Grammar Guidelines In Transcription

Grammar Guidelines In Medical Transcription

1. Abbreviations

2. Acronyms and Initialisms

3. Address Guidelines

4. Ampersand

5. APGAR Score

6. Cancer Classification

7. Capitalization Guidelines

8. Decimal Usage

9. Diabetes Mellitus Terms

10. Drug Prescription Abbreviations

11. Drug Terminology

12. Eponym Usage

13. Format For Letters

14. Fraction Usage

15. Geographic Names & Proper

Names

16. Genus & Species Names

17. Genetic Terminology

18. Globulins and Immunoglobulins

19. Guidelines with Ages

20. Guidelines with Blood Counts

21. Guidelines with Blood Pressure

22. Guidelines with Dates

23. Guidelines with Proper names

24. Guidelines for Transcribing

Numbers

25. Obstetrics Terminology

26. MT Grammar Guidelines-In Brief

27. Plurals

28. SI unit of Measurement

29. Suture Material Guidelines

30. Transcribing Percentages

31. Transcribing Suture Sizes

32. Virgule

ABBREVIATIONS

ABBREVIATIONS

An abbreviation is a shortened, contracted, or brief form of words or phrase. Physicians mostly use abbreviations

while dictating in order to speed up communication. Sometimes, abbreviations can instead lead to confusion in the

report or the transcriber can misinterpret them. Some most common examples are COPD, TIA, TAH-BSO, CBC, etc.

When to use Abbreviations?

By rule, one must not use abbreviated forms even if dictated in admission or discharge diagnosis, preoperative or

postoperative diagnosis, impressions, assessment, or titles of procedure of operative procedure, as these are very

crucial points of information in a report and should be expressively communicated. However, in the remaining

narrative portion of the report abbreviations can be used. However, all other abbreviations should be transcribed in

full.

Generally, one must not abbreviate the terms dictated in full except for unit of measurement, for example, milligrams

as ml, centimeter as cm. deciliter as dl, which are accepted in the abbreviated form only.

In case of abbreviations having multiple meanings as in the case of PE which could pleural effusion. pulmonary

embolism, pulmonary edema, physical examination, and so on or if the abbreviation is not clearly understandable in

cases such as GTT, GGT, GPT, GOT, GT where it becomes increasingly difficult to understand, then it is the

transcriptionist’s duty to figure out the correct one by going through the remaining part of the report. If still

unsuccessful, it is better to keep a note rather than end up making a grave mistake.

Usage of periods in Abbreviations:

·Abbreviations for degrees or professional credentials (for example: MA, BA) and professional credentials (for

example: CMT, RNP), and also courtesy titles like Mr, Mrs, Dr are used without periods.

·Most abbreviations used in medical reports are transcribed without periods, including brief forms, acronyms, and

units of measure. For example, COPD (chronic obstructive pulmonary disease), lab data, cm, WBC.

·In case of junior and senior (Jr, Sr), a period is used only when they come in the end of the sentence, not otherwise.

·Latin abbreviations used in English communication, like etc. (et cetera), e.g. (exempli gratia), i.e. (idest) always take

periods and are placed in between commas in a sentence. Appropriate references should be made use of for the

appropriate placement of periods.

·Periods are a must when using lowercased drug-related Latin abbreviations like p.o., b.i.d., t.i.d., q.i.d., q.4-6h, etc.

If 2 or 3 Latin abbreviations are used together, it is obligatory to put a space between them.

For example:

The patient was advised to take ranitidine p.o. b.i.d. p.r.n. for his acidity.

·If the sentence is ending with an abbreviation that has a period, there is no need to add another period.

For example:

The patient is taking ranitidine p.o. p.r.n. (correct)

The patient is taking ranitidine p.o. p.r.n .. (incorrect)

Abbreviating in Plurals:

·To form a plural of a capitalized abbreviation, only a lowercased 's' is added.

For example:

EKGs, WBCs, PVCs.

·In case of lowercased abbreviations, apostrophe 's' is used to make a plural.

For example:

wbc's.

·In case of short forms for some laboratory terms and some other brief forms also, just 's' is added. For example,

segs, lymphs, labs, exams.

Abbreviations with Numerals:

A numeral associated with a unit of measure or any associated abbreviation should not be separated. They should

always be present in the same line and to do that a non-breaking space should be used.

There are certain abbreviations, which are not written in all capitals but in a mixed pattern like pH, PhO. So always

make sure through appropriate references as to which is the correct abbreviated form.

ACRONYMS AND INITIALISM

ACRONYMS AND INITIALISM

·In general usage, the term acronym is commonly used to describe all abbreviations made from initial letters,

regardless of pronunciation. Initialism originally referred to abbreviations formed from initials, without reference to

pronunciation. Many writers and speakers do not observe any difference between acronyms and initialisms.

·Acronyms are abbreviations formed by taking the initial letter of each word from a series of words or phrase.

For example:

AIDS, Acquired immunodeficiency syndrome, MRI from magnetic resonance imaging, CBC from complete blood count.

·All letters of acronyms are always capitalized but the words or phrases from which they are generated are to be

capitalized only if they are proper nouns.

For example:

MRI from magnetic resonance imaging is not capitalized when spelled out. However, OPEC from Organization of

Petroleum Exporting Countries will be capitalized when spelled out because it is a proper noun.

·With widespread usage, most of the commonly used medical acronyms are now used as words in their own sense,

meaning that such acronyms have now become the original word and are therefore transcribed as lower cased words

and not in abbreviated form.

For example:

Laser (light amplification by stimulated emission of radiation)

Folfox

·Periods are not used in between letters of acronyms.

·Plurals in acronyms are made by adding lower cased 's' to upper cased acronym as in WBCs. In case of lowercased

acronyms like rbc, plural is made by adding apostrophe 's' as in rbc’s.

·When using Acronym, apostrophe 's' is used to show possession to that acronym.

For example:

By OPEC's criteria, the whole world is their market place.

·Similar to abbreviations, acronyms should not be used in diagnosis, assessments of reports, as well as in the

procedure of operation.

·One note of caution: Acronyms whose meanings are either not known or understood should be better left as they are

rather than ending in putting your foot on the wrong side.

ADDRESS GUIDELINES

ADDRESS GUIDELINES

The United States Postal Service (USPS) is an agency of the United States government responsible for providing

postal service in the United States; it is generally referred to within the United States as "the post office." For any

letter addressed within the United States, the USPS requires two things on the envelope.

The first is the address of the recipient, to be placed in the center of the envelope. It is sometimes required to put the

name of the addressee above the address. Another optional addition to the address is a ZIP+4 code.

The formatting of the address is as follows

Line 1: Name of recipient

Line 2: Street address or P.O. Box

Line 3: City and ZIP+4 code

Example

Mr. John Dan

1111 JOHNSON ST

NEW YORK NY 10036-4658

The USPS maintains a list of proper abbreviations.

Check out at (http://www.usps.com/ncsc/lookups/usps_abbreviations.htm)

The formatting of a return address is identical. A common myth is that a comma is required after the city name, but

this is not true. The Post Office recommends use of all upper case block letters using the appropriate formats and

abbreviations and leaving out all punctuation except for the hyphen in the ZIP+4 code to ease automated address

reading and speed processing. USPS guidelines mention that all items in an address should be in all capital letters with

no punctuation marks on an envelope. Also, ZIP codes must be used on all mails. Zip codes have 5 digits or 9 digits.

In a 9-digit ZIP code, ZIP + 4 code, a hyphen is placed after the first 5 digits.

For example:

DENNIS RUSSO

PO BOX 6018

BABYLON NY

AMPERSAND

AMPERSAND

·An ampersand (&) is a logogram representing the conjunction "and". It is a symbol which represents word 'and'. The

name derives from the phrase "and per se and", meaning "and It is used in abbreviations.

For example:

D&C (dilatation and curettage)

T&A (tonsillectomy and adenoidectomy)

·No space is used before and after ampersand.

·As in abbreviations, ampersand is not to be used in diagnosis, operative titles, assessments, and conclusion.

APGAR SCORE

APGAR SCORE

The Apgar score was devised in 1952 by Virginia Apgar as a simple and repeatable method to quickly and summarily

assess the health of newborn children immediately after childbirth.

It is used to assess the condition of a newborn immediately after birth, i.e. 1 minute after birth and 5 minutes after

birth. The condition of a newborn is assessed on basis of 5 factors, namely heart rate, muscle tone, reflex irritability,

breathing effort, and color. Each of these factors is rated from 0 to 2, where 0 is lowest and 2 is highest score, thus

making a total score of 10.

Apgar score is reported in Arabic numerals, with the “A” of Apgar in upper case.

For example:

The infant's Apgar Score was 5 at 1 minute and 7 at 5 minutes.

The five criteria of the Apgar score:

Score 0 Score 1 Score 2 Acronym

Skin color blue all over blue at extremities normal Appearance

Heart rate absent <100 >100 Pulse

Reflex irritability no response

to stimulation

grimace/feeble cry

when stimulated

sneeze/cough/pulls away

when stimulated Grimace

Muscle tone none some flexion active movement Activity

Respiration absent weak or irregular strong Respiration

CANCER CLASSIFICATION AND GUIDELINES

CANCER CLASSIFICATION AND GUIDELINES

·Stages and Grades of Cancer: The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer

has spread. Cancers can be staged in various methods such as Ann Arbor staging, TNM staging, Roman Numeral

Staging.

·In transcription, the word “stage” and “grade” of cancer are not capitalized.

·By rule with stage, Roman numerals are used, and with grade, Arabic numerals are used.

·If the stage has a subdivision, it is placed immediately after the roman numeral without space. Subdivisions contain

uppercased alphabet or Roman numerals only.

For example:

stage I grade 1

stage IIA grade 4

stage III3

stage IVB

Several classification systems have been developed depending upon the body areas affected and the extent of tumor.

These are as follows:

Roman Numeral Staging

This system uses numerals I, II, III, and IV to describe the progression of cancer.

·Stage I cancers are localized to one part of the body.

·Stage II cancers are locally advanced, as are Stage III cancers. Whether a cancer is designated as Stage II or Stage

III can depend on the specific type of cancer; for example, in Hodgkin's Disease, Stage II indicates affected lymph

nodes on only one side of the diaphragm, whereas Stage III indicates affected lymph nodes above and below the

diaphragm. The specific criteria for Stages II and III therefore differ according to diagnosis.

·Stage IV cancers have often metastasized, or spread to other organs or throughout the body.

TNM staging

TNM Staging is used for solid tumors, and is an acronym for the words Tumor, Nodes, and Metastases. Each of these

criteria is separately listed and paired with a number to indicate the TNM stage. A T1N2M0 cancer would be a cancer

with a T1 tumor, N2 involvement of the lymph nodes, and no metastases (no spreading through the body).

·T (TI-T4): Tumor (T) refers to the primary tumor and carries a number of 0 to 4.

·N (N1-N3): N represents regional lymph node involvement and can also be ranked from 0 to 4.

·M (M0-Ml): Metastasis is represented by the letter M, and is 0 if no metastasis has occurred or 1 if metastases are

present.

For example:

T2, N1, M0

TX, N0, M0

·TNM classification makes use of staging indicators to define cancer and assess their stage. Capital letters are used for

staging followed by Arabic numeral without space. These are:

Grade: GX, G 1, G2, G3

Host performance: HO, HI, H2, H3, H4

Lymphatic invasion: LX, La, L1, L2

Residual tumor: RX, RO, RI, R2

Scleral invasion: SO, Sl, S2

Venous invasion: VX, VA, VI, V2

Broders Index

Broders index is a classification used to report the aggressiveness of a malignant tumor. It is reported in grades from

1 to 4, with grade 1 having best prognosis and grade 4 the worst. Arabic numeral from 1 to 4 is used to specify the

grade with grade being in lower case.

For example:

Broders grade 4.

CIN System

CIN stands for cervical intraepithelial neoplasia and is used to classify the lesions of the cervical cancer. It is classified

from 1 to 3 Arabic numerals, where

·1 represents mild dysplasia (lower severity),

·2 represents moderate dysplasia, and

·3 represents severe dysplasia (maximum severity). To transcribe, place the grade specified online with CIN with a

hyphen joining the two.

For example:

ClN-1

Clark Level

This classification is used to report level of invasion of the primary malignant melanoma or the skin, arising from

epidermis. Roman numeral from I to V are used to indicate the invasion.

Clark level I limited to epidermis.

Clark level II into underlying papillary dermis.

Clark level III to junction of papillary and reticular dermis.

Clark level IV into reticular dermis

Clark level V into subcutaneous fat.

Dukes Classification

This classification is used to report the extent of operable adenocarcinoma of the colon or rectum. It is classified from

A to C (uppercase alphabets).

Dukes A: confined to mucosa.

Dukes B1: extends into muscularis mucosa.

Dukes B2: extends through the muscularis mucosa.

Dukes C1: limited to the bowel wall with metastasis to the lymph nodes.

Dukes C2: extends through the bowel wall with metastasis to the lymph nodes.

Dukes is transcribed without apostrophe, (Dukes) and not (Duke's), with alphabet A, B, or C on the same line. The

Arabic numerals for subdivision of Band C are transcribed just immediate after it without the space.

For example:

Dukes C1

FAB Classification

It is a system of classification for acute leukemias, lymphocytic and myelogenous, where FAB stands for French-

American-British. This system utilizes FAB classification of malignant tumors explained later in this section.

Acute lymphocytic leukemia is divided in three classes, and transcribed by placing capital letter followed by Arabic

numeral 1 through 3.

·Small lymphoblasts with mature appearance

·More immature than L1, with different nuclear shapes and sizes

·Relatively large lymphoblasts

Acute myelogenous leukemia is classified from 0 to 7 (Arabic numerals). Upper case M is to precede the numeral

without a space.

M0: undifferentiated

M1: myeloblastic, with some immature cells

M2: myeloblastic with differentiation of cells

M3: promyelocytic

M4: myelomonocytic

M5: monocytic

M6: erythroleukemia

M7: megakaryocytic

FIGO Staging

It is a system of classification for staging of gynecologic cancers. FIGO stands for Federation Internationale de

Gynecologie et Obstetrique on the organization, which developed it. It is expressed in stages 0 to IV with 0 being

precancerous stage, and IV being highly malignant and most severe. For subdivisions, upper case alphabets are used

without space from the division. For example: ovarian cancer, FIGO stage IIB.

Gleason Tumor Score

It is a classification system used for adenocarcinoma of the prostate gland. The score or grade to determine the

severity is reached at by totaling the score achieved on a scale of 1 to 5 for each dominant and secondary pattern.

The higher the score, the severer is the prognosis. Arabic numeral is used for the score with space between word

grade and score. For example: The patient has Gleason score 8.

Jewett and Strong Staging

It is a system used to classify extent of the bladder carcinoma, from class 0 to 0 depending upon the extent of

invasion. Uppercased alphabets are used.

O: non-invasive, in situ

A: invading submucosa

B: invading mucosa

C: invading surrounding tissue

D: lymph node metastasis

For example:

The patient has bladder carcinoma, Jewett Class C.

CAPITALIZATION GUIDELINES

CAPITALIZATION GUIDELINES

Capitalization has always been a nagging question especially for the early beginners of transcription. Here we discuss

some basic rules of capitalization that are to be kept in mind when transcribing medical reports:

·Capitalize all the proper nouns-This includes names of a person, place, organization, languages, countries, races,

days of the week, and months.

For example:

George Bush

English

France

White House

Monday

June

·Capitalize brand names of drugs and not their generic names.

For example:

aspirin (generic) should be small unless the sentence starts with it.

Ecotrin (brand name)

·As discussed earlier, capitalize the words building, center, room, only when they accompany a proper noun or are

part of the official name, otherwise not.

For example:

Washington State Building

The patient was taken to Mercy Medical Center.

·Capitalize eponyms, but do not capitalize the adjectives, prefixes, and common nouns that accompany them. Also, do

not capitalize the nouns, adjectives, and verbs derived from eponyms.

For example:

non-Hodgkin’s lymphoma

Parkinson’s disease

red rubber Robinson catheter

parkinsonism

pasteurized milk

·All Acronyms are transcribed in upper-case letters (capitalized) except for a few, like wbc, rbc.

For example:

CABG from coronary artery bypass grafting.

COPD from chronic obstructive pulmonary disease

However, in abbreviated form (like S aureus, H pylori), the genus is capitalized.

·Capitalize compass directions (east, west, north, south) when part of the geographic name, otherwise not.

For example:

East Africa

South Korea

His house is in the west where the dark men reign.

·Capitalize name of religious holidays and festivals.

For example:

Thanksgiving

Memorial Day

Christmas Day

New Year Day

·Always capitalize sociocultural designations like races, religions.

For example:

Spanish

African-American

Hispanic

Caucasian

Methodist

DECIMALS

DECIMALS

·While transcribing decimals, periods are to be used “.”

·While transcribing quantities less than 1, zero (0) is placed before the decimal followed by the numeral value.

For example:

Clonidine.25 mg (Incorrect):

Clonidine 0.3 mg (Correct):

·While transcribing metric measurements, like cm, mg, mm, if fractions are dictated, they should be converted to

decimals and transcribed.

For example:

(Dictated): The cyst was two and a half cm in size.

(Transcribed): The cyst was 1.5 cm in size.

·But when only whole numbers are dictated and fractions are not dictated, then decimal point and zero should not be

placed though it does not changes the value.

For example:

(Correct): The patient was given dexamethasone 5 mg IV.

(Incorrect): The patient was given dexamethasone 5.0 mg IV.

But there is an exception to this as mentioned below.

·However, laboratory values and pathology specimens should be transcribed as dictated, even if decimal point and

zero are dictated following the whole number. Similarly, if they are not dictated, one should not place them on their

own.

(Dictated): The cyst measured 2.2 x 3.0 x 2.3 cm.

(Transcribed): The cyst measured 2.2 x 3.0 x 2.2 cm. (Correct)

The cyst measured 2.5 x 3 x 2.8 cm. (Incorrect)

Now take the second example.

(Dictated): The cyst measured 2 x 4 x 1.5 cm.

(Transcribed): The lesion measured 2 x 4 x 1.5 cm. (Correct)

The lesion measured 2.0 x 3.0 x 1.6 cm. (Incorrect)

Diabetes Mellitus

Diabetes Mellitus Terms

The American Diabetes Association (ADA) has categorized diabetes mellitus into the following types:

Type 1, insulin-dependent diabetes, which requires insulin usage for life time.

Type 2, non-insulin-dependent diabetes, which does not require insulin for sustaining life. Change in lifestyle, eating

habits, exercise, oral hypoglycemics may be used to keep it under control.

Impaired glucose tolerance, in which glucose levels are between normal and diabetic.

Gestational diabetes, develops in women during pregnancy and usually resolves after pregnancy.

Proper way of transcription – "Type" is followed by Arabic letter "1 or 2" in whic type is lower cased unless starting the

sentence. Hyphen is not used to join the "type" with "Arabic numeral."

For example:

Type 1 diabetes mellitus or diabetes mellitus type 2.

Non-insulin-dependent and insulin-dependent are always hyphenated either preceding or following the noun

"diabetes."

Insulin Terminology:

There are namely four types of insulin classified as:

Fast acting (Humalog insulin)

Short acting (Regular insulin)

Intermediate acting (NPH and Lente)

Extended or long acting: (ultralente insulin)

How to write the concentration: Concentration of insulin is measured in units per milliliter of blood. Normally, the

insulin is transcribed as 40 units, 35 units and so on but the ideal way is to write a capital letter "U" followed by

number of milliliters without any space between U and numeral to describe its concentration.

For example:

U35: 35 units of insulin per milliliter of blood.

U 70: 70 units of insulin per milliliter of blood.

Caution: The old theory of transcribing Ad verbatim should always be applied and transcribe as dictated. If U is

dictated, transcribe U. If units is dictated, transcribe units and there is no need to change it to U.

Drug Abbreviations

Drug Abbreviations:

These are some of the most commonly used drug abbreviations:

a.c. before meals or food

b.i.d. twice daily

h.s. at bedtime

p.c. after meals

p.o. by mouth

p.r.n. as needed

O.D. right eye

O.S. left eye

O.U. each eye

mcg microgram(s)

mg milligram(s)

mEq milliequivalent(s)

ML milliliter(s)

q.o.d. every other day

q.h. every hour

q.4h. every four hours

q.8h. every eight hours

q.i.d. four times a day

q.o.d. every other day

t.i.d. three times a day

Examples:

Remeron 30 mg p.o. q.h.s.

Amikacin 430 mg p.o. q.8h.

Pepcid 20 mg p.o. q.h.s.

Meropenem 1 gram IV q.8h.

Cisapride 10 mg p.o. q.i.d. p.r.n.

Meropenem 1 gram IV q.8h.

Lescol 20 mg p.o. q.h.s.

Paxil 40 mg p.o. q.d.

Keflex 500 mg p.o. q.i.d.

Enteric-coated aspirin 81 mg p.o. q.d.

Morphine soluble tablets one p.o. q.2-4h. p.r.n. breakthrough pain.

Dextromethorphan 15 mg p.o. t.i.d.

Drug Terminology

Drug Terminology

These are some of the most commonly used drug abbreviations:

a.c. before meals or food

b.i.d. twice daily

h.s. at bedtime

p.c. after meals

p.o. by mouth

p.r.n. as needed

O.D. right eye

O.S. left eye

O.U. each eye

mcg microgram(s)

mg milligram(s)

mEq milliequivalent(s)

ML milliliter(s)

q.o.d. every other day

q.h. every hour

q.4h. every four hours

q.8h. every eight hours

q.i.d. four times a day

q.o.d. every other day

t.i.d. three times a day

Some Dos and Donts in drug prescription:

Don’t Dos

q.day q.d.

q. four hours q.4h.

80 mg 0.80 mg

five hundred mg 500 mg

EPONYM USAGE

EPONYM USAGE

·Many terms in medicine, ranging from names of diseases to parts of the body to certain medical signs have been

named after people. Eponymous terms are most commonly named after the person who first described them but

occasionally they are named for famous patients who have had that condition.

For example:

Down syndrome

Ewing sarcoma

Arnold-Chiari malformation

Asperger syndrome

Gaucher disease

·Eponym is always capitalized but not the common nouns, adjectives, and prefixes that accompany them. Do not use

possessive forms with eponyms.

For example:

Down syndrome (Correct)

Down's syndrome (Incorrect)

McBurney point (Correct)

McBurney's point (Incorrect)

non-Hodgkin lymphoma (Correct)

Gaucher disease (Correct)

·Adjectives and/or verbs derived from eponyms are not capitalized.

For example:

The patient is suffering from parkinsonism.

·Plurals of eponyms are made by adding s or es. Apostrophe is never used.

For example:

Babinskis (Correct)

Babinski's (Incorrect)

·The genus names should be capitalized only when in singular form and accompanied by a species name. Species

name is never capitalized. The plurals and adjectival forms of genus are not capitalized.

For example:

Neisseria gonorrhoeae

Neisseria flavescens

Staphylococcus aureus

staphylococcal infection

meningococcal infection

staphylococci

Format For Letters

Format for Letters, Addressing Names, Salutations and Attention line

One of the most error-prone zone in transcription is while transcribing letters. Since letters are usually addressed to

doctors who are themselves highly proficient in their profession, any error in the letter can make them a little

annoyed. So take utmost care during transcribing letters.

The address is usually typed with a left margin alignment and is begun leaving a space of 3 to 4 lines below the date

of the letter. However, this can vary depending on letter size and customer specifications.

·Guidelines for Addressing Names of Persons:

Always a courtesy title like Mr., Mrs., Ms. or a professional title as Dr. is added to a name. If one does not know

whether the person is a man or a woman, do not use any title. Similarly, the title "Ms." should be used when one does

not know which title is to be used for a woman. In cases, when the degree of the person addressed is know, the

degree should be preferred over the title. Both the degree and title must never be used together.

For example:

Incorrect: Correct

Dr. James F. Bethpage, MD Dr. James F. Bethpage or James F. Bethpage, MD

Dr. Linda McKinley, DO Dr. Linda McKinley or Linda McKinley, DO

Mr. Shawn Patrice, Phd Mr. Shawn Patrice or Shawn Patrice, Phd

·Always use the complete name of a person if known with the courtesy title

For example:

Dr. Allen Markowitz

Professor John P. Doyle

Drs. Pugh, Hyle and McCArtney

Captain Copper W. Wright

·The name of the person should never be abbreviated when addressing him or her.

For example:

Patrick K. McCartney, MD is the right way to address and not Pat K. McCartney, MD

·When a person has two or more degrees, they are to be separated by a comma in between them and should be

placed in order of increasing distinction and recognition.

Example:

Lee J. Hills, MMS, MD, FACOG and not as Lee J. Hills, FACOG, MD, MS

·Sometimes, the names are written in reverse order with the last name first and first name last. In such cases, the

parts of the name are to be separated by comma. Usually a comma is placed after the last name and before the

degree if it needs to be mentioned.

For example:

Lee J. Hills, MD can also be written as Hills, Lee J., MD (see the comma usage)

However, one cannot address a person with the title in the reverse order. For example, it is wrong to write Dr. Hills,

Lee J. So the correct way of transcribing is Hills, Lee J., MD

·Guidelines for Addressing Names of Firms:

When transcribing name of the firm, always copy as it is printed on the company’s letterhead, website or as

mentioned in the directory. Under all circumstances, the abbreviations and punctations of the firm’s name are not to

be changed.

For example:

Queens-Long Island Medical Group.

Beth-Israel General Hospital

Copper & Raunchy Pathology Lab.

Schwanam, Haslip and Kimbrell Dental Clinic

·Guidelines for Addressing Persons with Business Titles:

While writing official letters or addressing people of higher business profile, mentioning the business title looks more

professional and respectful. When a business title accompanies any name, it is usually written last after the degree or

after the name separated by a comma but if the space does not permit it to be on the same line, it can be written on

the next line without the use of the comma.

For example:

Levlin K. Mirchandani, MS, Medical Director

Kevin Kasparov, LLB

Chief of Sales

Benjamin F. Camille, MD, MS

Head of Forensic Sciences

·Guidelines while writing address:

The address is to be written immediately flushed to the next line after the name of the person or the firm.

Usually the address starts with street name, apartment or suite number, city, state and Zip code. One should not

abbreviate North, South, West, Street, Avenue, Boulevard and even Apartment except when the address line is

getting too big. Usually, it looks nice to have the whole address mentioned in two or three lines. The city name is

always to be spelled out and separated with comma from the State. The state name can be abbreviated or can be

spelled out and is separated from the zip code with one or two space but no comma or dash. There is no need to put

comma or period at the end of the address line. Comma should only be used to separate the street and suite names

or as in city and state name.

Finally, it is better to copy the address as mentioned on the letter head, website or as approved by the USPS.

For example:

Kathy Suekat, MD

One Nameoke Street, Suite QE

Far Rockaway, New York 11432

(One should always be spelled out when used in building, street, suite or apartment number)

Elaine Markowitz, MD

1465 Broadway,

Hewlett, New York 11551

Susan B. Johnson, LLB

Apartment 34,

1782 Collinmore Street

Luxemborg, MA 13456

Napil B. Pakisha, MD

PO Box 1934

Maples, CA 44560

·Forms of Salutations:

After finishing with the address line starts the most important part of a letter i.e. salutation. This is a highly important

protocol when starting the letter. Usually, it’s easier to write the salutation when a person addressed is single but

becomes more difficult and more error prone, while addressing two or more people.

The salutation starts after leaving two blank lines after the address line and is to be followed by a co lon or a comma

as felt appropriate.

·Here are some common ways of writing salutation:

Dear Paul: or Dear Paul,

Dear Dr. Ben: or Dear Doctor Ben:

Dear Drs. Mike and Lee or Dear Dr. Mike and Dr. Lee:

Dear Linda and Betty: or Dear Linda and Betty,

Dear Mrs. Kathy and Ms. Brenda:

·Some examples for married couples.

Dear Mr. and Mrs. Bond:

Dear Professor Bill and Professor Kavita:

Dear Dr. Wu and Mrs. Cathy:

Dear Captain Pat and Professor Rina:

Dear Mr. Bright and Dr. Bright:

·Some examples for unmarried couples associated with business or work purposes.

Dear Professor Paul and Mrs. Wright:

Dear Dr. Mills and Dr. Hilton:

Dear William and Nancy:

·When addressing a large group together, use the standard salutation format.

Ladies and Gentleman:

Dear Professor McCarthy et al: (One can also use the name of the most senior person of the firm followed by et all,

meaning all others.)

·Guidelines to Use Attention Line:

Sometimes it becomes necessary to use the Attention line instead of going straight to salutation. When the attention

line is used, it should be typed two blank spaces after the last address line flushed with the left margin. It should be

written in full and usually capital form or even the first letter in caps would do but it is never to be abbreviated.

Example:

Attention: Mrs. Nancy P. Blake or ATTENTION: Mrs. Nancy P. Blake

If the title is going long, one can accommodate on the second line.

For example:

Attention: Mrs. Nancy P. Blake

Purchasing officer

Always take care that the second line should start at the same point where the name of the person starts. This

maintains clarity, visibility and neatness. It is wrong to use abbreviated form of Attention as Attn.

It is always debatable to use both the attention line and the salutation line. Some would like to use only the salutation

format without any attention line while some would prefer to use the attention line. In any case, the salutation should

always be in accordance with the attention line.

For example:

Attention: Mrs. Nancy P. Blake

Dear Madam,

This is the most frequent format used rather than using Dear Mrs. Nancy as mentioning the same name twice is

improper.

·So the start of a letter would look as follows:

May 28, 2006

Bethnovar Medical Clinic

1024 Nameoke Street, Suite 2B

Far Rockaway, New York 11621

Attention: Mrs. Nancy P. Blake

Dear Madam:

FRACTIONS

FRACTIONS

·In common usage a fraction is any part of a unit. A fraction is a way of expressing a quantity based on an amount

that is divided into a number of equal-sized parts.

For example, each part of a cake split into four equal parts is called a quarter (and represented numerically as 1⁄4);

two quarters is half the cake, and eight quarters would make two cakes.

Tips while transcribing Fractions:

·Fractions are to be spelled out when less than 1 and if it is not followed immediately by a noun.

For example:

The specimen measured one-quarter of a pound.

·Fractions are to be spelled out if the sentence begins with them.

For example:

One and a half years back, the patient had come to me.

·When the fraction precedes a noun, Arabic numeral should be used to transcribe it. Use a hyphen to join the fraction

with the noun it modifies.

For example:

A 1½-inch incision was made.

·Employ Arabic numerals for fractions in ages.

For example

The patient is a 4-½ -years old.

This 5-½-year-old patient underwent bilateral hand surgery.

·If a fraction is dictated with SI units, convert it into decimals. However, with other units of measure, fractions are

used.

For example:

(Dictated): The lesion was three and a half cm in size.

(Transcribed): The lesion was 3.5 cm in size. (Correct) .

The lesion was 3-1/2 cm in size (Incorrect)

·Place a hyphen following the whole number and place the fraction on the same line if there is no possibility of

reducing size of fractions.

For example:

A 4-l/2-year-old patient was brought to me for second opinion.

·In case of dimensions when using imperial units, always use numerals for fractions, with a hyphen between the whole

number and the fraction.

For example:

The cyst measured 1-1/2 x 2-1/2 x 1 inch.

Geographic Names & Proper Names

Geographic Names & Proper Names

·Always capitalize the names of geographic divisions like mountains, rivers, islands, oceans, states, countries, towns,

cities, continents, and streets.

Geographic Names

For example:

United States of America, Mount Everest, Tokyo, New York, Great Britain

·Capitalize common nouns only when they are a part of proper names, not when they stand alone.

For example:

River Ravi flows through India and Pakistan.

The ocean was quite dirty.

Though Niagara Falls is the most famous tourist attraction, the falls in Cherrapunji are extremely beautiful.

·The words, which are derived from geographic names but used to convey a special meaning, are not capitalized.

For example:

plaster of paris, french fries

·If the name of a city precedes the name of the state or if name of a state precedes the name of a country in text,

then separate the state and country from city and state respectively by commas.

For example:

The doctor lives in Babylon, New York.

His office is in San Jose, California.

·Proper adjectives and sociocultural derivatives from geographic names are capitalized.

For example:

This Spanish-speaking lady comes from New York, This is an 81-year-old African-American lady

Proper Names

·Names of a person, place, apartment, street, organization should always be capitalized.

For example:

George Bush II

Lady Harding Hospital.

·Common names, places, and things are not to be capitalized.

For example:

Novartis is a big pharmaceutical company

She owns her own cosmetic clinic

Columbia is a very famous university in Canada.