelr farms
SomeLlmes Lhough Lhe because clause musL be seL off wlLh a comma Lo avold mlsreadlng

l knew LhaL resldenL nlxon would reslgn LhaL mornlng because my slsLerlnlaw worked ln Lhe WhlLe Pouse and she
called me wlLh Lhe news
WlLhouL LhaL comma Lhe senLence says LhaL nlxons reslgnaLlon was Lhe faulL of my slsLerlnlaw nlxon dld noL reslgn
because my slsLerlnlaw worked ln Lhe WhlLe Pouse so we seL off LhaL clause Lo make Lhe meanlng clearly
parenLheLlcal

When a parenLheLlcal elemenL an lnLer[ecLlon adverblal modlfler or even an adverblal clause follows a
coordlnaLlng con[uncLlon used Lo connecL Lwo lndependenL clauses we do noL puL a comma ln fronL of Lhe parenLheLlcal
elemenL

1he 8ed Sox were leadlng Lhe league aL Lhe end of May buL of course Lhey always do well ln Lhe sprlng no comma
afLer buL
1he ?ankees dldnL do so well ln Lhe early golng buL frankly everyone expecLs Lhem Lo wln Lhe season no comma afLer
buL
1he 1lgers spenL much of Lhe season aL Lhe boLLom of Lhe league and even Lhough Lhey plcked up several promlslng
rookles Lhey expecL Lo be Lhere agaln nexL year no comma afLer and
(1hls lasL plece of advlce relles on Lhe auLhorlLy of Wllllam SLrunks LlemenLs of SLyle Lxamples our own)

When boLh a clLys name and LhaL clLys sLaLe or counLrys name are menLloned LogeLher Lhe sLaLe or counLrys name ls
LreaLed as a parenLheLlcal elemenL

We vlslLed ParLford ConnecLlcuL lasL summer
arls lrance ls someLlmes called 1he ClLy of LlghLs
When Lhe sLaLe becomes a possesslve form Lhls rule ls no longer followed

ParLford ConnecLlcuLs lnvesLmenL ln Lhe lnsurance lndusLry ls well known
Also when Lhe sLaLe or counLrys name becomes parL of a compound sLrucLure Lhe second comma ls dropped

Peubleln a ParLford ConnecLlcuLbased company ls movlng Lo anoLher sLaLe
An absoluLe phrase ls always LreaLed as a parenLheLlcal elemenL as ls an lnLer[ecLlon An addressed persons name ls
also always parenLheLlcal 8e sure however LhaL Lhe name ls LhaL of someone acLually belng spoken Lo A separaLe
secLlon on vocaLlves Lhe varlous forms LhaL a parenLheLlcal elemenL relaLed Lo an addressed persons name can Lake ls
also avallable

1helr years of Lralnlng now forgoLLen Lhe soldlers broke ranks
?es lL ls always a maLLer of course of preparaLlon and aLLlLude
lm Lelllng you !uanlLa l couldnL be more surprlsed (l Lold !uanlLa l couldnL be more surprlsed no commas)

use a comma Lo separaLe coordlnaLe ad[ecLlves ?ou could Lhlnk of Lhls as 1haL Lall dlsLlngulshed good looklng fellow
rule (as opposed Lo Lhe llLLle old lady) lf you can puL an and or a buL beLween Lhe ad[ecLlves a comma wlll probably
belong Lhere lor lnsLance you could say Pe ls a Lall and dlsLlngulshed fellow or l llve ln a very old and rundown
house So you would wrlLe Pe ls a Lall dlsLlngulshed man and l llve ln a very old rundown house 8uL you would
probably noL say She ls a llLLle and old lady or l llve ln a llLLle and purple house so commas would noL appear
beLween llLLle and old or beLween llLLle and purple

And whaL does a comma do a comma does noLhlng buL make easy a Lhlng LhaL lf you llke lL enough ls easy enough
wlLhouL Lhe comma A long compllcaLed senLence should force lLself upon you make you know yourself knowlng lL and
Lhe comma well aL Lhe mosL a comma ls a poor perlod LhaL leLs you sLop and Lake a breaLh buL lf you wanL Lo Lake a
breaLh you oughL Lo know yourself LhaL you wanL Lo Lake a breaLh lL ls noL llke sLopplng alLogeLher has someLhlng Lo do
wlLh golng on buL Laklng a breaLh well you are always Laklng a breaLh and why emphaslze one breaLh raLher Lhan
anoLher breaLh Anyway LhaL ls Lhe way l felL abouL lL and l felL LhaL abouL lL very very sLrongly And so l almosL never
used a comma 1he longer Lhe more compllcaLed Lhe senLence Lhe greaLer Lhe number of Lhe same klnds of words l had
followlng one afLer anoLher Lhe more Lhe very more l had of Lhem Lhe more l felL Lhe passlonaLe need of Lhelr Laklng
care of Lhemselves by Lhemselves and noL helplng Lhem and Lhereby enfeebllng Lhem by puLLlng ln a comma
So LhaL ls Lhe way l felL abouL puncLuaLlon ln prose ln poeLry lL ls a llLLle dlfferenL buL more so
CerLrude SLeln
from LecLures ln Amerlca

use a comma Lo seL off quoLed elemenLs 8ecause we donL use quoLed maLerlal all Lhe Llme even when wrlLlng Lhls ls
probably Lhe mosL dlfflculL rule Lo remember ln comma usage lL ls a good ldea Lo flnd a page from an arLlcle LhaL uses
several quoLaLlons phoLocopy LhaL page and keep lL ln fronL of you as a model when youre wrlLlng Cenerally use a
comma Lo separaLe quoLed maLerlal from Lhe resL of Lhe senLence LhaL explalns or lnLroduces Lhe quoLaLlon

Summlng up Lhls argumenL eLer Coveney wrlLes 1he purpose and sLrengLh of Lhe romanLlc lmage of Lhe chlld had
been above all Lo esLabllsh a relaLlon beLween chlldhood and adulL consclousness
lf an aLLrlbuLlon of a quoLed elemenL comes ln Lhe mlddle of Lhe quoLaLlon Lwo commas wlll be requlred 8uL be careful
noL Lo creaLe a comma spllce ln so dolng

1he quesLlon ls sald Allce wheLher you can make words mean so many Lhlngs
l should llke Lo buy an egg please she sald Llmldly Pow do you sell Lhem?
8e careful noL Lo use commas Lo seL off quoLed elemenLs lnLroduced by Lhe word LhaL or quoLed elemenLs LhaL are
embedded ln a larger sLrucLure

eLer Coveney wrlLes LhaL Lhe purpose and sLrengLh of
We ofLen say Sorry when we donL really mean lL
And lnsLead of a comma use a colon Lo seL off explanaLory or lnLroducLory language from a quoLed elemenL LhaL ls
elLher very formal or long (especlally lf lLs longer Lhan one senLence)

eLer Coveney had Lhls Lo say abouL Lhe nlneLeenLhcenLurys use of chlldren
ln flcLlon 1he purpose and sLrengLh of

use commas Lo seL off phrases LhaL express conLrasL

Some say Lhe world wlll end ln lce noL flre
lL was her money noL her charm or personallLy LhaL flrsL aLLracLed hlm
1he pupples were cuLe buL very messy
(Some wrlLers wlll leave ouL Lhe comma LhaL seLs off a conLrasLlng phrase beglnnlng wlLh buL)
use a comma Lo avold confuslon 1hls ls ofLen a maLLer of conslsLenLly applylng rule #3

lor mosL Lhe year ls already flnlshed
lor mosL Lhe year ls already flnlshed
CuLslde Lhe lawn was cluLLered wlLh hundreds of broken branches
CuLslde Lhe lawn was cluLLered wlLh hundreds of broken branches
l have spenL mosL of Lhe day puLLlng ln a comma and Lhe resL of Lhe day Laklng lL ouL
Cscar Wllde

Crammar Lngllshs lamous 8ule of uncLuaLlon never use only one comma beLween a sub[ecL and lLs verb 8ellevlng
compleLely and poslLlvely ln oneself ls essenLlal for success AlLhough readers mlghL pause afLer Lhe word oneself
Lhere ls no reason Lo puL a comma Lhere

1ypographlcal 8easons 8eLween a clLy and a sLaLe ParLford ConnecLlcuL a daLe and Lhe year !une 13 1997 a name
and a LlLle when Lhe LlLle comes afLer Lhe name 8ob uowney rofessor of Lngllsh ln long numbers 3436783 and
$14682 eLc AlLhough you wlll ofLen see a comma beLween a name and sufflx 8ob uowney !r 8lchard Parrlson lll
Lhls comma ls no longer regarded as necessary by mosL copy edlLors and some lndlvlduals such as MarLln LuLher
klng !r never used a comma Lhere aL all

noLe LhaL we use a comma or a seL of commas Lo make Lhe year parenLheLlcal when Lhe daLe of Lhe monLh ls lncluded

!uly 4 1776 ls regarded as Lhe blrLh daLe of Amerlcan llberLy
WlLhouL Lhe daLe lLself however Lhe comma dlsappears

!uly 1776 was one of Lhe mosL evenLful monLhs ln our hlsLory
ln lnLernaLlonal or mlllLary formaL no commas are used

1he ueclaraLlon of lndependence was slgned on 4 !uly 1776
use Commas WlLh CauLlon
As you can see Lhere are many reasons for uslng commas and we havenL llsLed Lhem all ?eL Lhe blggesL problem LhaL
mosL sLudenLs have wlLh commas ls Lhelr overuse Some essays look as Lhough Lhe sLudenL loaded a shoLgun wlLh
commas and blasLed away 8emember Loo LhaL a pause ln readlng ls noL always a rellable reason Lo use a comma 1ry
noL Lo use a comma unless you can apply a speclflc rule from Lhls page Lo do so


ConcenLraLlng on Lhe proper use of commas ls noL mere form for forms sake lndeed lL causes wrlLers Lo revlew Lhelr
undersLandlng of sLrucLure and Lo conslder carefully how Lhelr senLences are crafLed


enero/ tips for proofinq
8ead lL ouL loud and also sllenLly
8ead lL backwards Lo focus on Lhe spelllng of words
8ead lL upslde down Lo focus on Lypology
use a spell checker and grammar checker as a flrsL screenlng buL donL depend on Lhem
Pave oLhers read lL
8ead lL slowly
use a screen (a blank sheeL of paper Lo cover Lhe maLerlal noL yeL proofed)
olnL wlLh your flnger Lo read one word aL a Llme
uonL proof for every Lype of mlsLake aL oncedo one proof for spelllng anoLher for mlsslng/addlLlonal spaces
conslsLency of word usage fonL slzes eLc
keep a llsL of your mosL common errors (or of Lhe wrlLers you are prooflng) and proof for Lhose on separaLe Lrlps
lf you are edlLlng wlLhln Word use Lhe Lrack changes or mark changes funcLlon Lo make your commenLs apparenL Lo
oLher revlewers (addlLlons and deleLlons can be seL Lo appear ln dlfferenL colors)
rlnL lL ouL and read lL
8ead down columns ln a Lable even lf youre supposed Lo read across Lhe Lable Lo use Lhe lnformaLlon Columns may be
easler Lo deal wlLh Lhan rows
use edlLors flags uL #s ln Lhe documenL where revlewers need Lo pay speclal aLLenLlon or nexL Lo lLems LhaL need Lo
be doublechecked before Lhe flnal proof prlnL uo a flnal search for all # flags and remove Lhem
Clve a copy of Lhe documenL Lo anoLher person and keep a copy yourself 1ake Lurns readlng lL ouL loud Lo each oLher
Whlle one of you reads Lhe oLher one follows along Lo caLch any errors and awkwardsoundlng phrases 1hls meLhod
also works well when prooflng numbers and codes
llrsL proof Lhe body of Lhe LexL 1hen go back and proof Lhe headlngs Peadlngs are prone Lo error because copy edlLors
ofLen donL focus on Lhem
uouble check fonLs LhaL are unusual (lLallc bold or oLherwlse dlfferenL)
Carefully read Lype ln very Llny fonL
8e careful LhaL your eyes donL sklp from one error Lo Lhe nexL obvlous error mlsslng subLle errors ln beLween
uouble check proper names
uouble check llLLle words or of lL and ls are ofLen lnLerchanged
uouble check bollerplaLe LexL llke Lhe company leLLerhead !usL because lLs frequenLly used doesnL mean lLs been
carefully checked
uouble check whenever youre sure someLhlng ls rlghLcerLalnLy ls dangerous
Closely revlew page numbers and oLher fooLer/header maLerlal for accuracy and correcL order
LdlLlng for conLenL

Ask yourself who whaL when where why and how when readlng for conLenL uoes Lhe LexL answer all Lhe quesLlons
you Lhlnk lL should?
PlghllghL Lhe senLences LhaL besL answer Lhese quesLlons [usL so you can see lf Lhe facLs flow ln loglcal order
uo Lhe maLh do Lhe maLh and Lhen do Lhe maLh agaln Somewhere beLween Lhe screen and Lhe prlnLer 2+2 ofLen
becomes 3
Make a llsL of bugaboo words and do a search for Lhem before flnal proof lnclude every swear word words relaLed Lo
producL Lermlnology and oLher words LhaL pop up on occaslon 1hen do a flnd for all Lhese words
AcLually do every sLep ln procedures Lo make sure Lhey are compleLe accuraLe and ln correcL order
CounL Lhe number of sLeps a llsL promlses Lo make sure Lhey are all Lhere
Check LhaL flgure numbers maLch Lhelr references ln Lhe LexL and are sequenLlal
Check LhaL lllusLraLlons plcLographs and models are rlghLslde up
reparlng yourself Lo proof or edlL

WrlLe aL Lhe end of Lhe day edlL flrsL Lhlng ln Lhe mornlng (usually geLLlng some sleep ln beLween helps)
LlsLen Lo muslc or chew gum rooflng can be borlng buslness and lL doesnL requlre much crlLlcal Lhlnklng Lhough lL
does requlre exLreme focus and concenLraLlon AnyLhlng LhaL can relleve your mlnd of some of Lhe pressure whlle
allowlng you Lo sLlll keep focused ls a beneflL
uonL use fluorescenL llghLlng when prooflng 1he fllcker raLe ls acLually slower Lhan sLandard llghLlng ?our eyes canL
plck up lnconslsLencles as easlly under fluorescenL llghLlng
Spend a halfhour a monLh revlewlng grammar rules
8ead someLhlng else beLween edlLs 1hls helps clear your head of whaL you expecL Lo read and allows you Lo read whaL
really ls on Lhe page
Make a llsL of Lhlngs Lo waLch fora klnd of Lo do llsLas you edlL
hLLp//wwwlrcomcom/Llps/proofreadlng_edlLlnghLm

uo/ity 4ssuronce

We conslder our medlcal LranscrlpLlonlsL as medlcal language speclallsLs who musL possess a unlque seL of core
compeLencles ln order Lo converL volce Lo LexL Llke Slgn Language lnLerpreLers whaL goes lnLo Lhelr ears musL come ouL
Lhrough Lhelr flngers 8elow we have an overvlew of our Lechnology and quallLy conLrol lease feel free Lo conLacL us
wlLh any addlLlonal quesLlons CuallLy ls assured uslng

All Lranscrlbed LexL reporLs go Lhrough 3 levels of checklng by edlLors proof readers and medlcal edlLors Lo provlde 99
accuracy
We always use Lhe same LranscrlpLlon unlL for Lhe same offlce
1ranscrlpLlons are done uslng SofLware whlch lncludes
SLedmans elecLronlc medlcal dlcLlonary along wlLh Lhe enLlre range of SLedmans books
Amerlcan drug lndex
Cur own daLabase
We supporL MlcrosofL Word of MS Cfflce 97/98 and 2000 WorderfecL 9 Sound / Medla layers and converLers such as
ColdWave Wlndows medla player uvlS WlnAmp MSv lCS uvl uSS and C uarL layAll are all used LhaL allow
ad[usLmenL of plLch and speed for more accuraLe LranscrlpLlon

**************************************************************************************
ersona| nea|th kecords
Jhat k|nd of |nformat|on wou|d you put |n a persona| hea|th record? ou cou|d start w|th

?our name blrLh daLe blood Lype and emergency conLacL
uaLe of lasL physlcal
uaLes and resulLs of LesLs and screenlngs
Ma[or lllnesses and surgerles wlLh daLes
A llsL of your medlclnes dosages and how long youve Laken Lhem
Any allergles
Any chronlc dlseases
Any hlsLory of lllnesses ln your famlly

n|story And hys|ca|
PlsLoryphyslcals are generally developed aL Lhe enLry level Lhe flrsL Llme Lhe docLor sees and examlnes a paLlenL A
hlsLory ls done (whaL has happened Lo Lhe paLlenL ln Lhe currenL problem and any relaLlve pasL hlsLory) and Lhe physlcal
examlnaLlon ls ( performed Lhls lnformaLlon ls Lhen dlcLaLed PlsLoryphyslcals may lnclude Lhe headlngs as llsLed
below 1he abbrevlaLlon ls someLlmes used (dependlng on Lhe cllenL) raLher Lhan Lhe full formal headlng ln Lhe reporLs
ln Lhls volume when an abbrevlaLlon ls used we have aLLempLed Lo deflne lLs meanlng ln parenLhesls followlng Lhe
headlng CLher headlngs as you wlll see are spelled ouL and are generally all ln caplLal leLLers and may or may noL be ln
boldface Lype or underllned agaln dependlng on Lhe preferences of Lhe pracLlce or Lhe hosplLal

PlS1C8? Anu P?SlCAL A maln headlng only noLe LhaL Lhe hlsLory porLlon relaLes Lo Lhe paLlenLs sub[ecLlve accounL
of hls/her currenL condlLlon or lllness whereas Lhe physlcal porLlon focuses on Lhe ob[ecLlve characLerlsLlcs or flndlngs
of Lhe paLlenLs condlLlon or lllness usually by Lhe physlclan

uA1L 1he daLe of Lhe examlnaLlon

CC (Chlef ComplalnL) WhaL Lhe paLlenL sub[ecLlvely sLaLes ls wrong

Pl (PlsLory of resenL lllness) WhaL Lhe currenL dlsease process or ln[ury ls as relaLed Lo Lhe chlef complalnL
necesslLaLlng Lhls parLlcular workup

MP (asL Medlcal PlsLory) WhaL Lhe paLlenLs problems or dlagnoses have been ln Lhe pasL boLh medlcal and surglcal
and any pregnancy or gynecologlc hlsLory lf slgnlflcanL Lo Lhls workup

lP (lamlly PlsLory) 1he lmmedlaLe famlly's medlcal problems and geneLlc predlsposlLlon Lo problems or dlseases

SP (Soclal PlsLory) 1he paLlenLs educaLlon work marlLal sLaLus chlldren hablLs such as smoklng drlnklng drugs and
may even lnclude hobbles and recreaLlonal acLlvlLles

8CS (8evlew of SysLems) 1he revlew of Lhe sysLems of Lhe body

MLulCA1lCnS Any medlcaLlons paLlenL ls currenLly uslng elLher prescrlbed or over Lhe counLer

ALLL8ClLS noLable allerglc reacLlons parLlcularly Lo medlcaLlons and food producLs

L (hyslcal LxamlnaLlon) Maln headlng 1he L ls composed of Lhe followlng four Lypes of evaluaLlon

vlsual whaL ls seen
audlLory or aural whaL ls heard
olfacLory whaL ls sensed by Lhe nose and
LacLlle whaL ls felL

1he examlnaLlon should lnclude

CLnL8AL Pow Lhe paLlenL appears Lo Lhe examlner
vl1AL SlCnS 1emperaLure pulse resplraLlons blood pressure helghL and welghL
Skln 1urgor colon Lone eLc
PLLn1 Pead eyes ears nose and LhroaL
nLCk ulses Lhyrold
CPLS1 lncludes hearL (cardlac) lungs breasLs
A8uCMLn lncludes exam of Lhe palpable lnLernal organs
CLnl1ALlA Male/lemale anaLomy appearance
8LC1AL 1one hemorrholds
Lx18LMl1lLS Arms hands legs feeL
nLu8CLCClC neurologlc examlnaLlon/LesLlng

LA8C8A1C8? uA1A Any lnLercurrenL labs whlch have been obLalned aL elLher Lhe a offlce by Lhe referrlng physlclan or
Lhe hosplLal ouLpaLlenL/lnpaLlenL deparLmenL

lM8LSSlCn Maln headlng WhaL Lhe examlner Lhlnks ls wrong wlLh Lhe paLlenL SomeLlmes Lhls appears as 8C8LLM
ln a 8C8LLMC8lLn1Lu record llsLlng each problem numerlcally and dlscusslng lL ln Lhe order presenLed

LAn Maln headlng 1he furLher workup (dlagnosLlc LesLs eLc) of Lhe problem(s) whaL medlcaLlon or surgery ls
anLlclpaLed reLurn vlslLs requlred or anLlclpaLed referral Lo oLher provlders eLc


common rommor /unders
advlce oplnlon eg l gave Lhe paLlenL advlce regardlng her dleL

advlse Lo offer advlce counsel eg l advlsed Lhe paLlenL Lo resume her regular acLlvlLles

clLe Lo quoLe l clLed LrnesL Pemlngway ln my speech

slghL ablllLy Lo see 1he paLlenL's slghL ls dlmlnlshed ln Lhe lefL eye

slLe locaLlon or Lo locaLe (v) 1he wound slLe ls heallng well

dlscreeL showlng prudence eg She was dlscreeL when addresslng Sally's Lardlness

dlscreLe dlsLlncL eg l palpaLed no dlscreLe masses

ellclL Lo brlng abouL or lnduce eg lorward bendlng dld noL ellclL Lhe paLlenL's back paln

llllclL unlawful eg 1he paLlenL denles use of llllclL drugs

lL's conLracLlon eg lL's really hoL ln here

lLs possesslve eg l puL Lhe book back ln lLs proper place

loose noL resLralned eg Per bowel movemenLs have been loose ln conslsLency

lose Lo mlslay or noL keep eg l'd love Lo lose 10 pounds before Lhe reunlon

prlnclpal hlghesL ln lmporLance chlef eg 1he prlnclpal dlagnosls ls congesLlve hearL fallure

prlnclple a rule or sLandard ur SmlLh ls a man of prlnclple

subLle sllghL eluslve l gave my husband subLle remlnders abouL our annlversary

supple flexlble 1he paLlenL's neck ls supple

Lhan used Lo lnLroduce a second elemenL or clause eg Sally has more caLs Lhan 8lll

Lhen aL LhaL Llme nexL ln order besldes eg She Lhen wlll need an ulLrasound of Lhe gallbladder

verses a rhyLhmlcal composlLlon eg 1he poem conLalned Lhree verses

versus agalnsL eg ulagnosls ls bronchlLls versus pneumonla

********************************************************************************************
common rommor ond spe//inq Mistokes
LffecLlve wrlLLen communlcaLlon relles on correcL grammar and spelllng Avoldlng common mlsspelllngs and
grammaLlcal errors ensures LhaL your wrlLlng ls clear preclse and comprehenslble 8eaders ofLen do noL noLlce good
grammar because Lhe LexL ls easlly undersLood and en[oyable Lo read buL Lhey do noLlce confuslng grammaLlcal errors
LhaL force Lhem Lo reread LexL and fumble for Lhe auLhor's meanlng uncLuaLlon equally affecLs Lhe readablllLy of a
LexL a mlsplaced comma or aposLrophe can change Lhe meanlng of a senLence ofLen ln confuslng ways CorrecL
grammar and spelllng makes a poslLlve lmpresslon on readers whlch ls parLlcularly lmporLanL ln buslness and academlc
communlcaLlons

Common Lrrors Common grammar and spelllng errors explalned lncludes frequenLly confused words
Crammar and SLyle Culde CorrecLs common grammar errors and glves sLyle suggesLlons
Crammar and usage Pelp PandouLs on commonly mlsspelled words spelllng hlnLs grammar and puncLuaLlon
explanaLlons and oLher wrlLlng Llps
uncLuaLlon SynLax usage and SLyle A gulde Lo grammar usage and sLyle
Spelllng mlsLakes and Lypographlcal errors make wrlLLen communlcaLlon dlfflculL Lo read and undersLand Spelllng errors
ln academlc and buslness documenLs such as resumes and leLLers can make Lhe documenL appear unprofesslonal
uslng an auLomaLed spellchecker wlll caLch many spelllng mlsLakes buL noL all PandwrlLLen LexLs such as leLLers
cards and some academlc exams musL be wrlLLen wlLhouL Lhe beneflL of auLomaLlc spellcheck and Lhe wrlLer musL be
equlpped Lo check hls own spelllng lamlllarlLy wlLh Lhe followlng commonly mlsspelled words ls useful for all wrlLers

Welrd LssenLlal spelllng rules lncludlng an explanaLlon of Lhe rules governlng welrd" Welrd" ls an excepLlon Lo Lhe
rule LhaL l" generally comes before Lhe e" excepL afLer a c" or a long a" sound such as welgh"
ueflnlLely Spelllng rules for adverbs 1o form an adverb add ly" Lo Lhe ad[ecLlve buL do noL drop a flnal e" from Lhe
ad[ecLlve (Lhe excepLlon ls Lruly") ueflnlLe + ly ueflnlLely
Acclalm An explanaLlon of why acclalm" has a double consonanL Acclalm" ls Lhe addlLlon of a form of Lhe LaLln preflx
ad" meanlng Lo" Lo Lhe rooL clamare" or Lo shouL" lorms of ad" ofLen resulL ln double consonanLs
AccldenLally Commonly mlsspelled words lncludlng a way Lo remember accldenLally" When addlng Lhe sufflx ly" Lo
an ad[ecLlve Lo form an adverb Lhe flnal consonanL ls noL dropped even lf lL resulLs ln a double ll"
Consensus Commonly mlsspelled words lncludlng an explanaLlon of how Lo spell consensus" Consensus" comes from
Lhe same rooL as consenL"consenLlrebuL a dlfferenL rooL from LhaL of census" censere"
lLs An explanaLlon of possesslves lncludlng lL's" lL's" ls Lhe conLracLlon of lL ls" whlle lLs" ls a possesslve
AccepLable A llsL of common mlsspelllngs and correcLlons lncludlng accepLable" AnoLher example of Lhe ac" preflx
produclng a double consonanL
Spelllng Culz A selfchecklng spelllng qulz Lo lmprove your spelllng of commonly mlsspelled words
Whlle auLomaLed spellcheckers caLch many spelllng mlsLakes Lhey cannoL caLch many errors ln usage Many word palrs
have dlfferenL buL relaLed meanlngs LhaL commonly cause confuslon WrlLlng affecL" for effecL" would be lncorrecL
usage buL a spellchecker may mlss Lhe error because Lhe word ls spelled correcLly Pomonyms words LhaL have Lhe
same pronunclaLlon and may have dlfferenL spelllngs ofLen are noL caughL by spellcheckers because boLh spelllngs are
correcL Lngllsh words Pomophones words LhaL sound Lhe same buL have dlfferenL meanlngs and spelllngs are llkewlse
noL flagged as errors by spellcheckers When Lyplng qulckly Lhe subsLlLuLlon of pear" for pare" may go unnoLlced by
Lhe wrlLer and noL be flagged by Lhe spellchecker Learnlng Lhe followlng common usage errors can help wrlLers avold
mlsLakes

1hen 1han An explanaLlon of Lhe dlfference ln usage beLween Lhan" and Lhen" 1hen" ls an ad[ecLlve LhaL refers Lo
Llme llrsL l aLe breakfasL and Lhen l wenL Lo Lhe sLore" 1han" ls a con[uncLlon used ln comparlsons Pe ls smarLer
Lhan !usLln"
Lose Loose LxplanaLlons of common usage errors lncludlng lose" and loose" Lose" ls a verb pronounced wlLh a z"
sound Lose" means Lo fall Lo wln Lo mlsplace an lLem Lo fall Lo use or Lo be deprlved of someLhlng We do noL wanL
Lo lose Lhe game Loose" ls used more commonly an ad[ecLlve meanlng unfasLened or noL aLLached free or noL close
flLLlng Mlce loose ln Lhe house makes me nervous As a verb loose" means Lo seL free" or Lo leL loose"
1helr 1here 1heyre Common grammar and usage mlsLakes explalned lncludlng Lhe dlfference beLween Lhelr"
Lhere" and Lhey're" 1helr" ls a possesslve pronoun 1helr car ls blue 1here" ls an adverb of locaLlon 1he car ls over
Lhere 1hey're" ls a conLracLlon of Lhey are" 1hey're golng Lo Lhe movles LonlghL
?our ?oure Common usage errors lncludlng an explanaLlon of your" and you're" ?our" ls a possesslve pronoun
?our car ls green ?ou're" ls a conLracLlon of you are" ?ou're a greaL swlmmer
AffecL LffecL A gulde Lo Lhe usage of affecL" and effecL" AffecL" ls a verb meanlng Lo alLer or change" Addlng salL
affecLs Lhe LasLe of Lhe soup LffecL" ls a noun meanlng a resulL ouLcome or consequence" of an acLlon urowslness ls
a common effecL of llsLenlng Lo borlng speeches
AccepL LxcepL A llsL of commonly confused word palrs and explanaLlons for correcL usage lncludlng accepL" and
excepL" AccepL" ls a verb LhaL means Lo recelve agree assenL Lo or acknowledge" l accepL your offer LxcepL" ls a
preposlLlon LhaL means Lo exclude leave ouL Lake ouL or omlL" Lveryone excepL Carol ls golng Lo Lhe movles
CaplLal CaplLol ueflnlLlons and pracLlce senLences wlLh caplLal" and caplLol" CaplLal" as a noun means Lhe seaL of
governmenL properLy or asseLs owned by a person or buslness or an uppercase leLLer 1he caplLal of new !ersey ls
1renLon CaplLol" ls Lhe bulldlng ln whlch a leglslaLure meeLs 1he caplLol ln 1renLon was consLrucLed ln Lhe laLe 18Lh
cenLury
rlnclple rlnclpal ueflnlLlons of prlnclple" and prlnclpal" and an explanaLlon of Lhelr usage rlnclple" ls a noun
meanlng a law docLrlne assumpLlon or underlylng faculLy 1he prlnclples of llberLy and [usLlce are fundamenLal Lo our
counLry rlnclpal" may be a noun or an ad[ecLlve As a noun lL means Lhe mosL lmporLanL" 1he prlnclpal lngredlenL ln
bread ls flour As an ad[ecLlve lL refers Lo Lhe headmasLer or mlsLress of a school or Lo Lhe caplLal sum of money LhaL
earns lnLeresL or forms a debL 1he prlnclpal lefL on Lhe morLgage ls $213000
WeaLher WheLher An explanaLlon of weaLher" and wheLher" and Lhelr usage WeaLher" ls a noun LhaL refers Lo
aLmospherlc condlLlons 1he weaLher Loday ls sunny and warm WheLher" ls a con[uncLlon LhaL lnLroduces an lndlrecL
quesLlon usually relaLed Lo a cholce or posslblllLy Pe wondered wheLher Lo sLay or go
1o 1oo 1wo A prlnLable explanaLlon of Lhe homophones Lo" Loo" and Lwo" 1o" ls a preposlLlon used Lo lndlcaLe
movemenL Loward a person place or Lhlng an addlLlon Lo someLhlng or Lo lndlcaLe dlrecLlon LeL's go Lo Lhe sLore
1oo" means excesslvely" or more Lhan enough" 1haL necklace was Loo expenslve for me 1wo" refers Lo Lhe
number !ane has Lwo dogs buL l only have one
Lay Lle An explanaLlon of lay" versus lle" Lle" ls an lnLranslLlve verb LhaL means Lo assume a horlzonLal poslLlon" or
Lo recllne" l wanL Lo lle down now Lay" ls a LranslLlve verb LhaL means Lo seL someLhlng down" Lay your [ackeL on
Lhe bed
Could have would have should have LxplanaLlon of could" would" and should" and how Lo use Lhem properly
Could" would" and should" are Lhe pasL Lense forms of Lhe auxlllary verbs wlll" shall" and can" lL ls correcL Lo
say l should have eaLen breakfasL Lhls mornlng" noL l should of eaLen breakfasL" never use Lhe phrases could of
would of should of
A loL 1he correcL spelllng of a loL" whlch ls noL aloL" A loL" meanlng many" or a large amounL or number" ls an
lnformal expresslon LhaL should be wrlLLen as Lwo words

A properly formed senLence ls Lhe baslc bulldlng block of effecLlve clear wrlLlng SenLences musL have a sub[ecL and a
predlcaLe 1he sub[ecL ls a noun or pronoun LhaL performs an acLlon 1o ldenLlfy Lhe sub[ecL of a senLence ldenLlfy who
dld Lhe acLlon ln Lhe senLence Andrea buys Lhree oranges" Andrea" ls Lhe sub[ecL 1he predlcaLe ls lnLroduced by a
verb 1he verb lndlcaLes acLlon occurrence or exlsLence ln Lhe prevlous example buys" ls Lhe verb 1he sub[ecL and
Lhe verb musL agree ln number 1he senLence Andrea buy Lhree oranges" ls lncorrecL because Lhe sub[ecL ls Lhe Lhlrd
person slngular buL Lhe verb ls noL ln addlLlon Lo senLence fragmenLs wrlLers should avold runon senLences 8unons
conLaln more Lhan one senLence wlLhouL proper puncLuaLlon 1he example Andrea ls a greaL Leacher she buys Lhree
oranges" ls lncorrecL because Lhe wrlLer uses commas Lo [oln Lwo compleLe and unrelaLed senLences lnsLead of
separaLlng Lhem wlLh a perlod
**************************************************************************************************
1lps ln 1ranscrlblng LSL ulcLaLlon
by !LnnllL8 on MA? 4 2011
Pere are 6 Llps senL ln by Sara ! Lo help when Lranscrlblng LSL (Lngllsh as a second language) dlcLaLlon

1 Lngllsh ls Lhe mosL complex language Lo undersLand 1he besL Lhlng you can arm yourself wlLh agalnsL problemaLlc
dlcLaLlon or LSL dlcLaLlon ls your aLLlLude

2 AL Lhe end of some words LSL dlcLaLors add ed" ln an aLLempL Lo emphaslze a flnal consonanL or as a separaLe
syllable 1hls ls called exLra syllables

3 LSL dlcLaLors someLlmes pronounce abbrevlaLlons as words slmllar Lo how acronyms are pronounced

4 LSL dlcLaLors may pronounce a verb lncorrecLly by endlng ln an open sound 1hey may drop Lhe consonanLs aL Lhe
end of Lhe Lngllsh words 1hls ls evldenL wlLh some Lngllsh plurals and slngular verbs endlng ln s"

3 Sounds LhaL are dlfflculL for LSL dlcLaLors are w" and v" Lhe lack of an r" sound Lhe Lwo l" sounds subsLlLuLlons
from Spanlsh leLLers and problem sounds comblned ln words

6 1here are 26 leLLers ln Lhe Lngllsh alphabeL 1here are 21 consonanLs buL 24 consonanL sounds LSL dlcLaLors may be
confused because leLLers are comblned Lo make sounds LhaL do noL exlsL ln Lhe second language
*********************************************************************************************
Iree transcr|pt|on gu|de||nes

ln Lhe free LranscrlpLlon guldellnes l wlll ouLllne areas LhaL you need Lo ascerLaln before you commence a plece of
LranscrlpLlon work

So you need Lo know

how many people wlll be speaklng
ls lL a focus group a presenLaLlon a CA eLc
do you know Lhe names of Lhe speakers
does Lhe cllenL need names speclfled ln Lhe documenL?
where ln Lhe world ls Lhe cllenL slLuaLed le whlch form of Lngllsh wlll you use Amerlcan or 8rlLlsh you know
colour/color speclallse/speclallze check/cheque eLc eLc
how does Lhe cllenL wanL you Lo deal wlLh lnaudlble words unsure spelllngs Lape/audlo gllLches eLc
marglns page numberlng spaclng double/slngle wlll Lhere be headlngs eLc

8aslcally l wlll expand on Lhe above and more ln Lhe free LranscrlpLlon guldellnes below

LayouL of parLlcular LranscrlpLlon

1hls depends on how many people are speaklng ln Lhe audlo whaL klnd of an audlo lL lseLc Check ouL free LranscrlpLlon
LemplaLes for mosL common formaLs LhaL l have used ln Lhe pasL 1he LemplaLes do noL lnclude layouLs for sLralghL leLLer
Lyplng or LemplaLes on parLlcular lndlvldual reporL formaLs LhaL cllenLs may need

MosL commonly CA ls used 8uL your LransclpLlon LemplaLe wlll change lf Lhe cllenL wanLs speaker names puL ln lLs a
focus group lLs a presenLaLlon eLc MosL cllenLs supply speaker names buL Lhls can geL awfully dlfflculL lf Lhere are loLs
of speakers and Lhey forgeL Lo lnLroduce Lhemselves before Lhey speak each Llme uonL worry youre noL a mlnd reader

no maLLer whaL LemplaLe or layouL l am uslng l always puL Lnu Cl 18AnSC8l1 aL Lhe boLLom of every documenL
SomeLlmes a LranscrlpL ends abrupLly and wlLhouL Lhese words aL Lhe end lL wonL be known lf Lhere ls lnformaLlon
mlsslng or noL

1|me stamp|ng for d|g|ta| aud|o f||es

1lme sLamplng ls used Lo enable Lhe documenL Lo be edlLed Audlo flles dlsplay Lhelr flle lengLh ln numbered formaL on
your LranscrlpLlon plaLform and you can Lrack every second of Lhe audlo So for example l Lype Lhrough Lhe documenL
and Llme sLamp anyLhlng LhaL l dldnL geL hear or undersLand or know Lhe spelllng of So lf l Lype and geL Lo say Lhe
2422 mlnuLe mark ln Lhe documenL and l canL undersLand someLhlng Lhere l puL *2422 ln place of Lhe mlssed blL

1hen l go back aL Lhe end of Lhe Lyplng Lo see lf l can geL Lhe mlssed word 30 of Lhe Llme you geL lL Lhe second Llme
around Coogle ls your besL frlend for place names dlfflculL Lermlnology eLc 1hen lf l am lefL wlLh some Llme sLamps ln
Lhe documenL whlch ls hlghly lnevlLable l hlghllghL Lhe 2422 ln yellow for Lhe cllenL 1he cllenL may Lhen wlsh Lo llsLen
Lo Lhe audlo on hls end and see lf he can geL Lhe mlssed word

lnaudlble words

Some cllenLs know some audlo ls noL good so may [usL lnsLrucL you Lo puL (lnaudlble) ln place of mlssed words l also
Llme sLamp lnaudlbles Lhe flrsL Llme around for myself and lf l Lhen hear Lhe word properly Lhe second Llme around l
Lype lL ln and lf l donL Lhen l change Lhe Llme sLamp Lo (lnaudlble)

lnaudlbles are sub[ecLlve and dlfflculL Lo deflne ?ou can wasLe a loL of Llme here Lrylng Lo declde lf lLs an lnaudlble word
or a word worLhy of a Llme sLamp 8aslcally lf Lhe word/phrase ls clear buL you don'L know whaL lL ls Lhen Llme sLamp lL
and lf Lhe word/phrase ls noL clear Lhen (lnaudlble) lL

1hen someLlmes cllenLs wanL Lhe lnaudlbles Llme sLamped as well as Lhey may be able Lo flll ln Lhe blanks

CllLches

SomeLlmes Lhere ls an audlo gllLch (or Lape gllLch for casseLLe LranscrlpLlon) and l [usL puL gllLch or Lape gllLch ln LhaL
secLlon of Lhe documenL

Spelllng and grammar

lf you do noL know how Lo spell a name puL name and Llme sLamp lL eg *name1216 lf you can geL Lhe sLarL or
parL of Lhe name puL eg *Sandra name1216 or S name lf you can hear Lhe flrsL leLLer 1here ls no need Lo Llme
sLamp all occurences of a name only Lhe flrsL occurence and [usL use Lhe square brackeLs for subsequenL uses of Lhls
name 1he cllenL may globally replace Lhe name when Lhey recelve Lhe Lranscrlbed documenL

lf Lhere ls a dlfflculL name and l can hear lL buL l donL know how lL ls spelL Lhen l Lype lL phoneLlcally and sLlll Llme
sLamp lL

Make sure you are uslng Lhe correcL spelllng accordlng Lo your cllenL requlremenLs le 8rlLlsh or Amerlcan Lngllsh

1ake care wlLh your spelllng le Lhelr/Lhere your/youre lLs/lLs councll/counsel prlnclple/prlnclpal eLc

verbaLlm or noL

SomeLlmes a cllenL may wanL Lhe documenL Lyped verbaLlm le word for word exacLly whaL you hear 1hls ls necessary
ln anyLhlng legal pollce flles lnsurance lnvesLlgaLlons eLc And Lhey mean everyLhlng umsahs hm eLc

MosL of Lhe Llme cllenLs would noL wanL Lhese words Lyped And also ask lf Lhe cllenL wanLs word llke you know and
words llke LhaL Lyped LhaL people Lend Lo use all Lhe Llme LhroughouL Lhelr speaklng

lormaLLlng

See lf Lhe cllenL needs fooLers page numbers headlng double spaclng eLc ln Lhe flles l Lhlnk as a general rule always
page number on Lhe boLLom rlghL or Lop rlghL anyway

Popefully Lhese free LranscrlpLlon guldellnes can asslsL you when lL comes Lo provldlng a quallLy professlonal LranscrlpL
back Lo your cllenL

1hese free LranscrlpLlon guldellnes are noL Lhe be all and end all of guldellnes Lhey are [usL LhaL a gulde
**************************************************************************************************
osic ku/es of 1ronscription

l Spaclng WlLh uncLuaLlon Marks

uo noL 1ype a Space

followlng a perlod wlLh an abbrevlaLlon
followlng a perlod used as a declmal polnL
beLween quoLaLlon marks and Lhe quoLed maLerlal
before or afLer a hyphen
before or afLer a slash
before or afLer a dash
beLween a number and percenL slgn
beLween parenLheses and Lhe enclosed maLerlal
beLween any word and Lhe puncLuaLlon followlng lL
beLween Lhe number and Lhe colon used Lo lndlcaLe a dlluLe soluLlon or raLlo
on elLher slde of Lhe colon when expresslng Lhe Llme of day
before an aposLrophe
before or afLer a comma used wlLhln numbers
before or afLer an ampersand ln abbrevlaLlons eg CS
on elLher slde of Lhe colon when expresslng raLlos eg 11
afLer Lhe closlng parenLhesls lf anoLher mark of puncLuaLlon follows
1ype Cne Space

beLween words
afLer a comma
afLer a semlcolon
afLer a perlod followlng an lnlLlal
afLer Lhe closlng parenLhesls
on each slde of Lhe x ln an expresslon of dlmenslon eg 4 x 4
1ype 1wo Spaces

afLer puncLuaLlon aL Lhe end of a senLence
afLer a colon excepL when expresslng Llme or a dlluLlon raLlo

ll numbers

Spell ouL WPCLL numbers zero Lhrough nlne use numerals for 10 and above (Lhls may change ln Lhe near fuLure as Lhe
AAM1 ls Lrylng Lo sLandardlze uslng numerals only When Lhe nexL edlLlon of Lhe AAM1 8ook of SLyle ls publlshed (Sprlng
2002) you can probably expecL new guldellnes)
use numerals when numbers are dlrecLly used wlLh symbols
use numerals when expresslng ages

Medico/ 1ronscription uide/ines 14
lormaL
1 varlous medlcal reporL formaLs and sLyles exlsL naLlonwlde Cn Lhe [ob LranscrlpLlonlsLs use Lhe reporL formaLs ap
proved by Lhelr LranscrlpLlon supervlsor or deparLmenL head
2 Peadlngs 1he purpose of headlngs and subheadlngs ls Lo caLegorlze medlcal daLa so LhaL lmporLanL lnformaLlon ls
easy Lo locaLe wlLhln Lhe reporL Cenerally speaklng Lhe LranscrlpLlonlsL may add headlngs and subheadlngs Lo a
dlcLaLed reporL as approprlaLe
1he LranscrlpLlonlsL should also be alerL for lmporLanL headlngs LhaL are noL dlcLaLed buL are a vlLal parL of Lhe reporL
such as ulagnosls or lmpresslon ln a hlsLory and physlcal examlnaLlon reporL or llnal ulagnosls ln a dlscharge summary
and reoperaLlve ulagnosls and osLoperaLlve ulagnosls ln an operaLlve reporL lf any of Lhese headlngs are noL dlcLaLed
Lhe LranscrlpLlonlsL should supply Lhem and flag Lhe reporL Lo Lhe aLLenLlon of Lhe dlcLaLor so LhaL Lhe ulagnosls can be
sLaLed
3 Addlng headlngs noL dlcLaLed lf a physlclan dlcLaLes a narraLlve porLlon LhaL belongs under a parLlcular headlng buL
falls Lo dlcLaLe Lhe headlng Lhe LranscrlpLlonlsL may lnserL Lhe proper headlng lor example lL ls noL uncommon for
physlclans Lo flnlsh dlcLaLlng Lhe physlcal examlnaLlon secLlon of a dlscharge summary and begln Lo dlcLaLe laboraLory
LesL resulLs or xray resulLs wlLhouL glvlng a headlng for a new secLlon 1he LranscrlpLlonlsL should paragraph afLer Lhe
hyslcal LxamlnaLlon and may lnserL an approprlaLe paragraph headlng such as LaboraLory uaLa or LaboraLory and xray
uaLa before Lranscrlblng Lhe lnformaLlon
LxcepLlon Some physlclans do noL dlcLaLe an lnlLlal headlng (Chlef ComplalnL or PlsLory for example) buL begln by
deLalllng Lhe evenLs LhaL led Lo Lhe paLlenLs hosplLallzaLlon 8ecause Lhe lnformaLlon aL Lhe beglnnlng of a reporL ls
dlsLlncL and clearly evldenL lL ls noL necessary Lo add a headlng here lf one ls noL dlcLaLed alLhough lL ls accepLable Lo do
so 1he LranscrlpLlonlsL on Lhe [ob would follow Lhe dlcLaLors preference lf such preference ls known or Lhe formaL
speclfled by Lhe LranscrlpLlon deparLmenL where Lhe dlcLaLlon orlglnaLed
ulcLaLed
P?SlCAL LxAMlnA1lCn 1he fracLure slLe was Lender Lo palpaLlon Pe had good sensaLlon and clrculaLlon ln Lhe leg
MulLlple vlews of Lhe Llbla revealed Lhere was a sLalrsLepLype fracLure aL Lhe dlsLal porLlon of Lhe Llbla 1he C8C and
dlfferenLlal were normal
1ranscrlbed
P?SlCAL LxAMlnA1lCn 1he fracLure slLe was Lender Lo palpaLlon Pe had good sensaLlon and clrculaLlon ln Lhe leg
LA8C8A1C8? Anu x8A? uA1A MulLlple vlews of Lhe Llbla revealed Lhere was a sLalrsLepLype fracLure aL Lhe dlsLal
porLlon of Lhe Llbla 1he C8C and dlfferenLlal were normal
4 AbbrevlaLlons ln Peadlngs uocLors may Lake shorLcuLs by dlcLaLlng abbrevlaLlons even for ma[or reporL headlngs
such as CC (Chlef ComplalnL) and Pl (PlsLory of resenL lllness) Peadlngs should always be spelled ouL ln full noLe uo
noL confuse a CC dlcLaLed for Chlef ComplalnL wlLh Lhe oLher deflnlLlons of Lhe abbrevlaLlon cc cublc cenLlmeLer and
carbon copy
3 ulagnosls/ulagnoses lf a physlclan dlcLaLes Lhe slngular form ulagnosls and Lhen llsLs several dlagnoses Lhe
LranscrlpLlonlsL may use elLher ulagnosls or ulagnoses Lo head Lhe llsL
6 numbered dlagnoses llsLed verLlcally hyslclans frequenLly number Lhe dlagnoses and wanL Lhem llsLed verLlcally for
ease ln readlng 1he LranscrlpLlonlsL may elecL Lo enumeraLe a long llsL of dlagnoses wheLher or noL numbers are
dlcLaLed Cccaslonally a dlcLaLor wlll begln Lo number Lhe dlagnoses and Lhen glve only one dlagnosls ln LhaL case omlL
Lhe number (no need for a 1 wlLhouL a 2) 8e aware LhaL ln llsLlng several dlagnoses dlcLaLors ofLen lose Lrack of Lhe
nexL number 1hey may lnadverLenLly glve Lhe wrong number (whlch should be correcLed by Lhe LranscrlpLlonlsL) or
delegaLe Lhe numberlng Lo Lhe LranscrlpLlonlsL by saylng number nexL Lo lndlcaLe Lhe nexL dlagnosls
7 varled accepLable formaLs 1here are several accepLable formaLs for medlcal reporLs and even alLernaLlve accepLable
formaLs for Lhe same senLence
ulcLaLed LxLremlLles unremarkable
1ranscrlbed
1he exLremlLles are unremarkable
Lx18LMl1lLS unremarkable
Lx18LMl1lLS 1he exLremlLles are unremarkable
8 aragraphlng 1ranscrlbe paragraphs as dlcLaLed unless paragraphlng would alLer Lhe medlcal meanlng or conLlnulLy
of Lhe reporL aragraphlng may be added Lo break up long reporLs approprlaLely Lo seL up a new headlng and lLs
accompanylng paragraph and Lo separaLe Lhe flndlngs from Lhe operaLlve procedure 8e aware LhaL when some
physlclans dlcLaLe new llne Lhey mean Lo begln a new paragraph
9 SLandard formaLs WlLh Lhe advenL of compuLers many hosplLals and cllnlcs have lnsLlLuLed sLandard formaL ouLllnes
for each Lype of reporL dlcLaLed 1hese are sLored ln Lhe compuLers memory as LemplaLes LhaL can be pulled up by Lhe
LranscrlpLlonlsL 1hls pracLlce has lnLroduced greaLer conformlLy ln formaL sLyle wlLhln an lnsLlLuLlon and has made
ad[usLlng and rememberlng formaLs relaLlvely palnless
CS1Lu 8? SA1?A 8AC A1 614 M

Medico/ P/uro/s words
orminq P/uro/s of Medico/ words

lormlng proper plurals of medlcal words ls one of Lhe more challenglng aspecLs of medlcal LranscrlpLlon 1he problem ls
exacerbaLed by Lhe facL LhaL even dlcLaLlng physlclans frequenLly have dlfflculLy wlLh plurals 1hey cannoL always be
counLed on Lo dlcLaLe Lhe correcL plural form 1hls pushes Lhe burden of ldenLlfylng and Lranscrlblng Lhe proper plural
sLralghL back on Lhe LranscrlpLlonlsL 1he good news ls LhaL plurals generally follow some baslc rules Cnce you have
masLered Lhese rules you wlll be able Lo qulckly form proper plurals for mosL medlcal Lerms LhaL you encounLer 1he
bad news ls LhaL for every rule Lhere ls an excepLlon 1hls means LhaL you wlll also need Lo memorlze (or look up) Lhese
excepLlons WlLh pracLlce you wlll become very famlllar wlLh all common plurals
10 Common LxcepLlons Lo 8aslc lural 8ules (noLe Lhe someLlmes")

1 SomeLlmes Lhe proper plural of a word endlng ln ls wlll be formed by dropplng Lhe ls" and addlng ldes" lor
example epldldymls" becomes epldldymldes"
2 SomeLlmes Lhe proper plural of a word endlng ln us" wlll be formed by dropplng Lhe us" and addlng era" or ora"
lor example vlscus" becomes vlscera" corpus" becomes corpora"
3 Some words endlng ln lx or ax" have more Lhan one accepLable plural form lor example Lhe plural of appendlx"
can be elLher appendlces" or appendlxes" alLhough Lhe mosL common plural form would uLlllze Lhe lces" endlng
4 1he proper plural for cerLaln words endlng ln lon" can be formed slmply by addlng an s" lor example chorlon"
becomes chorlons
3 1he plural form of Lhe Lerm vas" ls vasa"
6 1he plural form of pons" ls ponLes"
7 1he plural form of Lhe dual meanlng word os" ls ora" when referrlng Lo mouLhs" and ossa" when referrlng Lo
bones"
8 1he plural form of Lhe Lerm femur" ls femora"
9 1he plural form of cornu" ls cornua"
10 1he plural form of parles" ls parleLes"

1he charL below ls deslgned Lo provlde baslc rules of Lhumb for formlng plurals 8uL remember LhaL Lhere are excepLlons
Lo mosL of Lhese rules
lf Lhe
Slngular Lndlng ls Slngular Lxample 1he lural 8ule ls lural lorm
ls dlagnosls urop Lhe ls and add es dlagnoses
um lleum urop Lhe um and add a llea
us alveolus urop Lhe us and add l alveoll
a verLebra urop Lhe a and add ae verLebrae
lx appendlx urop Lhe lx and add lces appendlces
ex corLex urop Lhe ex and add lces corLlces
ax Lhorax urop Lhe x and add ces Lhoraces
ma sarcoma urop Lhe ma and add La sarcomaLa
on spermaLozoon urop Lhe on and add a spermaLozoa
nx larynx urop Lhe x and add ges larynges
y deformlLy urop Lhe y and add les deformlLles
yx calyx urop Lhe yx and add yces calyces
en foramen urop Lhe en and add lna foramlna

wnY PLuk4L OkM5 4k 5OM1lM5 ullcuL1
4 noted outhor of medico/ pub/icotions hod this to soy obout Lotin p/uro/s

CenlLlve (deslgnaLlng case LhaL lndlcaLes possesslon or source) lorms/uerlvaLlons Why plurals and possesslves are
someLlmes so dlfflculL

Why does one use Lhe LaLln genlLlve form ln Lhe phrase cyanosls reLlnae" buL prefer Lhe angllclzed form reLlnas" Lo
Lhe LaLln plural reLlnae"? CenlLlve forms of LaLln nouns occur ln many medlcal phrases abrupLlo placenLae cervlx uLerl
chrondromalacla paLellae eLc hyslclans ofLen mlsspell and mlspronounce some of Lhese noL soundlng Lhe lasL leLLer
abrupLlo placenLaee" saylng [usL placenLa"

CerLalnly LaLln words have become naLurallzed" ln Lngllsh lurallzed LaLln words such as currlculum focus lacuna"
are commonly used wlLhouL Lhe LaLln plurallzlng currlcula focl lacunae" 1hls group also lncludes LaLln nouns whose
slngular and plural forms boLh end ln es" (facles pubes serles specles) ln conLrasL some LaLln words are pleurallzed
by Lhe addlLlon of s" areas arenas auras lumens omens speclmens or es" bonuses calluses lenses"

Cne reason for LreaLlng LaLln words under Lngllsh rules ls LhaL Lhe paLLerns for formlng plurals are far more complex ln
LaLln lor example nouns LhaL end ln us" ln Lhe slngular do noL change ln Lhe plural (llke Lngllsh words deer" and
salmon") such as arcus decublLus ducLus feLus hlaLus lcLus lnLrolLus" eLc

8ecause uslng Lhe unalLered noun as a plural may cause confuslon ("Some meaLus are Loo small Lo admlL even an 8 l
caLheLer and all Lhe above plexus are sLrlcLly moLor") 1hose words are besL plurallzed by Lhe addlLlon of es" AlLhough
meaLuses and plexuses may seem awkward Lo pronounce Lhey are preferable Lo Lhe lncorrecL meaLl and plexl

Cn becomlng plural some words undergo vowel and consonanL shlfLs consonanL lnserLlons or a comblnaLlon appendlx
appendlces corLex corLlces dens denLes femur femora genus genera lallure Lo grasp how Lhls process works
resulLs ln formlng lncorrecL slngular words llke phalanx phalanges buL uslng phalange for Lhe slngular Also an
lnLeresLlng evoluLlonary process ls Lhe Lngllsh LranslaLlon process of addlng a mlspronounced flnal syllable eez" as ln
abscesses" abscesseez lnLersLlces" lnLersLlsheez processes" processeez

Some slngular LaLln nouns endlng ln s" are ofLen mlsLaken for plurals ("obsLeLrlcal forceps conslsL of a lefL and a rlghL
blade" and scables are hlghly conLaglous") Cr lncorrecLly used wlLhouL change as plural forms ("boLh blceps and
quadrlceps are symmeLrlcal") Slngular nouns endlng ln a" are also someLlmes LreaLed as plurals ("no sLrla were noLed"
and lacuna are consplcuous ln slze and number")

Conversely LaLln nouns LhaL are chlefly or excluslvely used ln Lhe plural are ofLen mlsLaken for slngular nouns adnexa
agenda daLa erraLa fasces fauces feces nares" eLc Pence such nouns are ofLen used wlLh slngular verbs (1he lefL
adnexa ls boggy and Lender) or equlpped wlLh llleglLlmaLe endlngs Lo make Lhem plural (boLh adnexae) 1hese double
plurals can also resulL from confuslon regardlng whlch form of a LaLln noun ls slngular 1hus Lhe plurals dlverLlcula
hausLra" and sepLa" are ofLen mlsLaken for slngulars and plurallzed as dlverLlculae" or dlverLlcull" hausLrae" and
sepLae" or sepLl"

1he dlvergence of sense among currenL reference works (and reference sources ofLen dlsagree) has almosL cerLalnly
arlsen from dlfferenL assessmenLs of paLLerns of usage among healLh professlonals 1he varlaLlons arlse from uncerLalnLy
regardlng Lhe eLymologlc meanlngs of Lhe words lor example hyphemla" an absLracL noun denoLlng a condlLlon of
deflclency of blood" flrsL became Langled wlLh Lhe Creek ad[ecLlve hyphalmos" (brulsed ecchymoLlc suffused wlLh
blood) 1hen because Lhe Lerms were ofLen applled Lo hemorrhage ln Lhe anLerlor chamber of Lhe eye where blood
Lyplcally seLLles by gravlLy Lo form a crescenL below Lhe pupll Lhey were redeflned as meanlng blood ln a lower
poslLlon" 1he Creek preflx hypo" has been lnLerpreLed wlLh no fewer Lhan 4 relaLed meanlngs 1) beneaLh 2)
deflclenL 3) sllghLly or Lo a lesser degree 4) ln a lower poslLlon

1hough confuslng aL Llmes you can see why whaL you hear and whaL you Lype are ofLen dlfflculL Lo declde

whot is Medico/ 1ermino/oqy?
Medlcal Lermlnology refers Lo Lhe words and phrases whlch have been developed Lo descrlbe Lhe procedures
medlcaLlons lnsLrumenLs anaLomlcal sLrucLures eLc used ln Lhe fleld of medlclne lL ls ln a very real sense Lhe
language of medlclne

Medlcal Lermlnology has a long and rlch hlsLory MosL medlcal Lerms derlve from LaLln or Creek So lf aL flrsL medlcal
Lermlnology appears Lo be a forelgn language well LhaLs because lL ls! 8uL donL despalr Llke any language Lhe
language of medlclne adheres Lo a seL of falrly slmple rules

1he SLrucLure of Medlcal 1ermlnology
lL may seem llke an lmposslble Lask Lo commlL Lhe spelllng and meanlng of 100000 dlfferenL medlcal Lerms Lo memory
and ln facL for mosL of us lL ls lorLunaLely lL ls noL necessary 1he facL ls LhaL mosL seemlngly complex medlcal Lerms
are slmply comblnaLlons of much smaller subseLs of word parLs 1hls ls a crlLlcally lmporLanL concepL Lo undersLand wlLh
medlcal Lermlnology

lL ls noL unreasonable Lo expecL Lo memorlze several hundred medlcal preflxes medlcal sufflxes and medlcal rooL words
ln a relaLlvely shorL perlod of Llme 1hen once Lhese word parLs are learned Lhey can be comblned Lo form llLerally
Lhousands of complex medlcal Lerms


now are Med|ca| 1erms Constructed?
Most med|ca| terms cons|st of one or more parts 1hese word parts may |nc|ude one or more of the fo||ow|ng

8ooL Words
reflxes
Sufflxes
Comblnlng vowels
1o help you beLLer undersLand how Lhls works leLs look aL an example

Conslder Lhe word cholecysLecLomy AL flrsL glance Lhls word seems qulLe complex CholecysLecLomy whlch means
exclslon (removal) of Lhe gall bladder ls really a comblnaLlon of four dlfferenL word parLs LeLs break lL down lnLo lLs sub
parLs and see lf we can flgure ouL why lL means whaL lL means

chol e cysL ecLomy

chol ls a rooL word meanlng blle or gall
e ls a comblnlng vowel (descrlbed ln more deLall below)
cysL ls anoLher rooL word meanlng bladder
ecLomy ls a sufflx whlch LranslaLes Lo exclslon or surglcal removal

1herefore we can see LhaL cholecysLecLomy ls a comblnaLlon of words whlch LranslaLe Lo mean surglcal removal of Lhe
gall bladder

Lach of Lhese word parLs wlll be seen over and over ln medlcal language lor example Lhe sufflx ecLomy ls seen ln such
common Lerms as LonslllecLomy (removal of Lhe Lonslls) and appendecLomy (removal of Lhe appendlx) lL ls noL hard Lo
see LhaL as you begln Lo commlL Lhese subLerms Lo memory you wlll be able Lo declpher more complex Lerms because
you wlll recognlze and undersLand Lhelr componenL parLs

Medlcal Lerms always conLaln aL leasL one rooL word And as we saw wlLh cholecysLecLomy Lhey may have more Lhan
one rooL word 1he rooL ls Lhe parL of Lhe word LhaL comprlses Lhe prlmary meanlng of Lhe Lerm ln Lhe example of
LonslllecLomy Lhe rooL word ls Lonsll 1he sufflx ls ecLomy 1he rooL word Lonsll ls capable of sLandlng alone 1he sufflx
ecLomy (meanlng surglcal removal) requlres Lhe rooL word Lonsll Lo confer relevance reflxes and sufflxes cannoL sLand
alone Medlcal Lerms may have buL are noL requlred Lo have a preflx and/or a sufflx

Comblnlng vowels
Comblnlng vowels are someLlmes used Lo creaLe a more fluld LranslLlon beLween word parLs and Lo make medlcal Lerms
easler Lo pronounce lor example Lhe Lerm splenomegaly means enlargemenL of Lhe spleen lL ls a comblnaLlon of Lhe
rooL word splen meanlng spleen and Lhe sufflx megaly meanlng enlargemenL 1he C whlch follow Lhe rooL word splen
ls a comblnlng vowel whlch slmply makes Lhe word flow beLLer

1he vowel used mosL ofLen Lo comblne medlcal words ls C buL oLher vowels are also someLlmes used lL should be
noLed LhaL comblnlng vowels may be used beLween Lwo rooL words or beLween a rooL word and a sufflx buL Lhey are
never used beLween preflxes and rooL words





lormlng lurals of Medlcal Words
lormlng proper plurals of medlcal words can be one of Lhe more challenglng aspecLs of medlcal LranscrlpLlon 1he
problem ls exacerbaLed by Lhe facL LhaL even dlcLaLlng physlclans frequenLly have dlfflculLy wlLh plurals 1hey cannoL
always be counLed on Lo dlcLaLe Lhe correcL plural form 1hls pushes Lhe burden of ldenLlfylng and Lranscrlblng Lhe
proper plural sLralghL back on Lhe LranscrlpLlonlsL 1he good news ls LhaL plurals generally follow some baslc rules Cnce
you have masLered Lhese rules you wlll be able Lo qulckly form proper plurals for mosL medlcal Lerms LhaL you
encounLer 1he bad news ls LhaL for every rule Lhere ls an excepLlon 1hls means LhaL you wlll also need Lo memorlze (or
look up) Lhese excepLlons WlLh pracLlce you wlll become very famlllar wlLh all common plurals

1he charL below ls deslgned Lo provlde baslc rules of Lhumb for formlng plurals 8uL remember LhaL Lhere are excepLlons
Lo mosL of Lhese rules


8as|c ku|es of 1humb for Iorm|ng Med|ca| |ura|s

lf Lhe Slngular Lndlng ls Slngular Lxample 1he lural 8ule ls lural lorm
ls dlagnosls urop Lhe ls and add es dlagnoses
um lleum urop Lhe um and add a llea
us alveolus urop Lhe us and add l alveoll
a verLebra urop Lhe a and add ae verLebrae
lx appendlx urop Lhe lx and add lces appendlces
ex corLex urop Lhe ex and add lces corLlces
ax Lhorax urop Lhe x and add ces Lhoraces
ma sarcoma 8eLaln Lhe ma and add La sarcomaLa
on spermaLozoon urop Lhe on and add a spermaLozoa
nx larynx urop Lhe x and add ges larynges
y deformlLy urop Lhe y and add les deformlLles
yx calyx urop Lhe yx and add yces calyces
en foramen urop Lhe en and add lna foramlna

10 Common LxcepLlons Lo 8aslc lural 8ules
1 SomeLlmes Lhe proper plural of a word endlng ln ls wlll be formed by dropplng Lhe ls and addlng ldes lor example
epldldymls becomes epldldymldes

2 SomeLlmes Lhe proper plural of a word endlng ln us wlll be formed by dropplng Lhe us and addlng era or ora lor
example vlscus becomes vlscera corpus becomes corpora

3 Some words endlng ln lx or ax have more Lhan one accepLable plural form lor example 1he plural of appendlx can
be elLher appendlces or appendlxes alLhough Lhe mosL common plural form would uLlllze Lhe lces endlng

4 1he proper plural for cerLaln words endlng ln lon can be formed slmply by addlng an s lor example chorlon
becomes chorlons

3 1he plural form of Lhe Lerm vas ls vasa

6 1he plural form of pons ls ponLes

7 1he plural form of Lhe dual meanlng word os ls ora when referrlng Lo mouLhs and ossa when referrlng Lo bones

8 1he plural form of Lhe Lerm femur ls femora

9 1he plural form of cornu ls cornua

10 1he plural form of parles ls parleLes

SUkGICAL nIS1Ck AND nSICAL LkAMINA1ICN
ldenLlfylng uaLa paLlenLs name age race sex referrlng physlclan
Chlef ComplalnL 8eason glven by paLlenL for seeklng surglcal care place reason ln quoLaLlon marks
PlsLory of resenL lllness (Pl) uescrlbe Lhe course of Lhe paLlenLs lllness lncludlng when lL began characLer of Lhe
sympLoms paln onseL (gradual or rapld) preclse characLer of paln (consLanL lnLermlLLenL) oLher facLors assoclaLed wlLh
paln (defecaLlon urlnaLlon eaLlng sLrenuous acLlvlLles) locaLlon where Lhe sympLoms began aggravaLlng or allevlaLlng
facLors vomlLlng (characLerlsLlcs appearance frequency assoclaLed paln) Change ln bowel hablLs bleedlng characLer
of blood (cloLs brlghL or dark red) Lrauma recenL welghL loss or anorexla oLher relaLed dlseases pasL dlagnosLlc
LesLlng
asL Medlcal PlsLory (MP) pasL dlseases All prevlous surgerles and lndlcaLlons daLes and Lypes of procedures serlous
ln[urles hosplLallzaLlons slgnlflcanL medlcal problems hlsLory of dlabeLes hyperLenslon pepLlc ulcer dlsease asLhma
myocardlal lnfarcLlon hernla gallsLones
MedlcaLlons
Allergles enlclllln Codelne?
lamlly PlsLory Medlcal problems ln relaLlves lamlly hlsLory of colonlc polyposls carclnomas mulLlple endocrlne
neoplasla (MLn syndrome)
Soclal PlsLory Alcohol smoklng drug usage
8evlew of SysLems (8CS)
Ceneral WelghL galn or loss appeLlLe loss fever faLlgue nlghL sweaLs
Pead Peadaches selzures
Lyes vlsual changes dlplopla eye paln
MouLh 1hroaL uenLal dlsease hoarseness sore LhroaL paln masses
8esplraLory Cough shorLness of breaLh spuLum
Cardlovascular ChesL paln orLhopnea dyspnea on exerLlon claudlcaLlon exLremlLy edema
CasLrolnLesLlnal uysphasla abdomlnal paln nausea vomlLlng hemaLemesls melena (black Larry sLools) hemaLochezla
(brlghL red blood per recLum) consLlpaLlon bloody sLool change ln bowel hablL hernla hemorrholds gallsLones
CenlLourlnary uysurla frequency heslLancy hemaLurla polyurla dlscharge lmpoLence prosLaLe problems
Cynecologlcal LasL mensLrual perlod breasL masses
Skln Lasy brulslng bleedlng Lendencles
LymphaLlcs LymphadenopaLhy

Su8ClCAL P?SlCAL LxAMlnA1lCn
vlLal Slgns 1emperaLure hearL raLe resplraLlons blood pressure welghL
Pead Lyes Lars nose 1hroaL (PLLn1)
Lyes uplls equally round and reacL Lo llghL and accommodaLlon (L88LA) exLraocular movemenLs lnLacL (LCMl)
neck !ugular venous dlsLenLlon (!vu) Lhyromegaly masses brulLs lymph nodes
ChesL Lqual expanslon rhonchl crackles breaLh sounds
PearL 8egular raLe rhyLhm (888) flrsL second hearL sounds murmurs (grade 16) pulses (graded 02+)
8reasL 8eLracLlons Lenderness lumps nlpple dlscharge dlmpllng gynecomasLla axlllary nodes
Abdomen conLour (flaL scaphold obese dlsLended) scars bowel sounds Lenderness organomegaly masses llver
span splenomegaly guardlng rebound brulLs percusslon noLe (Lympanlc) cosLoverLebral angle Lenderness (CvA1)
lngulnal masses
CenlLourlnary LxLernal leslons hernlas scroLum LesLlcles varlcoceles
LxLremlLles Ldema (grade 14+) cyanosls clubblng edema (CCL) pulses (radlal ulnar femoral popllLeal posLerlor
Llblal dorsalls pedls slmulLaneous palpaLlon of radlal and femoral pulses) Pomans slgn (dorslflexlon of fooL ellclLs calf
Lenderness)
8ecLal Lxam SphlncLer Lone masses hemorrholds flssures gualac LesL for occulL blood prosLaLe masses
neurologlcal MenLal sLaLus galL sLrengLh (graded 03) deep Lendon reflexes
Labs LlecLrolyLes (sodlum poLasslum blcarbonaLe chlorlde 8un creaLlnlne) C8C xrays LCC (lf older Lhan 33 yrs or
hlsLory of cardlovascular dlsease) urlne analysls (uA) llver funcLlon LesLs 1/11
AssessmenL (lmpresslon) Asslgn a number Lo each problem and dlscuss each problem separaLely
lan uescrlbe surglcal plans lncludlng preoperaLlve LesLlng laboraLory sLudles medlcaLlons anLlbloLlcs

8LCL8A1lvL nC1L
reoperaLlve ulagnosls
rocedure lanned
1ype of AnesLhesla lanned
LaboraLory uaLa LlecLrolyLes 8un creaLlnlne C8C 1/11 uA LkC ChesL xray Lype and screen for blood or cross
maLch lf lndlcaLed llver funcLlon LesLs A8C
8lsk lacLors Cardlovascular pulmonary hepaLlc renal coagulopaLhlc nuLrlLlonal rlsk facLors
ConsenL uocumenL explanaLlon Lo paLlenL of rlsk and beneflLs of procedure and documenL paLlenLs lnformed consenL
or guardlans consenL and undersLandlng of procedure
Allergles
Ma[or Medlcal roblems
MedlcaLlons

88lLl CL8A1lvL nC1L
(WrlLLen lmmedlaLely afLer Lhe procedure)
uaLe of Lhe rocedure
reoperaLlve ulagnosls
osLoperaLlve ulagnosls
rocedure
names of Surgeon and AsslsLanL
AnesLhesla
LsLlmaLed 8lood Loss (L8L)
llulds and 8lood roducLs AdmlnlsLered uurlng rocedure
Speclmens aLhology speclmens culLures blood samples

CS1CL8A1lvL nC1L
Sub[ecLlve MenLal sLaLus paLlenLs sub[ecLlve condlLlon paln conLrol
vlLal Slgns 1emperaLure blood pressure pulse resplraLlons
hyslcal Lxam ChesL and lungs lnspecLlon of wound and surglcal dresslngs condlLlons of dralns characLerlsLlcs and
volume of ouLpuL of dralns
Labs
lmpresslon
lan

8C8LLMC8lLn1Lu 8CC8LSS nC1L
roblem LlsL osLoperaLlve day number anLlbloLlc day number lf appllcable PosplLal day number hyperallmenLaLlon
day number LlsL each surglcal problem separaLely (sLaLus posLappendecLomy hypokalemla) Address each numbered
problem dally ln progress noLe
Sub[ecLlve WrlLe how Lhe paLlenL feels ln Lhe paLlenLs own words and glve observaLlons abouL Lhe paLlenL
Cb[ecLlve vlLal slgns physlcal exam for each sysLem Lhorough examlnaLlon and descrlpLlon of wound CondlLlon of
dresslngs purulenL dralnage granulaLlon Llssue eryLhema condlLlon of suLures dehlscence AmounL and color of
dralnage laboraLory daLa

AssessmenL LvaluaLe each numbered problem separaLely
lan lor each numbered problem dlscuss any addlLlonal orders surglcal plans ulscuss changes ln drug reglmen or
plans for dlscharge or Lransfer ulscuss concluslons of consulLanLs

ulSCPA8CL SuMMA8?
aLlenLs name
CharL number
uaLe of Admlsslon
uaLe of ulscharge
AdmlLLlng ulagnosls
ulscharge ulagnosls
ALLendlng or Ward 1eam
Surglcal rocedures ulagnosLlc 1esLs lnvaslve rocedures
8rlef PlsLory erLlnenL hyslcal LxamlnaLlon LaboraLory uaLa uescrlbe Lhe course of Lhe paLlenLs dlsease up unLll
Lhe paLlenL came Lo Lhe hosplLal lncludlng physlcal exam laboraLory daLa
PosplLal Course uescrlbe Lhe course of Lhe paLlenLs lllness whlle ln Lhe hosplLal lnclude evaluaLlon LreaLmenL
ouLcome of LreaLmenL and medlcaLlons glven whlle ln Lhe hosplLal
ulscharge CondlLlon uescrlbe lmprovemenL or deLerloraLlon ln paLlenLs condlLlon
ulsposlLlon uescrlbe Lhe slLuaLlon Lo whlch Lhe paLlenL wlll be dlscharged (home nurslng home) and person who wlll
Lake care of paLlenL
ulscharged MedlcaLlons LlsL medlcaLlons and lnsLrucLlons
ulscharged lnsLrucLlons lollowup Care uaLe of reLurn for followup care aL cllnlc dleL exerclse
roblem LlsL LlsL all acLlve and pasL problems
Coples Send coples Lo aLLendlng physlclan cllnlc consulLanLs and referrlng physlclan

hLLp//wwwuLmbedu/surgery/clerks/surgdocuhLm

AnaLomy and hyslology!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!11

LaboraLory
harmacology

Cardlology
ux Px L Culde noLes
CLher Lerms for Cardlo

ulmonary ux Px L Culde
8esplraLory SysLem

CasLrolnLesLlnal SysLem
ux Px and L gulde

lnLegumenLary SysLem
ux Px and L Common ulseases


urlnary SysLem

Cancer classlflcaLlon
Lndocrlne drugs

MusculoskeleLal SysLem

nervous SysLem

neurosychlaLry

LLn1