Hardworking and Knowledgeable Medical Scribe well-versed in medical terminology and specialty support. Successful at operating in fast-paced, high-volume environments. Competent and focused professional with expertise in updating charts and submitting paperwork. Offering 2.5 years of related experience.
Overview
4
4
years of professional experience
1
1
Certification
Work History
ER MEDICAL SCRIBE
HonorHealth
09.2023 - Current
Utilized critical thinking skills to ensure that all relevant information was included in each chart note
Provided pertinent and timely documentation of procedures, activations, medications, and physical exam findings during CODEs and Trauma Activations to assist physician through life-threatening cases
Ensured that all data entered into the EHR was accurate according to established protocols
Maintained confidentiality regarding all patient information as per HIPAA guidelines
Developed strong working relationships with physicians by providing timely and accurate documentation support during their patient visits
Managed a high volume of requests simultaneously while ensuring quality assurance standards were met
Resolved discrepancies between dictated reports and transcribed documents prior to finalizing records for submission
Collaborated with other members of the healthcare team including nurses, therapists, pharmacists, to ensure continuity of care for patients
Analyzed laboratory results to determine if they were within normal range or required further action from the treating physician.
MEDICAL SCRIBE
HIGHLAND FAMILY MEDICINE TEAM
12.2021 - 09.2023
Accompanied medical provider during patient interviews and physical examinations to update patient charts with new findings
Reviewed pathologies and procedure findings on patient imaging with licensed provider
Updated Patient medical charts as needed including imaging reports, consultations and care team communications in correspondence to HIPAA
Performed live medical encounter note documentations under my assigned providers during live examinations and procedures such as cervical cancer screenings, IUD replacement and reinsertion, and external hemorrhoid excision
Documented and organized encounter HPI, Objective, Subjective, Assessment in the medical charts.
EMERGENCY MEDICAL TECHNICIAN TRAINEE
TRI-COMMUNITY AMBULANCE SERVICES
02.2020 - 02.2023
Lead and performed first line basic life support methods and procedures to manage patient conditions in emergency settings
Written HIPAA secure legal documentation of history of emergency calls in which I provided patient care
Received my NYS EMT-B certification in January 2021
Communicated with dispatchers and treatment center personnel to provide information about situation, to arrange reception of victims and to receive instructions for further treatment
Attended training classes maintained certification licensure, kept abreast of new developments in field and maintained existing knowledge
Administered first aid treatment and life support care to sick and injured persons in prehospital settings
Performed emergency diagnostic and treatment procedures, such as stomach suction, airway management, and heart monitoring, during ambulance ride
Observed, record and report to physician patient's condition and injury, treatment provided and reactions to drugs and treatment
Coordinated work with other emergency medical team members or police or fire department personnel
Maintained vehicles and medical and communication equipment and replenished first aid equipment and supplies
Decontaminated ambulance interior following treatment of patients with infectious diseases and reported cases to proper authorities.