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Ahima Ccs Practice Exam [2023] - Complete
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The root operation of resection applies to which of the following? a. Removal of the entire body part and removal of an entire lobe of the liver b. Partial incidental appendectomy and the closure portion of a procedure c. Blunt, digital, manual, or mechanical lysis of adhesions d. Partial cholecystectomy - Correct Answer-A. Removal of the entire body part and removal of an entire lobe of the liver. When coding benign neoplasm of the skin, the section noted above directs the coder to: D23- Other benign neoplasms of skinIncludes: Benign neoplasm of hair follicles Benign neoplasm of sebaceous glands Benign neoplasm of sweat glands Excludes 1: benign lipomatous neoplasms of skin (D17.0-D17.3) melanocytic nevi (D22.-) a. Use category D23 for benign neoplasm of sweat glands b. Use category D23 for melanocytic nevi c. Use category D23 for benign lipomatous neoplasms of skin d. Use category D23 for malignant neoplasm of the skin - Correct Answer-A. Use category D23 for benign neoplasm of sweat glands A 64-year-old female was discharged with the final diagnosis of acute renal failure and hypertension. What coding rule applies? a. Use combination code of hypertension and renal failure. b. Use separate codes for hypertension and chronic renal failure. c. Use separate codes for hypertension and acute renal failure. d. Use separate codes for elevated blood pressure and chronic renal failure. - Correct Answer-C Use separate codes for hypertension and acute renal failure Coding professionals need to have surgical references in order to discriminate between: a. Correct and incorrect documentation based on Joint Commission requirements b. Reportable and nonreportable procedures c. Chemotherapeutic drugs d. A comorbid condition and a complication that prolongs the length of stay - Correct Answer-B. Reportable and non reportable procedures
A patient is admitted with an acute inferior myocardial infarction and discharged alive. Which condition would increase the MS-DRG weight? a. Respiratory failure b. Atrial fibrillation c. Hypertension d. History of myocardial infarction - Correct Answer-A. Respiratory failure If a patient has undergone an outpatient echocardiogram and the cardiologist concludes in the report that the patient has mitral regurgitation, the coder should: a. Assign a diagnostic code for mitral regurgitation b. Query the physician about the diagnosis c. Code an abnormal finding of the echocardiogram d. No code can be assigned - Correct Answer-A. Assign a diagnostic code for mitral regurgitation A patient was treated in the emergency department with lacerations of the neck and underwent a repair of two (2) wounds of the neck (2.0 cm and 1.4 cm) with layered closure. What are the diagnosis (excluding external cause codes) and procedure codes assigned? S11.91XA Laceration without foreign body of unspecified part of neck, initial encounter S11.92XA Laceration with foreign body of unspecified part of neck, initial encounter 0HQ4XZZ Repair neck skin, external approach 12041 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2. cm or less 12042 Repair, intermediate, wounds of neck, hands, feet, and/or external genitalia; 2. cm to 7.5 cm a. S11.91XA, 0HQ4XZZ b. S11.92XA, 0HQ4XZZ c. S11.92XA, 12041, 12041 d. S11.91XA, 12042 - Correct Answer-D. S11.91XA, 12042 A patient is admitted to an acute care facility for detoxification from alcohol and barbiturate intoxication with chronic alcoholism and barbiturate abuse. The patient also has cirrhosis of the liver due to alcoholism. What codes should be assigned? a. F10.229, F13.129, K70.30, HZ2ZZZZ b. F10.129, F13.229, K70.30, HZ2ZZZZ c. F10.29, F13.129, K70.10, HZ2ZZXZ d. F10.229, F13.129, K70.9, HZ2ZZZZ - Correct Answer-A. F10.229, F13.129, K70.30, HZ2ZZZZ
c. Patient care, communication, research activities, and public health reporting d. All of the above - Correct Answer-d. All of the above The billing department has requested that copies of the final coding summary with associated code meanings for Medicare be printed remotely in the admission department. Currently they request the summaries only when there is an unspecified procedure. Each time the coding supervisor goes to the admission department, the coding summaries have been left on a table near the patient entrance. Of the actions presented here, what would be the best action for the coding supervisor to take? a. Comply with the request. b. Refuse to undertake this without further explanation. c. Ignore the request. d. Explain to the billing department supervisor that leaving the coding summary in public view violates the patient's right to privacy. - Correct Answer-d. Explain to the billing department supervisor that leaving the coding summary in public view violates the patient's right to privacy. What percentage will the facility be paid for procedure code 10060? 989323 T 10060 0006 $ 989323 T 64605 0220 $1, a. 50% b. 75% c. 0% d. 100% - Correct Answer-a. 50% To correct an entry in the medical record, the provider should: a. Draw a single line through the error, add a note explaining the error, initial and date, add the correct information in chronological order b. Draw a double line through the error, initial and date, add the reason for the correction c. Draw a single line through the error, and add the correct information in chronological order d. Draw several lines through the error, obliterate the documentation as much as possible, initial and date, add the correct information in chronological order - Correct Answer-a. Draw a single line through the error, add a note explaining the error, initial and date, add the correct information in chronological order Most hospitals require a medical record is completed within: a. 5 days b. 10 days c. 7 days
d. 30 days - Correct Answer-d. 30 days The patient was admitted from the emergency department because of chest pain. Following blood work, it was determined that the patient had elevated CPKs and MB enzymes. The EKG shows nonspecific ST changes. What type of diagnosis might this indicate? a. Unstable angina b. Myocardial infarction c. Congestive heart failure d. Mitral valve stenosis - Correct Answer-b. Myocardial infarction Two areas of documentation in the health record that are significant areas of focus of accrediting agencies are: a. Incident reports notation in the medical record and attorney's notes b. Past medical reports and social worker's notes c. Timeliness and legibility of medical documents d. Patient documentation and pastoral counseling - Correct Answer-c. Timeliness and legibility of medical documents A patient is discharged with a diagnosis of acute pulmonary edema due to congestive heart failure. What condition(s) should be coded? a. Acute pulmonary edema b. Congestive heart failure c. Acute pulmonary edema and congestive heart failure d. Unable to determine based on the information provided - Correct Answer-b. Congestive heart failure Using the following evaluation and management map, which answers represent documentation that should be considered when assigning an E/M code for hospital acuity points assignment? a. The surgical procedure performed b. The anesthesia provided c. Number of tests ordered d. The post visit follow-up date - Correct Answer-c. Number of tests ordered Assign the code(s) for diagnostic left and right cardiac catheterization, left and right coronary arteriogram with low osmolar contrast and fluoroscopic guidance. 4A023N6 Measurement of cardiac sampling and pressure, right heart, percutaneous approach 4A023N7 Measurement of cardiac sampling and pressure, left heart, percutaneous approach
a. The colposcopy and endometrial biopsy are represented by a combination code. b. Two codes would be used with modifier -59 appended. c. Two codes would be used in accordance with CPT code instructions. d. Only one code is used and it does not state that it includes endometrial biopsy specifically. - Correct Answer-c. Two codes would be used in accordance with CPT code instructions. When a Medicare patient receives an injection of IM penicillin G benzathine, 100, units only, what is the appropriate code assignment? 96372 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular 96374 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug J0558 Injection, penicillin G benzathine, and penicillin G procaine 100,000 unitsJ Injection, penicillin G benzathine, 100,000 units a. 96372 b. J c. 96374 d. 96372, J0561 - Correct Answer-d. 96372, J If a patient has an excision of a malignant lesion of the skin, the CPT code is determined by the body area from which the excision occurs and the: a. Length of the lesion as described in the pathology report b. Dimension of the specimen submitted as described in the pathology report c. Width times the length of the lesion as described in the operative report d. Diameter of the lesion as well as the margins excised as described in the operative report - Correct Answer-d. Diameter of the lesion as well as the margins excised as described in the operative report The use of the outpatient code editor (OCE) is designed to: a. Correct documentation of home health visits b. Facilitate reporting of adverse drug events c. Reduce the use of computer assisted coding d. Identify incomplete or incorrect claims - Correct Answer-d. Identify incomplete or incorrect claims A patient is admitted with a high temperature, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient also has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." What is the next step for the coder?
a. Code sepsis as the principal with a secondary diagnosis of urinary tract infection due to E. coli. b. Code urinary tract infection with sepsis as a secondary diagnosis. c. Query the physician to determine if the patient is being treated for sepsis, highlighting the clinical signs and symptoms. d. Ask the physician whether the patient had septic shock so that this may be used as the principal diagnosis. - Correct Answer-c. Query the physician to determine if the patient is being treated for sepsis, highlighting the clinical signs and symptoms. A patient is admitted because of congestive heart failure (CHF). During the treatment of the CHF, the patient was also found to have elevated liver function tests. The physician worked up the elevated liver function tests but was not able to determine a diagnosis. The following diagnoses should be assigned: a. Congestive heart failure with liver disease b. Abnormal liver function tests c. Congestive heart failure and abnormal liver function tests d. Congestive heart failure - Correct Answer-c. Congestive heart failure and abnormal liver function tests The use of standard protocols to enable different computer systems to communicate is referred to as: a. Digital assistance b. A data set c. Interoperability d. Pay for communication - Correct Answer-c. Interoperability Data accuracy is also referred to as: a. Consistency b. Comprehensiveness c. Timeliness d. Validity - Correct Answer-d. Validity A routine computer back-up procedure is an example of a security program that ensures data loss does not occur. This type of control is: a. Computer b. Validity c. Responsive d. Preventive - Correct Answer-d. Preventive A bronchoscopy with biopsy of the left bronchus was completed and revealed adenocarcinoma. What, if any, modifier should be added to the procedure codes?
requested if the physician needs it for continuity of care, but an entire list of patients cannot be provided. An 84-year-old woman was admitted and discharged with hemiplegia and aphasia. A CT scan of the brain was performed that revealed an acute cerebral infarction and a possible small brain mass. After further testing, the patient was discharged with a final diagnosis of acute cerebral infarction. The condition(s) that should be coded are: a. Acute cerebral infarction b. Hemiplegia and aphasia c. Acute cerebral infarction, hemiplegia, and aphasia d. Possible brain mass, hemiplegia, and aphasia - Correct Answer-c. Acute cerebral infarction, hemiplegia, and aphasia A quality improvement study showed that maternity cases are not being coded with the correct diagnostic codes reflecting the need for a cesarean section delivery. What index could be used to evaluate this? a. Birth certificate registry or master patient index b. Transcription registry or correspondence registry c. Quality improvement or operative registry d. Disease index from billing and reimbursement data - Correct Answer-d. Disease index from billing and reimbursement data According to the UHDDS, section III, the definition of other diagnoses is all conditions that: a. Coexist at the time of admission, that develop subsequently, or that affect the treatment received or the length of stay b. Receive evaluation and are documented by the physician c. Receive clinical evaluation, therapeutic treatment, further evaluation, extend the length of stay, increase nursing monitoring/care d. Are considered to be essential by the physicians involved and are reflected in the record - Correct Answer-a. Coexist at the time of admission, that develop subsequently, or that affect the treatment received or the length of stay A method of checking the accuracy of data is to: a. Validate the purpose for the data collection b. Warehouse data on a regular basis c. Authenticate all end users d. Ensure that each record or entry within the database is correct - Correct Answer-d. Ensure that each record or entry within the database is correct Determining medical necessity for outpatient services includes all the following except:
a. Local coverage determinations (LCDs) b. National coverage determinations (NCDs) c. Diagnoses linked to procedures by claims-processing software tests ensuring that the procedure is cross-referenced, or linked, correctly to an acceptable diagnosis code for that service d. Requiring new HCPCS codes be developed to replace codes in the CPT code book - Correct Answer-d. Requiring new HCPCS codes be developed to replace codes in the CPT code book During a coronary artery bypass surgery, the patient underwent saphenous bypass grafts; from the aorta to the left anterior descending branch of the left main coronary artery, and the left posterior descending of the left main coronary artery. The patient also underwent a repositioning of the mammary artery to the right coronary artery. Choose the best description for this procedure. a. Three aortocoronary grafts b. Two aortocoronary grafts and one mammary-coronary graft c. Two aortocoronary grafts and two saphenous bypass grafts d. Three aortocoronary grafts and one mammary-coronary graft - Correct Answer-b. Two aortocoronary grafts and one mammary-coronary graft If a diagnosis of rule-out pneumonia with cough and malaise is specified in an emergency department visit, the coder should assign a code for: a. Malaise b. Pneumonia c. A cough d. Cough and malaise - Correct Answer-d. Cough and malaise A patient was admitted with end stage renal disease (ESRD) following kidney transplant. The patient also had angina and chronic obstructive pulmonary disease. The diagnoses would be sequenced as: a. Kidney failure; status post kidney transplant; chronic obstructive pulmonary disease; angina b. End-stage renal disease; status post kidney transplant; chronic obstructive pulmonary disease; angina c. Chronic kidney disease, stage 5; status post kidney transplant; chronic obstructive pulmonary disease; angina d. Acute kidney failure; status post kidney transplant; chronic obstructive pulmonary disease; angina - Correct Answer-b. End-stage renal disease; status post kidney transplant; chronic obstructive pulmonary disease; angina A patient is admitted and diagnosed with fever and urinary burning. The discharge diagnosis is Escherichia coli, urinary tract infection. Which of the following represents the correct diagnoses and appropriate sequence of those conditions?
A 65-year-old patient is admitted with pain and loosening of a left total hip prosthesis. The acetabular component has loosened and become painful. The patient was admitted for open removal and replacement of the acetabular component of the left hip prosthesis. What is the appropriate code(s) for the admission? a. T84.031A, 0SPB0JZ, 0SRE0JZ b. T84.50XA, 0SUR0BZ c. T84.031D, Z96.642, 0SP90JZ d. T84.50XA, Z96.642 0SUR0BZ, 0SUA0BZ - Correct Answer-a. T84.031A, 0SPB0JZ, 0SRE0JZ A patient presents to a facility with a history of prostate cancer and mental confusion on admission. The patient completed radiation therapy for prostatic carcinoma three years ago and is status post a radical resection of the prostate. A CT scan of the brain reveals metastatic carcinoma of the brain. The correct coding and sequencing of this patient's record is: a. Metastatic carcinoma of the brain, carcinoma of the prostate, mental confusion b. Mental confusion, history of carcinoma of the prostate, admission for chemotherapy c. Metastatic carcinoma of the brain, history of carcinoma of the prostate d. Carcinoma of the prostate, metastatic carcinoma to the brain - Correct Answer-c. Metastatic carcinoma of the brain, history of carcinoma of the prostate A policy states that inpatients who undergo open reduction and internal fixation of a fractured femur should be routinely coded with blood loss anemia when there is intraoperative blood loss of 500 cc or more documented in the operative report and the patient has low hemoglobin. Is this correct or incorrect and why? a. It is correct to code blood loss anemia because the policy requires it. b. It is correct because the clinical signs are documented in the record. c. It is incorrect because the patient must also have a blood transfusion in order for blood loss anemia to be coded. d. It is incorrect because the physician did not document the blood loss anemia in the progress notes. - Correct Answer-d. It is incorrect because the physician did not document the blood loss anemia in the progress notes. A 59-year-old man who works in construction is diagnosed with basal cell carcinoma of the eye. An excision of basal cell carcinoma, 1.9-cm lesion left upper eyelid was done. What codes should be assigned? a. C44.121, 11622 b. C44.119, 11642 c. C44.119, 11640 d. C44.121, 11642 - Correct Answer-b. C44.119, 11642
What is assigned to CPT codes to indicate whether a service or procedure will be reimbursed under the OPPS? a. Ambulatory payment classifications b. Payment status indicators c. Payment modifiers d. Diagnosis-related groups - Correct Answer-b. Payment status indicators In teaching facilities where electronic signatures are used for residents and attending physicians: a. Attending signature is all that is needed b. Resident signature is all that is needed c. Resident should cosign after the attending signs the documentation d. Attending should cosign after the resident signs the documentation - Correct Answer- d. Attending should cosign after the resident signs the documentation The Joint Commission considers what kind of management to be important for safe, quality care? a. Resource management b. Recycling management c. Information management d. Incremental management - Correct Answer-c. Information management Which of the following is not a function of the outpatient code editor (OCE)? a. Editing the data on the claim for accuracy b. Specifying the action the FI should take when specific edits occur c. Assigning APCs to the claim (for hospital outpatient services) d. Determining payment-related conditions that require direct reference to ICD-10-CM codes - Correct Answer-d. Determining payment-related conditions that require direct reference to ICD-10-CM codes What diagnoses and procedures should be reported for recurrent left inguinal hernia with laparoscopic repair? K40.30 Unilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent K40.31 Unilateral inguinal hernia, with obstruction, without gangrene, recurrent K40.91 Unilateral inguinal hernia, without mention of obstruction or gangrene, recurrent 49520 Repair recurrent inguinal hernia, any age; reducible 49521 Repair recurrent inguinal hernia, any age; incarcerated or strangulated 49651 Laparoscopy, surgical; repair recurrent inguinal hernia a. K40.91, 49520
neighbors who is also a coworker at the hospital called the coding department to get the patient's diagnosis because she is a cancer survivor herself. The coder should: a. Discuss the case with the coworker b. Report the incident to hospital security c. Give the caller false information d. Explain that discussing the case would violate the patient's right to privacy - Correct Answer-d. Explain that discussing the case would violate the patient's right to privacy A 70-year-old patient was admitted with pneumonia. The history and physical documented that the patient has a history of diabetes, hypertension, and migraine headache about 10 years ago without recurrence. The patient was administered IV antibiotics, metformin, and altace during the hospitalization. Which conditions would be reported at the time of discharge? a. Pneumonia, diabetes, hypertension, and migraine headaches b. Pneumonia, diabetes, hypertension, and history of migraine headaches c. Pneumonia, diabetes, and hypertension d. Pneumonia - Correct Answer-c. Pneumonia, diabetes, and hypertension A condition is present on admission when: a. It is the principal diagnosis b. It is accordance with medical staff bylaws c. A condition that occurs prior to an inpatient admission d. It is present within 3 days after admission - Correct Answer-c. A condition that occurs prior to an inpatient admission Before an organization can measure the quality of information it produces, it must: a. Establish a data quality committee b. Investigate if there are fraudulent processes in current use c. Determine all attributes of poor quality d. Establish data standards within the organization - Correct Answer-d. Establish data standards within the organization Documentation in the record reveals that a patient is admitted with an acute exacerbation of COPD (MS-DRG 192). A higher-paying DRG may be appropriate if documentation is present in the record at the time the decision was made to admit the patient that confirms a diagnosis associated with which of the following: a. Angina was treated with nitroglycerin prn for chest pain b. Atrial fibrillation and underwent a cardioversion while hospitalized c. Blood gases of pO2 of 58, pCO2 of 55, pH of 7.32 upon admission and treated with intubation and mechanical ventilation for 23 hours
d. Anemia and was given a blood transfusion - Correct Answer-c. Blood gases of pO2 of 58, pCO2 of 55, pH of 7.32 upon admission and treated with intubation and mechanical ventilation for 23 hours A patient was admitted to an acute care facility with a temperature of 102 and atrial fibrillation. The chest x-ray reveals pneumonia with subsequent documentation by the physician of pneumonia in the progress notes and discharge summary. The patient was treated with oral antiarrhythmic medications and IV antibiotics. What is the correct code sequence? a. J18.9, I48. b. I48.91, J18. c. It does not matter which is used as the principal diagnosis. d. Not enough information is present. Query the physician. - Correct Answer-a. J18.9, I48. The patient was admitted for prostate carcinoma. This was treated with radiation. A member of the medical staff who was not associated with the patient's care requests to see the patient's record. What should the coder do? a. Provide the record to the physician. b. Report the incident to hospital security. c. Ask the physician to come back when the supervisor gets back. d. Explain that providing the record would violate the privacy policy. - Correct Answer-d. Explain that providing the record would violate the privacy policy. Generally, data quality is defined as: a. Ensuring the greatest amount of data possible is obtained from the medical record b. Ensuring the accuracy and completeness of an organization's data c. Ensuring accuracy of the case-mix index d. Ensuring the optimal reimbursement for each encounter - Correct Answer-b. Ensuring the accuracy and completeness of an organization's data Admission for repair of an inguinal hernia. This 30-year-old patient has acquired immunodeficiency syndrome (AIDS) but is not symptomatic at this time due to medication regimen. The procedure performed was a right indirect inguinal herniorrhaphy via open approach. What codes should be assigned? a. B20, K40.90, 0YQ5XZZ b. K40.90, B20, 0YQ50ZZ c. Z21, K40.90, 0YQ5XZZ d. K40.90, Z21, 0YQ50ZZ - Correct Answer-b. K40.90, B20, 0YQ50ZZ A female patient is diagnosed with congestive heart failure. Which of the following will increase the MS-DRG weight if present on admission?
a. 65710 b. 65730 c. 65750 d. 65755 - Correct Answer-a. 65710 According to the UHDDS, in order to assign a code for an other diagnosis, documentation must be present that: a. The condition is recorded in the patient record by a dietary clerk b. The condition is present in the admission department data c. The condition was clinically evaluated or therapeutically treated, extended the length of hospital stay, or increased nursing care or monitoring d. The condition is considered to be essential by the family - Correct Answer-c. The condition was clinically evaluated or therapeutically treated, extended the length of hospital stay, or increased nursing care or monitoring A patient presents for cystourethroscopy with removal of two lesions of separate locations in the bladder. One of these is a 1.5-cm bladder tumor in the anterior wall and one is measured as 0.75-cm in the lateral wall. What coding rule applies? a. Two CPT codes should be used with a modifier -59. b. Two CPT codes should be used. c. Code only the CPT code for cystourethroscopy. d. Code only the largest tumor. - Correct Answer-d. Code only the largest tumor. Assign code(s) for the following diagnosis: Congestive heart failure due to hypertension. I10 Essential (primary) hypertension I11.0 Hypertensive heart disease with heart failure I50.9 Heart failure, unspecified I50.23 Acute on chronic systolic (congestive) heart failure a. I10, I50. b. I11. c. I50.23, I d. I11.0, I50.9 - Correct Answer-d. I11.0, I50. During an admission for congestive heart failure (CHF), a chest x-ray was done to evaluate for the presence of CHF. An asymptomatic hernia was also found for which no treatment or evaluation was done. What is the reason that the hernia should not be coded? a. The patient's primary condition of interest is the CHF. b. The hernia is an incidental finding and does not meet the UHDDS requirements. c. The patient is asymptomatic.
d. The condition does not impact the reimbursement. - Correct Answer-b. The hernia is an incidental finding and does not meet the UHDDS requirements. A patient is admitted to the inpatient setting with hydronephrosis and a staghorn calculus of the right kidney. The patient underwent an ureteroscopy with placement of bilateral ureteral stents for dilation purposes and removal of calculus of right kidney. What codes should be assigned? a. N13.0, 0T788DZ, 0TC08ZZ b. N13.9, 0T787DZ, 0TC08ZZ c. N13.2, 0T788DZ, 0TC08DZ d. N13.2, 0T788DZ, 0TC08ZZ - Correct Answer-d. N13.2, 0T788DZ, 0TC08ZZ In CPT, if a patient has two lacerations of the arm that are repaired with simple closures, the coder would assign: a. Two CPT codes expressing each laceration repair b. One CPT code for the largest laceration c. One CPT code, adding the lengths of the lacerations together d. One CPT code for the most complex closure - Correct Answer-c. One CPT code, adding the lengths of the lacerations together A patient was admitted after a fall down the steps. The patient was unconscious for approximately 45 minutes and was admitted to the emergency department (ED) within 3 hours of the fall. A CT scan was performed within an hour of admission to the ED. A cerebral contusion was diagnosed by the ED physician based on the findings in the CT scan. What conditions should be reported on the Uniform Billing form 04 (UB-04)? R40.0 Somnolence S02.91XA Unspecified fracture of skull, initial encounter for closed fracture S06.331A Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 30 minutes or less, initial encounter S06.332A Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter W10.9XXA Fall (on) (from) unspecified stairs and steps, initial encounter a. S02.91XA, W10.9XXA b. R40. c. S06.331A, W10.9XXA d. S06.332A, W10.9XXA - Correct Answer-d. S06.332A, W10.9XXA In most circumstances, the person who authorizes release of medical information is: a. Chief executive officer b. Patient c. Physician
