A client should generally be registered using their 'preferred name' as it is more likely to be used in common usage and on subsequent visits to the facility. The family name by which the client wants to be identified should be indicated by the 'Preferred name indicator' data element as their preferred family name. This family name may be different from the family name on the client's Medicare card, or other family names the client may be identified by and these other family names should be recorded and indicated by the 'Name usage type' data element.
If family name is not known or cannot be established, record UNKNOWN.
The family name indicated by the 'Preferred name indicator' should be recorded in the format preferred by the client. For example this may be the same as that indicated by the client on a form. Where appropriate, the family name indicated by the 'Name usage type' data element should be the same format as that printed on the relevant identification card (eg. Medicare card) to ensure consistent collection of name data.
In Queensland a person is able to change his or her name for usage. Care should be taken when recording a change of name for a minor, all relevant legal documentation should be obtained and diligently managed. Ideally, the name recorded for the minor should be known to both of his/her parents or guardian/carer, so the minor's records can be retrieved and continuity of care maintained, regardless of which parent accompanies the minor to the facility.
Whenever a client informs the facility of a change of family name (eg. following marriage or divorce) the former family name should be recorded as an 'alias' name. A full history of names should be retained. Eg.'MARY GEORGINA SMITH' informs the hospital that she has been married, changed her family name and wishes to be known as 'MARY GEORGINA JONES'. Record 'JONES', as her 'preferred' family name and record 'SMITH' as an alias' name.
Punctuation
If special characters form part of the family name, consideration should be given to a system's capability to collect and interpret such characters. This is particularly relevant to older or legacy systems. For example '#' to indicate a truncated name and '~' for some ethnic names.
Hyphen eg. WILSON-PHILLIPS
If the client has a hyphenated family name it should be recorded with a hyphen, for example 'WILSON-PHILLIPS'.
Do not leave a space before or after a hyphen, ie. between the last letter of 'WILSON' and the hyphen, nor a space between the hyphen and the first letter of 'PHILLIPS'.
Sometimes clients with hyphenated family names use only one of the two hyphenated names for example 'WILSON-PHILLIPS'. Record the family name indicated by the client as the preferred name, for example 'WILSON' and record each of the family names as an alias, for example 'WILSON', 'PHILLIPS' and 'WILSON-PHILLIPS'.
Apostrophe eg. O'BRIEN
If a client has an apostrophe in their family name, do not leave a space before or after the apostrophe, ie. between the 'O' and the apostrophe, nor a space between the apostrophe and 'BRIEN'. eg. O'BRIEN,
D'AGOSTINO.
Full stop eg. ST. JOHN
If a client has a full stop in their family name, do not leave a space before a full stop, ie. between 'ST' and the full stop. Do leave a space between the full stop and 'JOHN'. eg. ST. JOHN, ST. GEORGE.
Spaces eg. VAN DER HUMM
If the client has recorded their family name as more than one word, displaying spaces in between the words,
record their family name in the same way leaving one space between each word. eg. VAN DER HUMM,
LE BRUN, MC DONALD.
Registered, unnamed, newborn babies
When registering a newborn, use the mother's family name as the baby's family name unless instructed otherwise by the mother. The family name by which the newborn is identified should be indicated by the 'Preferred name indicator' data element and recorded under the 'newborn', 'Name usage type' or record as an 'alias' name in the case of old or legacy systems that may only have this field available.
Clients with only one name
Some people do not have a family name and a given name and they have only one name by which they are known. If the client has only one name, record it in the 'Family name' field and populate the 'One name indicator' data element.
Registering an unidentified client
The default for unknown family name, should be UNKNOWN in all instances and the name recorded as an 'alias' name. Don't create a 'fictitious' family name such as 'DOE' as this is an actual family name. When the client's family name becomes known, record it as the family name and make every attempt to identify whether it is the preferred and/or Medicare card family name. Keep the UNKNOWN as an 'alias' name.
Registering people from disaster sites
Clients treated from disaster sites should be recorded under the 'alias' name usage type. Local business rules
should be developed for consistent recording of disaster site client details. Care should be taken not to use identical dummy data (family name, given name, date of birth, sex) for two or more clients from a disaster site.
If the family name needs to be shortened
If the length of the family name exceeds the length of the field, truncate the family name from the right (that is, dropping the final letters). Also, the last character of the name should be a hash (#) to identify that the name has been truncated (refer to Punctuation).
Use of aliases (incomplete names or fictitious names)
QH recognises that some people may prefer to use an 'alias' when they present to receive a health service. This may particularly be the case in sexual health.
Use of an alias is not recommended because it prevents QH from identifying and accessing all the information held on a client and providing the best possible care. Facilities should discourage clients from the use of aliases in the interests of their broader health care by explaining the benefits that may flow to them in the event that they are admitted to other QH facilities in an emergency situation and important information held under an alias, but relevant to their care, may be unavailable to the treating care team (Queensland Health Sexual Health Clinical Services and Privacy Policy).
If an alias name is recorded for the family name, it is recommended that a client be asked to also record their Medicare card family name. The family name that the client wishes to be identified by is indicated by the 'Preferred name indicator'.
Baby for adoption
The word 'adoption' should not be used as the family name, given name or alias for a newborn baby. A newborn baby that is for adoption should be registered in the same way that other newborn babies are registered. However, if a baby born in the hospital is subsequently adopted, and is admitted for treatment as a child, the baby is registered under their adopted (current) name with a new Unit Record Number (URN) or Medical Record Number (MRN), and the record should not be linked to the birth record. This should be the current practice. Any old references to adoption in client registers (for names) should also be changed to UNKNOWN. Refer to the Queensland Health Clinical records - Adoption Policy and Adoption Record Instruction for further information.
Prefixes
Where a family name contains a prefix, such as one to indicate that the client is a widow, this must be entered as part of the 'Family Name' field. For example, when widowed, some Hungarian women add 'OZVEGY' abbreviation is 'OZY') before their married family name, eg. 'Mrs SZABO' would become 'Mrs OZY SZABO'. That is, 'Mrs SZABO' becomes an alias name and 'Mrs OZY SZABO' becomes the family name. The preferred family name should be indicated.
Aboriginal/Torres Strait Islander names not for continued use
For cultural reasons, an Aboriginal or Torres Strait Islander may advise a facility that they are no longer using the family name that they had previously registered. Record their current name as the family and record the discontinued name as an alias. The client's preferred family name should be indicated as such.
Ethnic names
The Appendix C of the Australian Standard AS5017-2006 Health Care Client Identification or the Centrelink publication A Guide to Ethnic Naming Practices, provide information on the naming practices of people from culturally diverse backgrounds.
Misspelled family name
If the client's family name has been misspelled in error, update the family name with the correct spelling and record the misspelled family name as an 'alias' name. Recording misspelled names is important for filing documents that may be issued with previous versions of the client's name. Discretion should be used regarding the degree of recording that is maintained.