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 abbre viation is not clearly understandable in cases such as GTT, GGT, GPT, GOT, GT where it becomes increasingly difficult to understand, then it is the transcriptionists 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 diseas e), 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) al ways 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 rbcs. 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 Skin color Heart rate Reflex irritability Muscle tone Respiration blue all over absent no response to stimulation none absent Score 1 blue at extremities <100 grimace/feeble cry when stimulated some flexion weak or irregular Score 2 normal >100 sneeze/cough/pulls away when stimulated active movement strong Acronym Appearance Pulse Grimace Activity 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 i ndicates 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 Clark Clark Clark Clark level I limited to epidermis. level II into underlying papillary dermis. level III to junction of papillary and reticular dermis. level IV into reticular dermis 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 Dukes Dukes Dukes Dukes A: confined to mucosa. B1: extends into muscularis mucosa. B2: extends through the muscularis mucosa. C1: limited to the bowel wall with metastasis to the lymph nodes. 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 FrenchAmerican-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: M1: M2: M3: M4: undifferentiated myeloblastic, with some immature cells myeloblastic with differentiation of cells promyelocytic 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-Hodgkins lymphoma Parkinsons 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 capitali zed. 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 t he 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) Some Dos and Donts in drug prescription: Dont q.day q. four hours 80 mg five hundred mg Dos q.d. q.4h. 0.80 mg 500 mg

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

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 pe rson 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 companys letterhead, website or as mentioned in the directory. Under all circumstances, the abbreviations and punctations of the firms 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, its 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 Dear Dear Dear Dear Paul: or Dear Paul, Dr. Ben: or Dear Doctor Ben: Drs. Mike and Lee or Dear Dr. Mike and Dr. Lee: Linda and Betty: or Dear Linda and Betty, Mrs. Kathy and Ms. Brenda:

Some examples for married couples. Dear Dear Dear Dear Dear Mr. and Mrs. Bond: Professor Bill and Professor Kavita: Dr. Wu and Mrs. Cathy: Captain Pat and Professor Rina: 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 t he 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 14); 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 1-inch incision was made.

Employ Arabic numerals for fractions in ages. For example The patient is a 4- -years old. This 5--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.