In clinics with several physicians and other medical care practitioners, the demands on the medical record begin to resemble those of a hospital medical record. All of the medical care practitioners in the group must keep records in the same format, record enough information to allow any other medical care practitioners in the group to treat the patient, and identify patient problems with great specificity to ensure continuity of care. It is very important that the each person who cares for the patient be clearly identified in the chart. If nonphysician medical care practitioners are treating patients under a physician’s supervision, the supervising physician should be clearly identified in the chart. This can be a very important issue in Medicare billing because of the rules on what care may be billed by what class of provider. It is important for medical malpractice risk management to establish that state laws governing supervision of nonphysician personnel are followed.

Clinics where the patient sees whichever medical care practitioner is available at the time the appointment is made create the opportunity for patient problems to be ignored through shared authority for patient care. As with hospital-based care, the ideal is that there is one physician in charge of the patient’s overall care, and that the chart identifies this physician. The chart will be returned to this physician for review whenever the patient is treated by another member of the clinic group. This review allows the primary physician to reconcile the care of the other providers. If there are problems, the patient can be contacted. If there are no problems, the reviewing physician can add whatever notes are necessary to ensure that the next physician to see that patient has the proper information. In systems where this is impossible, the charts must kept in such as way as to preserve all the relevant data so that the medical care practitioner who treats the patient can try to make sense out of the previous care.