Maintaining good health records helps keep the public safe by contributing to the continuity of healthcare.
All registered health practitioners are required to comply with health record keeping requirements. National Board’s expectations about maintaining health records are outlined in their respective codes of conduct or ethics. Some National Boards have also developed specific guidelines in relation to records.
In addition to the requirements set by National Board, practitioners must also consider state, territory or Commonwealth legislation about health records and privacy that may apply.
To help practitioners better understand and meet their health record management obligations, the following seven National Boards have developed two new health record management resources:
Good records contribute to the safety and continuity of health care and help when practitioners need to provide information to involved parties e.g. other health practitioners, Medicare or National Boards.
This self-reflective tool helps practitioners reflect on whether their records and record management processes meet the relevant standards set out in the shared Code of conduct. Use the tool to reflect on your records and record management processes.
Download the self-reflective tool to help assess the adequacy of your record management (118KB, DOCX)
Maintaining clear and accurate health records is essential for the continuing good care of patients.
National Boards expectations about maintaining health records are set out in your profession’s code of conduct. This is a summary of those expectations.
Download the of PDF health record management obligations (64KB, PDF)
Some National Boards have specific guidelines in relation to records that you should familiarise yourself with.
You should also familiarise yourself with any state, territory or Commonwealth legislation about health records and privacy that may apply to health records you create. Useful resources for practitioners include:
For useful information about cultural safety, see the Australian Commission on Safety and Quality in Health Care’s User Guide for Aboriginal and Torres Strait Islander Health.