Grammer for medical transcription

1. Grammar For Medical Transcription
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PREFACE
This manual is a kind of refresher material as you have already learnt about the rules of English grammar, which plays a
very important role in the field of medical transcription.
We have done our best to include as many important topics as possible. We have also kept in mind that the users of this
manual are not freshers, but people who have undergone MT training and are ready to enter production.
The manual will be updated periodically.
We sincerely hope that this manual will be useful to you in providing insights into the language that you, as a Medical
Transcriptionist, will be listening to everyday.
Any suggestions and feedback are appreciated.

INTRODUCTION TO PARTS OF SPEECH
The basic foundation for the English language lies in the use of the parts of speech. To master the English language, one
must first learn the parts of speech. Some words function as different parts of speech in different sentences. To
determine the part of speech of a word, one must first decide on its function in a sentence.

THE NOUN:
A noun is the name of a person, place, animal, thing, idea, concept, feeling etc.
Every sentence either contains a noun or is about a noun.
Recognizing nouns: Ask the question "who" to the sentences; the answer you get is a "noun."
Example:
The inspector looked at all the passengers' passes.
Katherine Jenkins was an opera singer.
Types of nouns:
Common nouns
Proper nouns
Collective nouns
Abstract nouns
Gerunds
Compound nouns.

COMMON NOUNS: A common noun is a name given in common to every person or thing of the same class. Common
nouns are not capitalized. They are nouns that name any one or more of a general group of persons, places, things, ideas,
concepts, feelings, etc. E.g.: car, house, heart, happiness, doctor, hospital, college, city, country.

PROPER NOUNS: A proper noun is the name of a particular person or place.
E.g.: John, Dr. Jack, Sacred Heart Hospital, India
Common nouns Proper nouns
Boy John
Doctor Dr. Jack
Hospital Sacred Heart Hospital
Country India
Book Bible
Medication Prozac
Proper nouns are always capitalized. They are nouns that name specific persons, places, things, ideas, concepts, etc.
A few more examples of proper nouns are Dr. Johnson, Hershey Medical Center, Ford sedan, Washington D.C.

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COLLECTIVE NOUNS: A collective noun is a noun that denotes a collection of persons or things regarded as a unit.
E.g.: board, cabinet, class, committee, company, corporation, council, department, faculty, family, firm, group, jury,
majority, minority, navy, public, society, team, troop, staff, union
Usage determines whether the collective noun is singular or plural. If it is singular, it takes a singular verb and takes a
plural verb if it represents many groups.

ABSTRACT NOUNS: An abstract noun is a term used to denote the quality, action, or state of the object.
Quality - goodness, kindness, honesty, bravery, wisdom, etc.
Action - laughter, theft, movement, judgment, hatred, etc.
State - childhood, youth, death, sickness, poverty, etc.

GERUNDS: Gerunds are nouns that end in verb forms, i.e., -ing.
E.g.: a. Smoking is injurious to health.
b. Running is a good exercise.
c. Skiing is her favorite sport.

COMPOUND NOUNS: A compound noun is a noun that is made up of two or more words that act as a single noun.
Most compound nouns in English are formed by nouns modified by other nouns or adjectives.
Compound nouns can occur as one word, two words, or hyphenated.
E.g.: flashlight, doghouse, high school, seat belt, editor-in-chief, great-grandfather.
Some helpful tips:
The following is a list of some common noun endings. This does not cover nouns that are formed by allergies, but it will
help in identifying nouns by recognizing these endings.
Nouns ending in NESS: Goodness, madness, sadness, kindness, etc.
Nouns ending in ITY: Scarcity, magnanimity, simplicity, prosperity, etc.
Nouns ending in TION: Addition, subtraction, sensation, education, etc.
Nouns ending in MENT: Contentment, entertainment, management, etc.
Number: Nouns and pronouns both have number; it means that they can either be singular or plural. Not all nouns have
both singular and plural, but many do.
Nouns that have plurals:
Doctor/doctors. Examination/examinations. Person/people. Nouns that do not have plurals: Goodness. Contentment
Stupidity.

VERB
A verb is a word or phrase which indicates the action or state of being of the subject. It can also be defined as word or a
group of words that show action and is of vital importance to a sentence. It is the most important word in a sentence. A
verb indicates action or the state of being of the subject or noun.
Types of verbs:

Action or main verb. 2. Linking verb. 3. Auxiliary or helping verb. 4. Transitive verb. 5. Intransitive verb.

ACTION/MAIN VERB: Denotes the action/what is happening in the sentence.
E.g.: eat, sleep, causes, drink, go, operated, beats, come, etc.
Action verbs indicate what the subject does.
e.g.: Dr. Hutchins operated on the patient’s stomach.

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Poor personal hygiene causes disease.
His heart beats 100 times per minute.

LINKING VERB: Words like am, is, are, was, were, has, have, had, may, and might are called linking verbs when they
are the only verbs in the sentence. Instead, they connect the subject of a verb to additional information about the subject.
E.g.: a. The patient is well built.
b. She is alert and oriented to person, place, and time.
c. The patient has an allergy to morphine.
All verbs which indicate sense are also considered linking verbs because there is no particular action related to them.
E.g.: taste, feel, grow, become, look, smell, sound.
Identifying action verbs and linking verbs: If you can substitute am, is, or are for the verb and the sentence still sounds
logical, you have a linking verb on your hands. If, after the substitution, the sentence makes no sense, you are dealing
with an action verb. Here are some examples:
E.g.: Chris tasted the crunchy, honey-roasted grasshopper.
Tasted is an action verb in this sentence.
I smell the delicious aroma of the grilled octopus.
Smell, in this sentence, is an action verb.
The students looked at the calculus formula until their brains hurt.
Here, looked is an action verb.
Linking verbs indicate what happens to the subject or what the subject is. They are called linking verbs because they link
the subject to words that rename or describe them. The most common linking verbs are forms of the verb ‘to be’ and
seem, become, remain, feel, look, smell, sound, and taste.
E.g. the patient is a 36-year-old male with a history of epilepsy.
His heartbeat is 100 beats per minute.
The abrasions appear self inflicted.
Note: Some verbs double as both linking and action verbs. One must look at how they are used in the sentence. A
linking verb is often referred to as an equal sign. An action verb always denotes action.
e.g.: The patient smelled the smoke before seeing the fire. (Action verb).
The rose smells sweet (linking verb).

AUXILIARY/HELPING VERB: Words like is, are, am, was, were, will, would, shall, should, can, could, has, have,
had, may, might, do, does, did are called auxiliary verbs when they come in conjunction with the action verb. In these
cases, the helping verb indicates the time and certainty of the action.
E.g.: Do you like German food?
Does your mother speak English?
Did you come to school yesterday?
Why are you talking? You should be listening to me!
I was having a bath when you called!
A new road is being built behind the school.
Have you done your homework?
My father has never visited the USA.
How long have you been living in Germany?
By this time next year I will have been learning English for 35 years!

TRANSITIVE VERB: Transitive means "passing over." A transitive verb is accompanied by a direct object in which a
passive can be formed. In a sentence, if the action passes onto the object, then the verb is a transitive verb.

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E.g.: a. the boy kicks the football.
b. The doctor performed the surgery.
c. He spoke the truth.

INTRANSITIVE VERB: An intransitive verb denotes a complete action without being accompanied by a direct object
or state of being, as sit or lie, and does not form a passive.
E.g.: a. the baby sleeps.
b. There is a flaw in the diamond.
Some verbs can be transitive in one sentence and intransitive in another: watched is transitive in "The audience watched
the latest production," but intransitive in "The cook watched while the dishwasher picked up the broken dish."

ADJECTIVE
An adjective is a word, which modifies or describes a noun or pronoun.
Adjectives generally answer the following questions:
What kind? What color? What size? Which one? How many? How much?
It can also be said that adjectives help to specify or limit things.
“Man” is a very general category.
If we added the word “tall” and said “tall men,” it would make this group smaller.
If we said, “tall, well-built men,” it would limit the group even further.
ADJECTIVE PLACEMENT:
Adjectives may be found in two places in a sentence, i.e., preceding a noun, and following a linking verb.
1: Proceeding (before) a noun: Most adjectives are found immediately before the noun that they modify. A noun may
have one or more adjectives, which modify it.
Example: There is an unusual rash on the back of his neck. (Unusual modifies rash).
This unhealthy obese female came in for a routine exam (unhealthy and obese modify female).
2: Following a linking verb: Adjectives which follow linking verbs are known as predicate adjectives. They modify the
subject of the verb.
Example: This patient seems lethargic and unresponsive. (Seems is a linking verb. Lethargic and unresponsive modify
patient).

DEGREE OF ADJECTIVES:
Adjectives have degree, i.e., they tell you what the degree of description is.
Example: This is a strong drug. This is a stronger drug. This is the strongest drug.
Types of adjectives:

Simple adjectives
Compound adjectives

SIMPLE ADJECTIVES: A simple adjective modifies the noun or pronoun in one word.
E.g.: a. the lazy child was punished.
b. Take great care of yourself.
c. The back room was filled with large, yellow rain boots.
A sentence can have many simple adjectives. When listed one after another, the simple adjectives should be separated
with commas.
E.g. A tall, dark, handsome man entered the room.
A simple adjective ending in -ing is called a participle.

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E.g. The attending physician is Dr. Allen.

COMPOUND ADJECTIVES: When 2 or more words combine to modify one noun and function as one adjective, it is
called a compound adjective and sometimes requires a hyphen and sometimes not.
E.g.: a. the patient is a 32-year-old African American female.
b. This is a well-developed, well-nourished male.
c. The patient was advised to perform range of motion exercises.
A sentence can have a combination of simple and compound adjectives, all of which should be separated by commas.
E.g. The patient is a pleasant, elderly, thin, ill-appearing, 71-year-old African American female.
You may wonder why the sentence above has no comma separating 71-year-old and African American. A comma is not
to be placed between the last adjective and modified noun. To help differentiate when to use a comma, substitute the
comma for the word "and" to determine whether the sentence is grammatically correct.
E.g. the patient is a pleasant and elderly and thin and ill-appearing and 71-year-old African American female. You
would not say, "The patient is a pleasant and elderly and thin and ill-appearing and 71-year-old and African American
female."

ADVERB
A word that gives additional information about a verb, an adjective, or an adverb itself is called an adverb.
E.g.: a. Bob runs quickly (quickly tells something about the action of running, which is a verb).
He wore a dark blue shirt (in this sentence, shirt is a noun and blue is an adjective, dark modifies blue and becomes an
adverb). c. He attends medical conferences fairly regularly (here, regularly becomes an adverb modifying the verb
attends and fairly gives her his her his her his us more information about regularly which is an adverb, so fairly also
becomes an adverb. Regularly modifies the verb whereas fairly modifies the adverb).
The difference between an adjective and an adverb is that adjectives modify nouns and pronouns whereas adverbs modify
verbs, adjectives, and adverbs.
Although adjectives have definite positions in the sentence (pre-noun or post-verb), adverbs can be placed anywhere in
the sentence.
Most of the adverbs are formed -ly to the adjectives, and hence, they can be easily recognized; however, there are also
some adjectives that end in the same suffix -ly.
E.g.: early, elderly, unruly, ghastly.
Types of Adverbs:

Interrogative adverb
Conjunctive adverb
INTERROGATIVE ADVERBS: An interrogative adverb asks a question. The interrogative adverbs are how, when,
where, and why.
E.g.: a. How did you break your leg?. b. When does your plane leave?. c. Where did you put the mouse trap?.
d. Why do you bother me so?

CONJUNCTIVE ADVERBS: A conjunctive adverb acts as a transition between complete ideas. It normally shows
comparison, contrast, cause-effect, sequence, or other relationships. Conjunctive adverbs are not true conjunctions, but
these adverbs often function as conjunctions in joining 2 independent clauses.
The following words are common conjunctive adverbs:
accordingly, again, also, consequently, finally, furthermore, however, indeed, moreover, nevertheless, otherwise, then,
therefore, thus, anyway, besides, certainly, hence, incidentally, indeed, instead, likewise, meanwhile, nonetheless,
similarly, still, subsequently.

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ARTICLES
Definition of the Article.
Articles are modifiers that are used to indicate definiteness or indefiniteness. Consequently, articles are divided into 2
types: 1. Indefinite articles (a, an). 2. Definite articles (the)
A or an is called the indefinite article because it usually leaves indefinite the person or thing spoken of.
The is called the definite article because it normally points out some particular person or thing.
The indefinite article is used before singular countable nouns. Ex: A book, an orange, a boat.
The definite article is used before singular countable nouns, plural countable nouns, and uncountable nouns. Ex: The
book, the books, the milk, the river.
The choice between a and an is determined by sound. Before a word beginning with a vowel sound an is used. Ex: An
egg, an orange, an hour, an honor, an embarrassment
Before a word beginning with a consonant sound a is used. Ex: a university, a jug, a mattress, a European, a honest
person

Use of the definite article.
Definite article is used when we talk about a particular person or thing or one already referred to (that is, if it is clear
from the context which one we mean). E.g. The girl sang very well.
When a singular noun is meant to represent a whole class E.g. The cow is a useful animal.
Before some proper nouns E.g.: The Pacific Ocean, The Ganga, The Indian Ocean
Before the names of certain books E.g.: The Vedas, The Puranas, The Mahabharata
Before names of things that are unique of their kind. E.g.: The sun, the sky.
Before a proper noun when it is qualified by an adjective or a defining adjectival clause. E.g.: The great Caesar. The Mr.
Roy you met yesterday is my uncle.
With superlatives. E.g.: The darkest cloud has a silver lining.
With ordinals. E.g. The ninth chapter is interesting.
Before musical instruments. E.g.: The veena, the flute, the guitar, the saxophone
Before an adjective when the noun is understood. E.g.: The poor, the rich
As an adverb with comparatives. E.g. The more the merrier.
With decades or groups of years E.g. She grew up in the 1970s.
Use of the indefinite article.
The indefinite article is used in its original numerical sense of one. E.g. Not a word was said.
In the vague sense of a certainty. E.g.: A beggar, A liar, A thief
In the sense of any, to single out an individual as the representative of a class. E.g. A pupil should obey his teacher.
Before 100 and 1000. E.g. He earns a thousand dollars per month.
With names of jobs. E.g.: a doctor, an engineer, a dancer
Before nationalities and religion of individuals. E.g.: an Englishman, a catholic, an Indian, an American
With singular nouns after the words “what” and “such.” E.g. What a shame!
She is such a beautiful girl.
Before ages. E.g. She is an 83-year-old woman.
Please DO NOT use an article with:
With names of countries (if singular) Germany is an important economic power. He's just returned from Zimbabwe.
(But: I'm visiting the United States next week. With the names of languages. French is spoken in Tahiti . English uses
many words of Latin origin. Indonesian is a relatively new language. With the names of meals. Lunch is at midday.
Dinner is in the evening. Breakfast is the first meal of the day. With people's names (if singular): John is coming to the
party. George King is my uncle. (But: we're having lunch with the Morgans tomorrow.) With titles and names:

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Prince Charles is Queen Elizabeth's son. President Kennedy was assassinated in Dallas . Dr. Watson was Sherlock
Holmes' friend. (But: the Queen of England , the Pope.) With professions: Transcription is a useful career. He'll
probably go into medicine. With names of shops: I'll get the card at Smith's. Can you go to Boots for me? With years:
1948 was a wonderful year. Do you remember 1995? With uncountable nouns: Rice is the main food in Asia .
Milk is often added to tea in England . War is destructive. With the names of individual mountains, lakes and islands:
Mount McKinley is the highest mountain in Alaska . She lives near Lake Windermere. Have you visited Long Island?
With most names of towns, streets, stations and airports: Victoria Station is in the center of London . Can you direct me
to Bond Street? She lives in Florence. They're flying from Heathrow. In some fixed expressions, for example: by car,
by train, by air, on foot, on holiday, on air (in broadcasting), at school, at work, at University, in church, in prison, in
bed.

PREPOSITION
Prepositions are connecting words. They do not have any meaning or content in and of themselves. They exist only to
show relationship between 2 or more words. Prepositions are used to show the location, direction, time, or
action/movement of the subject or noun.
Common Simple Prepositions
The following list includes some, but not all, of the common prepositions used in English language.
About, above; across, after, against, along, among, around, as, at, before, behind, below, beneath, beside, between,
beyond
But, by, concerning, despite, down, during, except, for, from, in, into, like, near, next, of, off, on, onto, out, outside, over,
Past, per, round, since, through, throughout, to, toward, under, underneath, unlike, until, under, up, upon, with, within,
without
E.g.: a. Todd and Jan left during the intermission.
The patient presents with fever and body pain.
Her pinky was jammed between the doors.
I have prescribed a minimal painkiller for the next 3 days.
At that point in time, she will return for reexamination.
We will head for the movie theater around 3 p.m.
Common Prepositional Phrases
A prepositional phrase consists of a simple preposition preceded by a word from another category, such as an adverb,
adjective, or conjunction. The prepositional phrase includes the preposition and the object of the preposition as well as
any modifiers related to either.
Commonly used prepositional phrases AT
BY, FOR, FROM, UNDER, WITHOUT, at first, at least, at most, at times, at any rate, at last, at the latest, at once, at
short, notice, at an, advantage, at a, disadvantage, at risk, at a profit/loss, by accident, by far, by all, means, by heart, by
chance,
by and by, by the way, by the time, by no, means, by name, by sight, by now, by then, for now, for instance, for example,
for sale, for a while, for the, moment, for ages, for a change, for better or, worse, from now on, from then on, from bad
to,
worse, from my, point of view, from what I, understand, from personal, experience, under age, under control, under the,
impression, under guarantee, under the, influence of under obligation, under no, obligation, under suspicion, under his
thumb, under discussion under, consideration, without fail, without notice, without exception, without express, consent,
without success, without warning.
E.g.: 1. The flying saucer appeared above the lake before it disappeared into space.
ABOVE has an object to complete its meaning; therefore, ABOVE is a preposition and the entire phrase is a
prepositional phrase.

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Crystal could hear her sister snoring across the room.
Objects usually answer the question what. Therefore, we can ask across what? to determine the object of the preposition.
Christine discovered a pile of books hidden under the staircase.
You should consider reading the notes before class.
BEFORE is not an adverb because it alone does not answer where about the verb.
Remembering the right preposition combination is sometimes difficult. The following combinations can be troublesome:
Incorrect, apologize about, bored of, capable to, concerned to, on, in search for, independent, interested about, outlook of
life, puzzled on, similar with, Correct, apologize for, bored with, capable of, concerned about, over, with, in search of,
independent of, interested in, by, outlook on life, puzzled at, by, similar to.

IMPORTANT PUNCTUATION MARKS USED IN TRANSCRIPTION
COMMA (,)
Commas: A comma is a punctuation mark that indicates a pause is needed in a sentence. Commas help to clarify
meaning for the reader and give clarity to the sentence.
Use a comma before a coordinating conjunction joining 2 independent clauses, all FAN BOYS.
E.g.: a. The contestants had to complete the challenge in an hour, or they were disqualified.
The patient has had intermittent confusion, so a home health nurse was assigned to dispense the patient's medication.
A consultation was obtained, and liver function studies were done.
Use a comma after an introductory word, introductory phrase, or an introductory clause. This comma indicates that the
main part of the sentence is about to begin.
Introductory word
Fortunately, the patient's chest pain resolved after 12 hours of nitroglycerin.
Slowly, she became aware of where she was.
Introductory phrase
To pass the course, he had to research an author of his choice.
Due to her rapid deterioration, the patient was transferred to the ICU.
After the surgery, the patient was taken to postop recovery.
Introductory clause
An introductory clause is a dependent clause that appears at the beginning of the sentence. A comma should be placed
after a dependent clause to indicate the beginning of the main clause of the sentence.
E.g.: a. Because he spiked a fever, the patient was not cleared for discharge.
When he experiences typical chest pain, he always takes nitroglycerin sublingually.
When she called 911, the firemen rushed to her rescue.
However, if the dependent clause comes after the independent or the main clause, no comma should be put before the
dependent clause.
E.g.: a. The patient was not cleared for discharge because he spiked a fever.
He always takes nitroglycerin sublingually when he experiences typical chest pain.
The firemen rushed to her rescue when she called 911.
Use a comma to separate items in a series.
A series is formed of 3 or more entities. All of the entities in a series should be separated with a comma. Entities in a
series can be words, phrases, or clauses. Before the last item in a series and can be inserted.
E.g.: a. The patient will follow up in the clinic for a dressing change on Monday, Wednesday, and Friday.
I really don’t care whom you see, where you go, or what you do.
The patient was brought to the operating room, put on the table, and placed in the supine position.
Adjectives – Use a comma to separate 3 or more adjectives. Do not place a comma between the last adjective and
modified noun.

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E.g.: a. The patient is a pleasant, cooperative, elderly female (adjective and modified noun).
Physical examination reveals the abdomen to be soft, nontender, and nondistended.
Use a comma when a disease entity or condition is followed by its location in the body or when the term is followed by
an adjective describing it.
E.g.: a. Fracture, left hip.
He has degenerative arthritis, left knee, with increasing inability to cope.
Deep venous thrombosis, right leg.
Credentials and Professionals
Use commas to offset professional credentials when they follow the person's name.
E.g.: a. William Walter, MD
Stella Olson, CMT, AAMT director
In case of multiple degrees, degrees should be separated by commas and spaces.
E.g.: a. Wanda Stevens, MD, PhD
Susan Pierce, CMT, ART
Titles such as MD, CMT, head of the department are treated as nonessential clauses and hence, flanked in commas.
E.g.: a. Dr. Diana Williams, head of the department of psychiatry, will provide us with a detailed evaluation on this
patient.
Linda Campbell, CMT, transcribed the stat report.
Dates
When the alpha/numeric date (i.e., month, day, and year) is given in sequence, always place a comma after the year
except, obviously, when the date ends the sentence. (This comma rule does not apply to numbered dates separated by
virgules, i.e., 2/15/06.)
E.g.: a. She was admitted on April 27, 1998, and discharged on May 2, 1998.
A cholecystectomy was performed on August 17, 2005, and a hysterectomy on September 20, 2005.
If the date does not include the year, then no comma is necessary. Using the above examples:
She was admitted on April 27th and discharged on May 2, 1998.
A cholecystectomy was performed on August 17th and a hysterectomy on September 20th.
Commas should not be inserted if the complete date is not stated.
E.g. She was admitted in March 1993 and discharged in April 1993.
CRITICAL POINT
For incomplete dates, never enter of between the month and the year, even if it is dictated.
E.g. Incorrect: She was admitted in March of 1993 and discharged in April of 1993.
Numbers
Five-digit and larger numbers should be separated by commas after every 3 digits starting from the last digit (unit 1).
E.g. The patient was given 1000 mg of acetaminophen. (No comma – number is only 4 digits)
CBC: platelets 150,000, reticulocytes 35,000.
Do not use a comma if the number contains a decimal.
E.g. Specific gravity was 1.01459.
Use a comma to separate adjacent unrelated numerals if neither can be readily expressed in words and if the sentence
cannot be easily re-casted.
E.g.: a. In March 1991, 1038 patients were seen in the emergency room.
Prescription was given for Tylenol No. 3, 1 to 2 tablets q.4-6 h.
Lab data and values: When multiple lab results are given, separate related tests with commas. Values under one test
should be separated by commas; however, different tests should be separated by periods.

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E.g. White count 5900, hemoglobin 14.7, hematocrit 43.1, platelets 245,000. (These are values from a complete blood
count-CBC). Urine specific gravity 1.006, pH 6, negative dipstick. (These are values from a urinalysis-UA). Sodium
139, potassium 4.6, chloride 106, bicarbonate 28. (These are values from a basic metabolic panel-BMP).
Latin abbreviations: Latin abbreviations (viz., etc., i.e., e.g., et al.) are commonly used in English medical text. In such
cases, they should be flanked in commas.
viz.: videlicet = "namely," "precisely," "that is to say."
etc.: Et cetera = "and others," "and so forth," "and so on" (used to indicate that more of the same sort of class might have
been mentioned, but for brevity have been omitted).
i.e.: Id est = "that is" or "in other words."
e.g.: exempli gratia = "for example," "for the sake of example," "such as."
et al: et alia = "and others," "and elsewhere."
E.g.: a. She is fluent in several languages, viz., French, Italian, Spanish.
He played football, basketball, tennis, etc., despite his knee injury.
Initially, the patient was uncooperative, i.e., she refused all treatment.
She loves exotic fruit, e.g., mangoes, passion fruit, and papayas.
My research was derived from Taber's Cyclopedic Medical Dictionary, et al.
Parentheses: Do not precede a parenthesis by a comma. If a comma is required following the parenthetical information,
it must be placed after the closing parenthesis.
E.g. The patient is improving (despite her repeated insistence that she is dying), and we plan to discharge her to an
extended care facility next week.
Quotation marks: Always place a comma inside the closing quotation mark.
E.g. The patient stated that "the itching is driving me crazy," and she kept scratching her arms throughout our meeting.
State/country name: Offset in commas the state name if it follows city name, and country name if it follows state name.
E.g.: a. Modesto , California .
Venice , Italy .
The patient returned from a business trip to Paris , France , the week prior to admission.
The patient moved to Dallas , Texas , 15 years ago.
MISCELLANEOUS
Commas are used when writing names that are presented last name first.
E.g. Bond, James
Use commas to offset elements that express a contrast or a turn in the sentence.
E.g.: a. The house was cute, but too expensive for the newlyweds.
They were looking for something practical, not luxurious.

CRITICAL POINT
Do not use a comma or other punctuation between units of the same dimension.
E.g.: a. The infant weighed 5 pounds 3 ounces.
He is 5 feet 4 inches tall.
SEMICOLON (;)
A semicolon is another important tool you can use when you write.
Semicolons are used to:
Ø Help preserve the continuity of the subject
Ø Indicate a close relationship between independent clauses (in this case, sometimes referred to as a "soft period")
Ø Serve to separate sentences that describe different aspects of the same subject (in this case, sometimes referred to as
a "soft period")
Ø Help sort out a monster list (sometimes referred to as a "super comma")

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Rule 1: To connect 2 sentences use a semicolon to separate closely related independent clauses when they are not
connected by a conjunction.
E.g.: a. The patient had a radical mastectomy for a malignancy; the nodes were negative.
The patient's results came back; they were negative for streptococcal infection.
Rule 2: Use a semicolon before a conjunction connecting independent clauses if one or more of the clauses contain
complicated internal punctuation.
E.g. After the game, I won a red beanie baby, four edible ingots, and a certificate of excellence; but when the storm
came, I lost it all in a torrent of sleet, snow, and profanity.
Rule 3: When 2 independent clauses are connected by a conjunctive adverb, place a semicolon before the conjunctive
adverb and a comma after it.
E.g.: a. The patient had a radical mastectomy; however, the nodes were negative.
The patient did show signs of improvement in the emergency room; hence, he was discharged home.
Rule 4: As a super comma
A semicolon is used to separate items in a series, instead of a comma, if one or more items in the series include other
internal punctuation. This usage is frequently seen in lists of medications and dosages as well as in lists of lab results.
E.g.: a. The patient will take Cerubidine 120 mg; Cytosar 200 mg b.i.d.; thioguanine
80 mg in the morning and 120 mg in the evening; Oysco 500 every Sunday, Tuesday, and Thursday.
His lab results showed a white count of 5900; hemoglobin 14.6, last hemoglobin 10.1; hematocrit 43.1; PT 11.2; PTT
31.4.
Though the semicolon is an important punctuation mark, please do not overuse it.
PERIOD (.)
Use a period
Rule 1: at the end of a complete sentence that is a statement
E.g. The patient's past medical history is unremarkable.
However, if the last word in the sentence ends in a period, do not follow it with another period.
E.g.: Incorrect: The patient is to continue Remeron 1 tablet t.i.d..
Correct: z. Rule 2: after initially capitalized abbreviations and single letter abbreviations
E.g. Mr., Ms., Dr., Inc., Ltd., Joseph P. Myers
Rule 3: with lower case Latin abbreviations
E.g. a.m., p.m., b.i.d., t.i.d., p.o., q.4 h.
Rule 4: after the name of the genus when it is used with an abbreviated species name
E.g. E. coli, M. tuberculosis, E. histolytica
Rule 5: to separate a decimal fraction from the whole number with a period
E.g. His temperature was 98.4 degrees Fahrenheit.
Rule 6: to separate different tests under laboratory data
E.g. WBC of 6400, hemoglobin of 8.3, hematocrit of 26.6, platelets 284,000. BUN 15, creatinine 1.2. Sodium 141,
potassium 3.6, chloride 107.
Rule 7: to separate the description from the name for different organs in the physical examination
E.g. HEENT: Normocephalic, atraumatic. PERRLA, EOMs intact. Tympanic membranes intact. Septum in the
midline. Geographical tongue, dentures, moist buccal mucosa.
Rule 8: Always place the period inside the quotation marks.
E.g.: a. In Physics and Reality, Einstein said, "The whole of science is nothing more that a refinement of everyday
thinking."
The patient presents with “funny sounds in the ears.”
Rule 9: Use a period after numbers or letters in an enumerated list.
E.g. DIAGNOSES:

RAMPRASAD
Uncontrollable hypertension. 2. Left kidney failure.
DO NOT USE A PERIOD
in metric and English units of measurement. Abbreviate units of measure using no periods, even if dictated in full, if
they are accompanied by a numeral and are METRIC measurement (NOT English measurement).
E.g. km, cm, mm, kg, mg, ml, wpm, mph (SEE UNITS OF MEASURE BELOW)
with abbreviations that are brief forms of words.
E.g. exam, sed rate, flu, Pap smear
at the end of a parenthetical sentence within a sentence.
E.g. When I saw him on his return visit (Dr. Smith saw him on his initial visit), I was startled by the deterioration in
his condition.
with scientific abbreviations typed in a combination of capital and lowercase letters.
E.g. Rx, Dx, Hb, pH, IgG, mEq
between letters in an acronym. An acronym is an abbreviation coined from the initial letter of each successive word in a
term or phrase. The new word is pronounceable and memorable. In general, an acronym made up solely from the first
letter of the major words in the expanded form is rendered in all capital letters and does not take periods in between.
E.g.: UNESCO: United Nations Educational, Scientific, and Cultural Organization
CRY: Child, Rehabilitation, and You
AIDS: Acquired Immunodeficiency Syndrome
LASIK: Laser-Assisted in Situ Keratomileusis
BOTOX: Botulinum Toxin
with academic degrees. While periods continue to be used in academic degrees, the preferred form is without them. If
periods are used, do not space within the abbreviation.
E.g. Chris Jones, BA preferred over Chris Jones, B.A.
Also, certification, registration, and license abbreviations
E.g. CMA-A, CMT, RN, RRA, ART, LPN. With abbreviations typed in capital letters.
E.g.: COPD, MI, LAD, ICU, CBC
with currency, if the amount is less than one dollar.
E.g.: 50 cents
COLON (:)
The colon is one of the most helpful and easiest to use of all the punctuation marks.
The primary function of a colon is only one thing, to introduce. It can introduce just about anything: a word, a phrase, a
clause, a quotation, or a list.
Place a colon at the end of salutations in business correspondence. The salutation of a letter is the opening greeting. In
informal salutations, use commas.
Dear Dr Watson:
Gentlemen: Dear Emily:
When time is expressed using the 12-hour system (with either a.m. or p.m.) place a colon between the hours and minutes.
The military time is not formatted with colons.
The patient has a follow up appointment with her dermatologist next Tuesday at 8:30 a.m.
The winning time was 1:43:52. Defibrillation began at 1139.
Colon is normally placed after headings and subheadings.

OBJECTIVE: IMPRESSION:
Colon is used to separate the values of each quantity in the ratio.
We used a 1:10 solution of saline to sterile water.
Colon is used to introduce a formal listing.

RAMPRASAD
Recommendations are as follows: Cover the wound when bathing and limit sun exposure.
Colon is used to introduce an implied listing.
I have 2 recommendations: Cover the wound when bathing and limit sun exposure.

QUESTION MARK (?)
Direct inquiry
A question mark is used to indicate a direct inquiry. Thus, it is used at the end of an interrogative sentence (a direct
question), which starts with "wh" words or auxiliary verbs.
E.g.: a. Was the patient seen in the emergency room prior to admission?
Who authorized this procedure?
Indirect questions
Indirect questions are sentences that start with a subject and the question is asked indirectly. A question mark is not used
in this case.
E.g. The patient asked if he could be discharged by Saturday.
To express doubt or uncertainty
Use a question mark to indicate doubt or uncertainty. Sometimes, particularly with diagnoses, a question mark is placed
before a statement in order to indicate uncertainty. Either placement is acceptable, but do not place one before and one
after. A question mark should be put where it is dictated.
E.g.: a. His cholesterol levels were high normal (or minimally elevated?).
Diagnoses: Angina?
Never combine a question mark with a comma or with another ending punctuation mark, i.e., an exclamation point,
period, or another question.

HYPHEN (-)
A hyphen (-) is a punctuation mark. It is used to both join words and separate syllables.
Uses of hyphens
Use a hyphen to avoid confusion in meaning
Re-cover (cover again) and recover (to cure from illness)
Re-create (make or create again) and recreate (to enjoy or entertain).
Hyphenate compound numbers 21 to 99 when they are spelled out.
E.g. Twenty-five, ninety-seven, etc.
Compound modifier
A compound adjective is when 2 or more words unite together as a single adjective to modify one noun. A compound
adjective is hyphenated if the hyphen helps the reader differentiate a compound adjective from two adjacent adjectives
that each independently modify the noun. If, however, there is no risk of ambiguity, it may be written without a hyphen:
Sunday morning walk. Compare the following examples:
The hyphen is unneeded when capitalization or italicization makes grouping clear:
E.g.: a. old English scholar: an old person who is English and a scholar, or an old scholar who studies English.
Old English scholar: a scholar of Old English.
Some compound modifiers are so commonly used together that they are automatically read as a unit and do not need to
be connected with hyphens.
E.g.: a. deep tendon reflexes. b. jugular venous distention. c. left lower quadrant. d. low back pain. e. range of motion
exercises (used with preposition). f. mild to moderate pain (used with preposition).
When a compound adjective is followed by a noun and needs punctuation for clarity, words serving as a compound
adjective should be hyphenated.
E.g.: a. 36-year-old female. b. left-handed patient. c. well-developed and well-nourished male.

RAMPRASAD
This area specifically addresses the use of hyphens with compound modifiers. This is a quirky and very picky rule. If
you don't know this rule, it can lead to a number of mistakes throughout a report. Thankfully, the rule is very easy to
learn and assimilate into your writing habits and common knowledge.

THE RULE:
If the compound modifier appears BEFORE the word or phrase it modifies, then the modifier REQUIRES a hyphen.
E.g. The professor is a very level-headed person. (NOTE: "level-headed" modifies the noun "person." Because it
appears before the word "person," it requires a hyphen.)
If the compound modifier appears AFTER the word or phrase it modifies, then the modifier DOES NOT require a
hyphen.
E.g. Our professor is not very level headed. (NOTE: Because "level headed" appears after what it modifies—in this
case "professor"—it requires no hyphen.)
Adjectives ending in -ly
This can be confusing as most adverbs end in -ly. The confusion can be avoided by finding out the function of the word
ending in -ly. Determine if the –ly word is giving information about a noun/pronoun or verb/adjective. If your answer is
noun/pronoun, it is an adjective. If your answer is verb/adjective, the word ending in -ly is an adverb.
Use a hyphen in a compound modifier with an adjective ending in -ly.
E.g.: a. Scholarly-looking student
Squirrelly-faced stuffed animal
Sickly-appearing patient
Do not use a hyphen with left-hand components of a compound adjective that end in -ly, that modify right-hand
components that are past participles (ending in -ed).
E.g.: a. a hotly disputed subject
a greatly improved scheme
a distantly related cousin
Adjective-noun compound modifier
Use a hyphen in an adjective-noun compound that precedes and modifies another noun (see also "noun-adjective"
below).
E.g.: a. second-floor office but not the office on the second floor. b. round-table discussion. c. four-wheel drive (the
singular wheel not the plural wheels is used).
Adjective/Adverb with a preposition
Use hyphens in most compound adjectives that contain a preposition and are followed by a noun they modify.
E.g.: a. figure-of-eight sutures. b. finger-to-nose test. c. heel-to-shin test. d. moderate to severe pain
Use a hyphen with an original verb preceding a preposition that modifies a noun.
E.g.: a. stick-on label (verb + preposition = adverb + noun). b. stand-by fare - but also - it costs a lot less to travel stand-
by.
Adjective with a participle
Use a hyphen to join an adjective to a participle whether the compound precedes or follows the noun.
E.g.: a. Good-natured, soft-spoken patient. Or b. The patient is soft-spoken and good-natured.
Use a hyphen when an adjective preceding a noun to which -d or -ed has been added as a past-participle construction,
used before a noun. E.g.: a. loud-mouthed hooligan. b. middle-aged woman. c. rose-colored glasses.
Adjective with comparatives and superlatives
Use a hyphen with comparatives and superlatives in compound adjectives.
E.g.: a. the highest-placed competitor. b. a shorter-term loan.
Do not use a hyphen with compound adjectives that include comparatives and superlatives with more, most, less or least.

RAMPRASAD
E.g.: a. a more recent development. b. the most respected member. c. a less opportune moment. d. the least expected
outcome.
Adverb with a participle or an adjective
Use a hyphen to form a compound modifier made up of an adverb coupled with a participle or adjective when they are
followed by the noun they modify. A hyphen should not be placed if they are not followed by a noun.
E.g.: a. well-developed and well-nourished patient - but no hyphen with - The patient is well developed and well
nourished. b. fast-acting medication - but no hyphen with - The medication is fast acting.
Use a hyphen with a noun, adjective, or adverb preceding a present participle (ending in -ing).
E.g.: a. an awe-inspiring personality. b. a long-lasting affair. c. a far-reaching decision
Adverb ending in –ly
Do not use a hyphen in a compound modifier to link an adverb ending in -ly with a past participle or adjective.
E.g.: a. recently completed workup. b. moderately acute pain. c. financially stable investment
Adverb preceding a compound modifier
Do not use a hyphen in a compound modifier preceded by an adverb.
E.g.: a. somewhat well nourished patient
very well developed male. c. chronically ill appearing female. d. very much admired philosopher.e. really well accepted
proposal.
Disease-entity modifier
Do not use hyphens with most disease-entity modifiers even when they precede the noun.
E.g.: a. cervical disk disease. b. oat cell carcinoma. c. pelvic inflammatory disease. d. sickle cell carcinoma
e. urinary tract infection
Eponyms
Use a hyphen to join 2 or more eponymic names used as multiple word modifiers of diseases, operations, procedures,
instruments, etc. Do not use a hyphen if the eponymic name refers to a single person.
E.g.: a. Osgood-Schlatter disease. b. Chevalier Jackson forceps. c. Guillain-Barre syndrome.
Equal, complementary, or contrasting adjectives
Use a hyphen to join 2 or more adjectives that are equal, complementary, or contrasting when they precede or follow the
noun they modify.
E.g.: a. anterior-posterior aspect. b. physician-patient confidentiality form. c. His eyes are blue-green.
Foreign expressions
Do not use a hyphen for foreign expressions used in compound adjectives even when they precede the noun they modify
(unless they are always hyphenated).
E.g.: a. in vitro fertilization. b. carcinoma in situ. c. cul-de-sac (always hyphenated). d. ex officio member.
high- and low-
Use a hyphen in most high- and low- compound adjectives.
E.g.: a. high-density mass. b. low-frequency waves. c. high-powered field.
Noun with a participle
Use a hyphen to join a noun and a participle to form a compound modifier whether it comes before or after a noun.
E.g.: a. bone-biting forceps. b. She was panic-stricken. c. mucus-coated throat (the throat was coated with mucus, not
mucous) d. callus-forming lesion (the lesion was forming callus, not callous)
Numerals with words
Use a hyphen between a number (whether spelled out or numeric) and the word forming a compound modifier preceding
a noun.
E.g.: a. 3-week history. b. five-sided polygon. c. tenth-story window. d. 5 x 3 x 2-cm mass. e. 2-year 5-month-old child
f. 8-pound 5-ounce baby girl.
Proper noun as adjective

RAMPRASAD
Do not use hyphens in proper nouns even when they serve as a modifier preceding a noun.
E.g. John F. Kennedy High School , New Mexico residents, etc.
Series of hyphenated compound modifiers
Use a suspended hyphen after each incomplete modifier when there is a series of hyphenated compound modifiers with a
common last word that is expressed only after the final modifier in the series.
E.g.: a. 10- to 12-year history. b. 3- to 4-cm lesion. c. full- and split-thickness grafts
If one or more of the incomplete modifiers is not hyphenated, repeat the base with each, hyphenating or not, as
appropriate.
E.g. Preoperative and postoperative diagnoses (not pre- and postoperative diagnoses)
Hyphenated compound modifiers
Use a hyphen (-) or dash (–) to join hyphenated compound modifiers or a hyphenated compound modifier with a one-
word modifier.
E.g. non-disease-entity modifier or non–disease-entity modifier
Use a hyphen (-) or dash (–) to join two unhyphenated compound modifiers.
E.g. the North Carolina-South Carolina border (or) the North Carolina–South Carolina border
Use a hyphen (-) or dash (–) to join an unhyphenated compound modifier with a hyphenated one.
E.g. beta-receptor-mediated response or ß-receptor-mediated response (or) beta-receptor–mediated response or ß-
receptor–mediated response.
Use a hyphen (-) or dash (–) to join an unhyphenated compound modifier with a one-word modifier.
E.g. vitamin D-deficiency rickets or vitamin D–deficiency rickets
Compound words
Compound words are the nouns made of 2 or more words coming together and forming a different word.
E.g. Attorney-in-chief, beta-blocker, chief of staff, father-in-law, half-life, etc.
Do not use a hyphen in a combination of a proper noun and a common noun serving as a modifier.
E.g. Tylenol capsule administration
Use a hyphen in compound verbs unless one of the terms is a preposition.
E.g. single-space but not follow up
Sometimes hyphenated compound words become so well established that the hyphen is dropped and the words are joined
together without a hyphen.
When such a word can be used as a noun, adjective, or verb, the noun and adjective forms are joined without a hyphen,
but the verb form remains two separate words if one of them is a preposition.
Noun Adjective Verb
checkup check up
followup follow up
workup work up
followthrough follow through
E.g.: The patient was lost to followup. (noun). A followup exam will be in 3 weeks. (adjective). I will follow up the
patient in 3 weeks. (verb). The patient is here for a checkup. (noun). She can check up tomorrow. (verb). The patient’s
workup was negative. (noun). The resident will work up the patient. (verb). A small-bowel follow through has been
ordered. (adjective). He was asked to follow through with therapy. (verb).
When a Greek letter is part of the name, use a hyphen after the symbol but not after the spelled-out form.
E.g. ß-carotene. - but not -. beta carotene.
Plurals
For those written as a single word, form the plural by adding s.
E.g. fingerbreadths, tablespoonfuls, workups, etc.
For those formed by a noun and modifier(s), form the plural by making the noun plural.

RAMPRASAD
E.g. sisters-in-law (as in, "I have three sisters-in-law.")
For plural compound nouns containing a possessive, make the second noun plural.
E.g.: a. associate’s degrees (one person, multiple degrees). b. driver’s licenses (one person, multiple licenses)
For some compound nouns, the plural is formed irregularly. E.g. forget-me-nots
Possessive forms.
Use ’s after the last word in a hyphenated compound term. E.g. daughter-in-law’s inquiry
Prefixes
Do not use hyphens with the following prefixes: Prefix
Example
bi-, tri-, uni-, co-, contra-, counter-, de-, extra-, infra-, intra-, mid-, multi-, micro-, pseudo-, sub-, super-, supra-, ultra-,
out-, over-, ante-, anti-, semi-, un-, non-, pre-, post-, pro-, trans-
Bilateral, tricompartmental, unilateral, cooperate, contraindication, counterforce, extraocular, infraumbilical,
intraoperative, midshaft, multivitamin, microscopic, pseudocele, subcostal, superficial, supramammary, ultrasound,
outgrow, overdose, antecubital, antihypertensive, semicircle, unencumbered, underactivity, nontender, prenatal,
postoperative, transvaginal
Use a hyphen with all compound nouns containing ex- when ex- means former and precedes a noun that can stand on its
own.
E.g. ex-wife, ex-president, etc.
Use a hyphen when a prefix comes with a disease-entity modifier.
E.g. non-Hodgkin lymphoma, non-insulin-dependent diabetes, etc.
Use a hyphen when a prefix is followed by a proper noun.
E.g. anti-American, pseudo-Christian, etc.
Suffixes
Some suffixes are joined directly to the root word they refer to, others are joined by a hyphen, and still others remain
separated by a character space. Here are some guidelines:
Join most suffixes directly to the root word (without a hyphen) including -fold, -hood, -wise, -less.
E.g. linenfold, likelihood, anticlockwise, aimless, etc.
However, a numeric with the suffix -fold has a hyphen, but when spelled out takes a solid construction.
E.g. fifteenfold but 15-fold
Use a hyphen with numbers, whether spelled out or numeric, with –odd.
E.g. Sixteen-odd, 70-odd, etc. b. Use a hyphen to avoid a triple consonant or vowel.
E.g. shell-like, ileo-ascending colostomy, salpingo-oophorectomy, etc.
When like and most appear as suffixes, they are attached to the root word without a hyphen.
E.g.: bandlike pain, yeastlike fungus, anteriormost, distalmost
If the root word ends with the same letter as the first letter of the suffix, hyphenate the word for clarity.
E.g. shell-like growth, barrel-like chest
Fractions
Hyphenate fractions when written without the whole number.
E.g. one-fourth empty, two-thirds full, five-eighths inches, etc.
However, if the numerator or denominator is already hyphenated, the fraction itself does not take a hyphen.
E.g. thirty-three thousandth part. Fractions used as nouns have no hyphens. E.g. I ate only one third of the pie.
Use a hyphen to express the space between two vertebrae.
E.g. C4-C5, L5-S1, etc.
Use a hyphen between the numbers indicating suture sizes.
E.g. The fascia was closed with 3-0 Vicryl.
Colors in compounds

RAMPRASAD
Use a hyphen for colors in compounds.
E.g.: a. a dark-blue sweater. b. a reddish-orange dress
Geographical modifiers
Use a hyphen for compounds including two geographical modifiers,
E.g.: a. Afro-Cuban. b. Anglo-Asian
But not; a. African American, b. Asian American, c. Hispanic American

SUBJECT-VERB AGREEMENT
According to the rules of syntax, any sentence must contain a subject and a predicate and the most important part of the
predicate is the verb.
Subject is the topic of the sentence; in other words, what the sentence is about. The subject is normally a single word,
either a noun or pronoun. The subject may also consist of a noun and its modifiers. We also can have compound
subjects; more than one subject together.
Medical transcriptionists transcribe medical documents
We are learning grammar
System reviews are a common routine in medical assessment
Physical examination was performed
The trainees were excited about the new curriculum
They are going to be the star performers
What he really needs is a good night’s sleep.
Operating under a deadline can be stressful.
Verb is a word that expresses action or links the subject to words that describes the state of being
The trainees are transcribing files
The new boy sings beautifully
For complete understanding of the sentence, the verb must agree in person, number, and tense with its subject. Almost all
the verbs that we encounter are in the third person. When the subject is a noun, then it requires a third person verb form.
Only when pronouns are used do we concern ourselves with the first or second person verb form. With numbers, there
are only 2 options: the singular and the plural. Tense agreement is complicated with respect to irregular verbs
Using the irregular verb – to be
Some more examples of irregular verbs are –
Fall – fell, fallen. Do – did, does. See – saw, seen. Fly – flew, flown
The past form and participle form of irregular verbs need to be learnt and used accordingly.
In order to determine the subject agrees with the verb, it is necessary to identify the subject and verb of the sentence or
clause.
Verbs can either be action verbs or linking verbs. Action verbs express an action or activity and tell what the subject is
doing. Linking verbs do not express action but links the subject to words that rename the subject or describe the state of
being of the subject.
E.g.: She eats a balanced diet and exercises regularly.
The patient has responded well to treatment. The patient slipped into a coma. She is a surgeon. The patient was
feverish.
She has chronic bronchitis.
The subject either performs the action or receives the action performed.
E.g.: The surgeon removed the stitches – doer of the action
The physician prescribed Brontex to control his cough - doer of the action
Dr. Smith studied the patient’s case very closely - doer of the action
The patient was admitted to the hospital – recipient. The family was given adequate compensation – recipient

RAMPRASAD
Dealing with number agreement, a verb must agree in number with the subject, i.e., if the subject is plural, the verb must
be plural and if the subject is singular, the verb must be singular.
The pronoun You always take a plural verb.
You are late as usual.
Identifying subjects and creating subject-verb agreement
Intervening phrases and clauses: Ignore all intervening phrases and clauses when identifying subjects. Objects of phrases
are never subjects. There and here are never subjects.
E.g.: The blisters on her leg look worse today. (not - leg looks)
One of the wounds is infected. (not - wounds are)
The new lesion, which is much larger than the previous ones, seems to be responding well. (not – ones seem)
Inverted word order: When the verb precedes the subject
E.g.: There are 4 candidates for the post. (not – there is)
There are no other therapies to try. (not – there is). On the palm of the hand are many warts. (not - hand is)
Compound subjects joined by the conjunction and always take a plural verb, irrespective of the individual subjects being
singular or plural.
E.g.: The husband and wife together are going to the meeting.
(Both singular subjects)
The patient and his children have requested that no one disturb him. (first singular and second plural)
The Hendersons and their daughter were involved in the accident. (first plural and second singular)
The Hendersons and their children were involved in the accident. (Both plural subjects)
Bread and butter is my breakfast. – (Single subject)
With the conjunction or, the verb can either be singular or plural depending on the placement of the subject.
When both the subjects are singular, the verb is singular
E.g.: The doctor or the nurse will conduct your examination. She or her father is going to the market.
When the subject nearest to the verb is singular, the verb is singular.
E.g.: The parents or his sister is going to accompany him. The buses or the train is the mode of transport.
When the subject nearest to the verb is plural, the verb is plural.
E.g.: His sister or his parents are going to accompany him.
The record or the reports have been filed properly.
When both the subjects are plural, the verb is plural
E.g.: Tablets or gelcaps are available.
The trainees or the trainers have gone to the picnic.
The same rule applies for using neither…. nor…… and either ……or…..
E.g.: Neither the aspirin nor the cold compress seems to relieve the pain. (Both singular subjects)
Either the mother or the father visits the child every day. (Both singular subjects)
Neither the patients nor their families were told of the policy change. (Both plural subjects)
Either abrasions or rashes are common in such cases. (Both plural subjects)
Neither the patient nor his brothers agree with the plan.
We hope that either the medications or the topical cream works.
When nouns are joined by misleading connectives, the second noun is always ignored and the verb must agree in number
with the first noun. The second noun in fact is always the object of a preposition and is never a subject
E.g.: The patient, accompanied by his wife, presents to the ED.
The girls, along with their mother, were honored at the function. Marie, along with her daughters, is visiting Europe .
Some indefinite pronouns always take a singular verb: anyone, anybody, anything, each, either, neither, everyone,
everything, everybody, nobody, nothing, someone, somebody, something
E.g.: Either of the two applicants is satisfactory.

RAMPRASAD
Everything is fair in love and war. Nothing is impossible. Someone is going to win at last. Neither is willing to accept
defeat.
Some indefinite pronouns always take plural verb: Both, few, many, several
E.g.: Both the parents are with the child in the hospital. Few of them are writing the test.
Several of the questions in the paper were very easy.
Some indefinite pronouns can either take a plural verb or a singular verb: any, all, some, none, more, most
Countable pronouns take plural verbs and uncountable pronouns take a singular verb
E.g.: Any of the lesions were not purulent.
Most of the work is complete.
None of the drugs is causing the allergy.
Most of the tests are complete.
All of the water has dried up.
With misleading subjects: Some nouns have the same spelling in their plural and singular forms. To determine if the
noun is singular or plural, understand the context.
If the subject is preceded by the article a, then it is a singular subject and takes a singular verb.
E.g.: A new species of staphylococcus has been identified.
A series of mishaps has kept him from his work.
If the subject is preceded by a number greater than one, then it is a plural subject and takes a plural verb.
E.g.: Two species of streptococcus were identified. Three new series of tests were administered.
If the subject is preceded by the article the, then the verb may be either singular or plural depending on the context. In
that case, always transcribe as dictated.
Some words are always used in the plural and always take a plural verb – genetalia, adnexa, media, etc.
Some words are always used in the singular and always take a singular verb – diarrhea, ascites, etc.
Medical specialties and names of any other branch of study are always singular subjects and take singular verbs.
E.g.: Mathematics was my favorite subject. Pediatrics is her specialty.
Collective Nouns: Collective nouns represent a group of persons or things that can be regarded as a unit. They can either
be singular subjects or plural subjects depending on whether they are viewed as a unit or a collection of individuals.
Transcribe as dictated.
E.g.: The family is on vacation. (emphasis on unit)
The family were asked for their opinion. (emphasis on individuals)
The team at the training center is very good. (emphasis on unit)
The team has decided not to start a new batch. (emphasis on unit)
The writing team were all happy on the outcome. (emphasis on individuals)
In using time, money, and quantity, use a singular verb when referring to a total amount, and use a plural verb when
referring to a number of individual units.
E.g.: Three weeks is a long time
Five days have passed
In all, 4 doses were given and 20 mEq was given this morning
Hundred dollars is not worth paying for it
Dollars were stacked on the casino table
The word ‘number’ is considered to be plural when it is preceded by the article a and is singular when preceded by the
article the.
E.g.: The number of people giving presentations has increased.
The number on the board is not seen properly.
A number of orders were lost. A number of people were killed in the blast.
ACTIVE AND PASSIVE VOICE

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There are two special forms for verbs called voice:
Active voice
Passive voice
Active Voice: We say things in the active voice when we want to show who or what has done something. In the active
voice that agent (the person or thing that does something) becomes the subject to the subject.
E.g.: A. He stole my bike. B. She cleaned the office.
Please note that the active voice is the "normal" voice. This is the voice that we use most of the time. You are probably
already familiar with the active voice. In the active voice, the object receives the action of the verb:
Active, subject, verb, object. Cats eat fish.
Passive Voice: Passive construction occurs when the object or the receiver of the action is emphasized upon.
E.g.: A. My bike was stolen by him. B. The office was cleaned by her.
The passive voice is less usual. In the passive voice, the subject receives the action of the verb:
Passive. Subject. Verb. Object.
Fish are eaten by cats.
The passive voice is less usual than the active voice. The active voice is the "normal" voice. But sometimes we need the
passive voice. Let us look at how to construct the passive voice.
Construction of the Passive Voice
The structure of the passive voice is very simple:
subject + auxiliary verb (be) + main verb (past participle)
The main verb is always in its past participle form.
Look at these examples:
subject
auxiliary verb (to be) main verb (past participle)
Water is drunk by everyone. 100 people are employed by this company.
I am paid in euro. We are not paid in dollars. Are they paid in yen?
Use of the Passive Voice
We use the passive when: We want to make the active object more important. We do not know the active subject
Subject, verb, object give importance to active object (President Kennedy)
President Kennedy was killed by Lee Harvey Oswald.
active subject unknown. My wallet has been stolen.
? Note that we always use by to introduce the passive object (Fish are eaten by cats).
WAYS OF RECOGNIZING THE PASSIVE VOICE
Emphasis is on action or object rather than subject
Any combination of the verb "to be" connected with the past participle of the verb
TRANSFORMATION FROM ACTIVE INTO PASSIVE VOICE
The object of the active verb becomes the subject of the passive verb:
Subject. Verb. Object. Active; Everybody drinks water.
Passive; Water is drunk by everybody.
Step 1: When a sentence is transformed from the active to the passive voice, the subject and the object exchange
positions. Move the object to the subject position.
Step 2: After making what is acted upon the subject of the sentence, change the verb to a form of be + past participle. If
the verb in the active voice occurs without an auxiliary, then in passive voice one must add an appropriate auxiliary.
E.g.: The cat killed the mouse. (active voice). The mouse was killed by the cat. (passive voice)

SENTENCES
A sentence is a group of words containing a subject and a verb that forms a complete statement and is able to stand alone.

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Structure of the sentence: Subject, predicate, object, complement.
Subject: that part of a sentence about which something is being said
Predicate: that part of the sentence that says something about the subject
Predicate=verb + additional information
Object: something on whom the action is followed
Complement: any additional information about the subject, verb, or object
E.g. 1. The doctor advised the patient to undergo the surgery.
Subject: the doctor
Predicate: advised the patient to undergo the surgery
Verb: advised
Object: the patient
Complement: to undergo the surgery
E.g. 2. Exactly one year ago, Janet was promoted.
Subject: Janet. Predicate: was promoted exactly one year ago. Verb: was promoted
Complement: Exactly one year ago

Types of sentences:
Simple sentence
Compound sentence
Complex sentence
Compound complex sentence
Clipped sentence
Sentence fragment
Run-on sentence

SIMPLE SENTENCE: The most basic type of sentence is the simple sentence, which contains only one clause. It can
have more than one subject but only one predicate, expressing a single complete thought.
E.g.: a. The emperor was pleased. b. The patient was placed on the operating table.

COMPOUND SENTENCE: A compound sentence has 2 or more independent (but closely related) clauses, each of
which can stand alone as a simple sentence. The clauses in a compound sentence are joined by a comma and a
conjunction.
E.g. The x-ray was normal, and the gallbladder was well visualized.
In the sentence above, x-ray was normal is one simple sentence and the gallbladder was well visualized is another simple
sentence. These 2 simple sentences are joined together by the coordinating conjunction and, and these sentences are now
called independent clauses.

COMPLEX SENTENCE: A complex sentence has one independent (main) clause and one or more dependent
(subordinate) clauses which together express one complete thought.
Use a comma after a dependent clause if it is followed by an independent clause
E.g.: a. Although it was inflamed, the gallbladder was without stones.
The patient was involved in a motorcycle accident 5 years ago and still complains of headache and pain in the right leg.
I discussed his case with the pediatric nephrology fellow, who suggested a workup to rule out Bartter syndrome.

COMPOUND-COMPLEX SENTENCE: A compound-complex sentence has 2 or more independent clauses and one
or more dependent clauses.

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The posterior pack was removed and after the wound was copiously irrigated, the procedure was terminated.
The Election Commissioner announced the elections, and although the political parties began work in full swing, the
voters were unenthusiastic.
There were no difficulties with this anastomosis, and prior to completing it, the tourniquet was deflated and the last
suture placed.
In the above sentences, the clauses underlined are independent clauses, and the clauses in italics are dependent clauses.

CLIPPED SENTENCES: Clipped sentences are sentence fragments that miss one or more sentence components such
as articles, verbs, or sometimes the subject itself. But they are often meaningful and express a complete thought. The use
of clipped sentences is perfectly acceptable in medical transcription as long as the meaning is clear.
Conventional sentence: The patient’s extremities are pink and excoriated.
Clipped sentence: Extremities pink and excoriated (missing verb)
Conventional sentence: The primary physician will follow up in 2 weeks.
Clipped sentence: Will follow up, 2 weeks. (missing subject and preposition)
Clipped sentences are more frequently used in operative reports. Clipped sentences are often dictated under the headings
chief complaint, review of systems, physical examination, objective, and laboratory and diagnostic studies. Sometimes
entire reports like the Progress note (SOAP notes) are dictated in clipped sentences.
Do not expand clipped sentences to conventional sentences unless the client profile manual (infodoc.) indicates. In short,
never tamper with the author’s style.
Clipped sentences are punctuated the same way as conventional sentences. Terminal punctuation marks are never used at
the end of dates like discharge/admission dates that appear in the header or footer section of the report and also
sometimes in the body of the report. Clipped sentences are also sometimes dictated in a run-on format where it is difficult
to know where one sentence ends and the other begins. Run-on sentences use commas at the end rather than periods.
Commas are regularly used to punctuate clipped sentences in a conventional sense. In addition commas are also used to
indicate words that are inferred and are not dictated so as to make reading the clipped sentence easier. This special use of
comma is generally seen in the ROS, PE, and Lab data section of the report.
Dictated: Skin clear no rashes. Inferred: Skin clear with no rashes. Transcribed: Skin clear, no rashes
Dictated: Cataract right eye. Inferred: Cataract in the right eye. Transcribed: Cataract, right eye.
But commas are not inserted for every word that is inferred.
Some examples of clipped sentences:
Denies illicit drug use – subject missing
The patient denies illicit drug use.
Has no oral lesions – subject missing
He has no oral lesions
Neck: Supple, no palpable nodes – preposition
Neck: Supple with no palpable nodes
LDL acceptable at this point – verb missing
LDL is acceptable at this point
Actually saw the patient 2 days ago – subject missing
I actually saw the patient 2 days ago.
Patient will follow up in 2 days – article missing
The patient will follow up in 2 days
Describes it as a sensation of heaviness – subject missing
He describes it as a sensation of heaviness
The patient is 83-year-old female – article missing
The patient is an 83-year-old female

RAMPRASAD
Problem list includes the following: – not a clipped sentence
Plan as per orders – verb missing
Plan is as per orders
SENTENCE FRAGMENTS: Fragments are incomplete sentences. Usually, fragments are pieces of sentences that have
become disconnected from the main clause. Fragments occur when a sentence is missing a subject, verb, or main clause.
One of the easiest ways to correct them is to remove the period between the fragment and the main clause. Other kinds
of punctuation may be needed for the newly combined sentence.
E.g. Problem: Missing Subject

SENTENCES Fragment: He was just too eager. And called me about 18 times. And called me about 18 times is a
fragment since it has no subject.
Sentence:
He was just too eager and called me about 18 times.
Fragment:
Julia studied modernist theory as well. To supplement her paper on postmodernism.The second sentence does not
contain a verb, and thus is a fragment (it is also missing a subject!). To supplement is an infinitive, or verbal, not a
verb.Sentence:Julia studied modernist theory as well to supplement her paper on postmodernism.
Fragment:I ate the whole pie. Because I liked it.This is a subordinate clause since it is introduced by the subordinating
conjunction because. The clause is a fragment because it is not attached to an independent or main
clause.Sentence:Because I liked it, I ate the whole pie.orI ate the whole pie because I liked it. The clause because I liked
it needs another clause to depend on in order to form a complete sentence.

RUN-ON SENTENCES: A run-on sentence is a sentence in which two or more independent clauses are joined without
punctuation or conjunctions. It is considered a grammatical error. A run-on sentence consists of two or more main
clauses that are run together without proper punctuation.
It is important to realize that the length of a sentence really has nothing to do with whether a sentence is a run-on or not;
being a run-on is a structural flaw that can plague even a very short sentence.
E.g.: Incorrect: The boy showed us his tickets someone gave them to him.
Correct: The boy showed us his tickets. Someone gave them to him.
Incorrect: Arthur often went fishing when he was a little boy as dictator of an island nation Arthur no longer has time to
fish.
Correct: Arthur often went fishing when he was a little boy; as dictator of an island nation, Arthur no longer has time to
fish.

COMMONLY CONFUSING WORDS
Advise/Advice:
Advise (ad-vīz') (verb) means to give counsel to, offer an opinion or suggestion as worth following.
E.g. I will advise my client not to speak to you.
Advice (ad-vīs') (noun) is an opinion or recommendation offered as a guide to action.
E.g. I shall act on your advice.
Accept/Except:
Accept (verb) means to receive.
E.g. When it arrives, I will accept the package readily.
Except (preposition) means with the exclusion of.
E.g. They were all there except me.
Except (conjunction) means but.

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E.g. I would love to join you for a movie, except I don’t have a car.
Effect/Affect:
Effect (/i-fekt') (noun) means a result or the power to produce a result. Use effect when you mean bring about or brought
about, cause or caused.
E.g. The sound of the falling rain had a calming effect, nearly putting me to sleep.
Use effect when you mean result. Think 'E' for End result.
E.g. What effect (result) did that speech have?
Effect (verb) means to bring about or execute.
E.g. The speaker's somber tone effected (brought about) a dampening in the general mood of the audience.
Use effect whenever any of these words precede it: a, an, any, the, take, into, no.

NOTE: These words may be separated from effect by an adjective. (That book had a long-lasting effect (result) on my
thinking. Has the medicine produced any noticeable effects (results)?)
However, be careful! Affect will commonly have these words preceding it too, so make sure you have a clear definition.
Affect (uh-fekt') (verb) means to have an influence on. Use the verb affect when you mean to influence rather than to
cause.
E.g. His loud humming was affecting (influencing) my ability to concentrate.
How do the budget cuts affect (influence) your staffing?
Affect ('ah-fekt) (noun) is an emotional expression (commonly used in medical reports to describe a patient’s emotional
state).
E.g. She showed little affect (emotion) when told she had won the lottery.
The patient’s affect (emotional state) was flat and distant.
All right/Alright:
All right (adverb) means yes, very well, OK
E.g. All right, I’ll go with you.
satisfactorily, acceptably
E.g. His work is coming along all right.
without fail, certainly
E.g. You’ll hear about this, all right!
All right (adjective) means safe, sound
E.g. Are you all right?
satisfactory, acceptable
E.g. His performance was all right, but I’ve seen better.
Alright. Although alright is widely used, it is considered nonstandard English. As the American Heritage Dictionary
notes, it's not "all right to use alright." In medical transcription, avoid the use of alright.
Allusion/Illusion:
Allusion (uh-loo'-zhuh n) (noun) means an indirect reference or an incidental mention of something.
E.g. The speech made allusions to the final report.
Illusion (i-loo'-zhuh n) (noun) means a misconception or something that deceives by producing a false or misleading
impression of reality.
E.g. The policy is designed to give an illusion of reform.
Alternately/Alternatively:
Alternately (adverb) means in turn; one after the other.
E.g. We alternately spun the wheel in the game.
Alternatively (adverb) means on the other hand; one or the other.
E.g. You can choose a large bookcase or, alternatively, you can buy two small ones.

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Bare/Bear:
Bare (adjective) means unclothed, without furnishings, contents; open to view, unconcealed; unadorned, bald, plain;
scarcely or just sufficient; mere.
E.g.: a. The walls of their new home were bare.
The elderly man had just the bare necessities of life.
The infant was bare-naked.
Bear (verb) means to hold up or remain firm under a load
E.g.: a. The patient will bear weight (weightbear) as tolerated. b. The roof will not bear the strain of his weight.
to give birth, to bring forth young. E.g. to bear a child. to produce by natural growth. E.g. a tree that bears fruit
to hold up under, be capable of. E.g. His claim does not bear close examination. to suffer, endure, undergo
E.g. to bear the blame. to sustain without yielding or suffering injury, tolerate (used in negative constructions, unless
qualified) E.g.: a. I can’t bear your nagging. b. I can hardly bear to see her suffering so. to be fit for or worthy of
E.g. It does not bear repeating. to carry or bring. E.g. to bear gifts. to render, afford, give. E.g. to bear
witness; to bear testimony. to exhibit, to show. E.g. to bear a resemblance. to accept or have, as an obligation. E.g.
to bear responsibility; to bear the cost. to possess, as a quality or characteristic; have in or on. E.g. to bear traces; to
bear an inscription.
Bear (noun) is a carnivorous or omnivorous mammal having a massive body and coarse heavy fur.
Beer (noun) an alcoholic beverage. E.g. The beer was placed on the table.
Beside/Besides:
Beside (preposition) means next to. E.g. Stand here beside me.
Besides (adverb) means also
E.g. Besides, I need to tell you about the new products my company offers.
Capital/Capitol:
Capital (noun) is the city or town that is the seat of government
E.g. Tokyo is the capital of Japan .
a city regarded as being of special eminence in some field of activity
E.g. New York is the dance capital of the world.
wealth, whether in money or property
E.g. He had the capital to start his business.
a letter in uppercase
E.g. Please use capital letters when spelling city names.
Capitol (noun) the building occupied by a state legislature; the building in Washington , D.C. , used by the congress of
the U.S. for its sessions.
Cite/Site/Sight:
Cite (verb) means to quote as an authority or example
E.g. I cited several eminent scholars in my study of water resources.
to recognize formally
E.g. The public official was cited for service to the city.
to summon before a court of law, to issue a citation
E.g. Last year the company was cited for pollution violations.
Site (noun) means location
E.g. They chose a new site for the factory just outside town.
Sight (noun) means the power or faculty of seeing; perception of objects by use of the eyes; vision.
Sight (verb) means to see, glimpse, notice, or observe
E.g. The pirates sighted a ship to the north.
Sight (idioms) at the first glimpse, at once

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E.g. It was love at first sight.
catch sight of
E.g. We caught sight of the lake below.
out of sight, beyond reason, exceedingly high
E.g. The price is out of sight.
fantastic, marvelous (slang)
E.g. That concert was out of sight!
someone or something whose appearance on the scene is cause for relief or gladness
E.g. You are a sight for sore eyes!
without previous examination
E.g. I bought the car sight unseen.
Complement/Compliment:
Complement (noun) means something that completes or makes perfect
E.g. The red sweater is a perfect complement to the outfit.
a quantity or amount that completes anything
E.g. We now have a full complement of packers.
in immunology, any of the proteins in the complement system, designated C1, C2, etc.
E.g. I will order a full complement level for this patient due to her unexplained inflammation and
recurrent bacterial infections.
Complement (verb) means to complete; form a complement to
E.g. This belt complements the dress better than that one.
Compliment (noun) means an expression of praise, commendation, or admiration
E.g. A sincere compliment boosts one’s moral.
a formal act of expression or civility, respect, or regard
E.g. The mayor paid him the compliment of escorting him.
a courteous greeting, good wishes, regards
E.g. He sends you his compliments.
Compliment (verb) means to show fondness, regard, or express respect or esteem.
E.g. He complimented her on her last physics paper.
Comprise/Compose:
Comprise (verb) means to include or contain
E.g. The advisory board comprises six members.
to form or constitute
E.g. Seminars and lectures comprised the day’s activities.
Comprise (idiom) be comprised of, to consist of, be composed of
E.g. The sales network is comprised of independent outlets and chain stores.
Compose (verb) means to make or form by combining things, parts, or elements
E.g.: a. Five members compose (or make up) the board.
He composed (formed) his speech from many research notes.
to be or constitute a part or element of
E.g. a rich sauce composed of many ingredients
TIP: According to the traditional rule, the whole comprises the parts, and the parts compose the whole (the board
comprises six members). Comprise is often followed by the preposition of. When you are referring to the "whole" use
comprise; when referring to the "parts" use compose.
Concurrent/Consecutive:
Concurrent (adjective) means simultaneous or happening at the same time as something else.

RAMPRASAD
E.g. The concurrent strikes of several unions crippled the economy.
Consecutive (adjective) means successive or following one after the other.
E.g. The union called three consecutive strikes in one year.
Consecutive (adverb) means in a consecutive manner
E.g. We numbered the papers consecutively.
Connote/Denote:
Connote (verb) means to imply or suggest
E.g. The word ‘espionage’ connotes mystery and intrigue.
to involve as a condition or accompaniment
E.g. Injury connotes pain.
Denote (verb) means to be a mark or sign of, indicate
E.g. A fever often denotes an infection.
to represent by a symbol, stand as a symbol for
E.g. The symbol for ‘pi’ denotes the number 3.14159.
TIP: Adjectives can only connote, nouns can denote.
Convince/Persuade:
Convince (verb) means to move by argument or evidence to belief, agreement, consent, or a course of action
E.g. a. The attorney tried to convince the jury of his guilt.
A test drive will convince you that this car handles well.
to persuade, cajole
E.g. We finally convinced them to have dinner with us.
Persuade (verb) means to induce to believe by appealing to reason or understanding
E.g. He attempted to persuade the judge of the prisoner’s innocence.
to prevail on (a person) to do something, as by advising or urging
E.g. We could not persuade him to wait.
TIP: Pointing out that I was overworked, my friends persuaded [not convinced] me to take a
vacation. Now that I'm relaxing on the beach with my book, I am convinced [not persuaded] that they were right.
Following this rule, convince should not be used with an infinitive (take, come, be, etc.), as an infinitive is present tense;
and convinced is past tense, convince means to happen as a result of.
Council/Counsel:
Council (noun) means an assembly of persons summoned or convened for consultation, deliberation, or advice; a body of
persons serving in an advisory, administrative, or legislative capacity
E.g. the governor’s council on housing
A councilor is a member of a council, which is an assembly called together for discussion or
deliberation.
Counsel (noun) means advice, opinion or instruction given in directing the judgment or conduct of another
E.g. He was given strong counsel regarding his behavior at the meeting.
advocate: a lawyer who pleads cases in court
E.g. Is counsel for the defense present?
guidance: something that provides direction or advice as to a decision or course of action
E.g. The patient received counsel regarding her son’s mental illness.
A counselor is one who gives counsel, which is advice or guidance. More specifically, a counselor
can be an attorney or a supervisor at camp.
Desert/Dessert:
Desert ('dez-ert) (noun) is an arid land with little or no vegetation.
Desert (di-'zurt) (verb) means abandon, to leave without intending to return

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E.g. He deserted his wife.
to fail (someone) at a time of need
E.g. I would not desert my sister.
Dessert (di-'zurt - notice the same pronunciation of desert above) means cake, pie, fruit, pudding, ice cream, etc., served
as the final course of a meal.
Discreet/Discrete:
Discreet (adjective) means prudent, circumspect, or modest
E.g. Her discreet handling of the touchy situation put him at ease.
modestly unobtrusive, unostentatious
E.g. a discreet, finely wrought gold necklace
Used as an adverb
E.g. The student was discreetly pulled from class to join the dean in the office.
Discrete (adjective) means separate or individually distinct
E.g. Each company in the conglomerate operates as a discrete entity.
Disinterested/Uninterested:
Disinterested (adjective) means unbiased by personal interest or advantage, impartial, not influenced by selfish motives.
E.g. We appealed to the disinterested mediator to facilitate the negotiations.
Uninterested (adjective) means having or showing no interest, indifferent.
E.g. They seemed uninterested in our offer.
Elicit/Illicit:
Elicit (verb) means to draw out or bring forth, educe, evoke.
E.g.: a. to elicit the truth. b. to elicit a response with a question
Illicit (adjective) means not legally permitted or authorized, unlicensed, unlawful.
E.g. The patient denies smoking, drinking, or use of illicit drugs.
TIP: No matter how hard I tried to elicit a few scandalous stories from her, she kept all
knowledge of illicit activities discreetly to herself.
Emigrant/Immigrant:
Emigrant ('em-i-gruh nt) (noun) means one who leaves one's native country to settle in another.
E.g. The emigrants spent four weeks aboard ship before landing in Los Angeles.
Immigrant ('im-i-gruh nt) (noun) means one who enters and settles in a new country, usually for permanent residence.
E.g. Most of the immigrants easily found jobs.
TIP: One emigrates from a place; one immigrates to another.
Farther/Further:
Farther ('fahr-th er) (adjective) means more distant or remote than something or some place nearer.
E.g. the farther side of the mountain
Farther ('fahr-th er) (adverb) means at or to a greater distance, a more advanced point.
E.g. We drove 50 miles today; tomorrow, we will travel 100 miles farther.
Further ('fur-th er) (adjective) means more distant or remote; farther
E.g. The map shows it to be further than I thought.
more extended
E.g. Does this mean a further delay?
Further ('fur-th er) (adverb) at or to a greater distance, extent, or degree
E.g. We won't be able to suggest a solution until we are further along in our evaluation of the
problem.
in addition, moreover
E.g. They stated further that they would not change the policy.

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Few/Less:
Few (adjective) means small in number; used with countable objects.
E.g. This department has few employees.
Less (adjective) means small in amount or degree; used with objects of indivisible mass.
E.g. Which jar holds less water?
Figuratively/Literally:
Figuratively (adverb) means metaphorically or symbolically.
E.g. Happening upon the shadowy figure, they figuratively jumped out of their shoes.
Literally (adverb) means in the literal or strict sense, word for word, without exaggeration or
inaccuracy
E.g. I'm not exaggerating when I say I literally fell off my chair.
according to the exact meaning of the words
E.g. I translated the Latin passage literally.
Flammable/Inflammable:
Flammable (adjective) means capable of being easily set on fire, combustible, burning rapidly.
Inflammable (adjective) means capable of being easily set on fire, combustible, burning rapidly.
TIP: Both of these words are synonymous and interchangeable.
Flaunt/Flout:
Flaunt (flawnt) (verb) means to parade or display oneself conspicuously, defiantly, boldly or
shamelessly.

E.g. Eager to flaunt her knowledge of a wide range of topics, Helen dreamed of appearing on a TV trivia show.
Flout (flout) (verb) means to treat with disdain, show scorn or contempt, scoff at, mock.
E.g. Louis disliked boarding school and took every opportunity to flout the house rules.
Foreword/Forward:
Foreword (noun) means an introductory note or preface.
E.g. In my foreword I explained my reasons for writing the book.
Forward (adverb) means toward or at a place, point, or time in advance.
E.g.: a. from this day forward
Let’s move forward so we can hear better.
He brought forward several good suggestions.
Please step forward when your name is called.
Forward (adjective) means directed toward a point in advance, moving ahead, onward.
E.g.: a. a forward motion. b. a rude, forward child
Forward (verb) means to send on.
E.g.: a. Forward the letter to the customer's new address. b. The training will help to forward your career.
Founder (verb) means to become wrecked, fail utterly.
E.g. The project foundered because public support was lacking.
Founder (verb) means to fill with water and sink.
E.g. The ship foundered after colliding with an iceberg.
Founder (noun) is one who establishes something or formulates the basis for something.
E.g.: a. the founder of a university. b. the founders of a new nation.
Flounder (verb) means to struggle clumsily or helplessly
E.g. He saw the child floundering about in the water.
to act clumsily and in confusion
E.g. After floundering through the first half of the course, Amy finally passed with the help of a tutor.

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TIP: A good synonym for flounder is blunder.
Flounder (noun) any of various marine flatfishes.
Hanged/Hung:
Hanged (verb) is the past tense and past participle of hang when the meaning is to execute by
suspending by the neck.

E.g.: a. They hanged the prisoner for treason. b. The convicted killer was hanged at dawn.
Hung (verb) is the past tense and participle of hang when the meaning is to suspend from above with no support from
below.
E.g.: a. I hung the painting on the wall. b. The painting was hung at a crooked angle. c. The curtains were hung
yesterday.
Historic/Historical:
Historic (adjective) means well known or important in history.
E.g.: a. a historic building. b. Independence Day is a historic occasion.
Historical (adjective) means of, pertaining to, treating, or characteristic of history or past events.
E.g.: a. historical records. b. historical research. c. historical reenactment of the Battle of Gettysburg
Horse/Hoarse:
Horse (noun) is a large, solid-hoofed, four-legged animal.
Hoarse (adjective) means having a vocal tone characterized by weakness of intensity and excessive breathiness; husky,
raucous voice.
E.g. You sound hoarse – do you have a sore throat?
i.e./e.g.:
i.e. (abbreviation) Latin for id est. Means that is or in other words.
E.g. Initially, the patient was uncooperative, i.e., she refused all treatment.
e.g. (abbreviation) Latin for exempli gratia; means for example, for the sake of example, such as.
E.g. She loves exotic fruit, e.g., mangoes, passion fruit, and papayas.
Imminent/Immanent/Eminent:
Imminent (im-uh-nuh nt) (adjective) means likely to occur at any moment; impending.
E.g. Her death is imminent.
Immanent (im-uh-nuh nt) (adjective) means remaining within; indwelling; inherent
E.g. We think of God as immanent in nature.
of a mental act performed entirely within the mind
E.g. Cognition is an immanent act of mind.
Eminent (em-uh-nuh nt) (adjective) means standing above others in quality or position
E.g. eminent members of the community
of imposing height; especially standing out above others
E.g. an eminent peak of lofty mountains
conspicuous or noteworthy
E.g. eminent fairness
prominent, projecting, protruding
E.g. an eminent nose
It’s/Its:
It's (a contraction) for it is. (Not to be used in medical transcription except when contained in a direct quote.)
Its (pronoun) is the possessive form of it.
TIP: It's a shame that we cannot talk about its size).
Laid/Lain/Lay:

RAMPRASAD
Laid (verb) is the past tense and the past participle of the verb lay. It means to put or place in a horizontal position of rest;
set down.
E.g. He laid his book on the desk.
Lain (verb) is the past participle of lie. It means to be or remain in a specified condition.
E.g. The dust has lain undisturbed for years.
Lay (transitive verb) is the past tense of the verb lie. It means to put or place in a horizontal position of rest; set down.
E.g. Lay your book on the desk.
TIP: To help differentiate the proper use of lay and lie:
LAY is a transitive verb that means TO PUT OR PLACE in a horizontal position of rest; set down, so it TAKES A
DIRECT OBJECT. In other words, there is something that the action of the verb is being done to.
E.g.: a. Please lay the book on the table.
The crew will lay the pipeline.
We will lay the foundation for further negotiations.
It only makes sense to lay blame on the inspector.
The government laid an embargo on oil shipments.
Our chickens lay eggs.
The patient was taken to the operating suite and laid in the supine position.
LIE is an intransitive verb that means to BE IN or MOVE into a horizontal position on a surface, so
IT CANNOT TAKE A DIRECT OBJECT—you cannot "lie" something down.
E.g.: a. The mechanic was lying on his back underneath my car. b. The cat just loves to lie in front of the fire. c. Lie still
a moment, John. d. He lies awake at night worrying. e. I usually lie down for an hour after lunch.
MORE . TIPS:
He laid his books down and lay down on the couch, where he has lain for an hour.
You need to lie down today; yesterday you lay down (BE CAREFUL! It sounds like "laid down"); in the past you have
lain down.
Today, lay the book on the table. Yesterday, you laid the book on the table. In the past, you have laid the book on the
table.
Loan/Lend:
Loan (noun) means the act of lending; a grant of the temporary use of something.
E.g. I was able to get a loan from the bank.
Loan (verb) means to make a loan of; lend.
E.g. Will you loan me your umbrella?
Lend (verb) means to give temporarily; let have for a limited time.
E.g. To lend one’s aid to a cause.
TIP: Lend and loan are both acceptable as verbs in standard English (Can you lend (loan) me a dollar?). However, only
lend should be used in figurative senses (Will you lend me a hand?)
Lightening/Lightning:
Lightening (verb) means to make light or lighter; illuminate or brighten.
E.g. The bright sunlight caused lightening of her hair.
Lightning (noun) is a brilliant electric spark discharge in the atmosphere, occurring within a
thundercloud, between clouds, or between a cloud and the ground.
E.g. The lightning lit up the sky.
Lightning (verb) means to emit a flash or flashes of lightning.
E.g. If it starts lightning, we better go inside.
Lightning (adjective) means pertaining to, resembling lightning, especially in regard to speed of movement.
E.g. lightning speed, lightning flashes

RAMPRASAD
Loose/Lose:
Loose (loos) (adjective) means free from anything that binds or restrains
E.g. a loose tooth
Loose (loos) (adverb) means in a loose manner
E.g. loose-fitting clothing
Loose (loos) (idioms) means to release from domination or control
E.g. to cut loose (slang)
to remain relaxed and unperturbed
E.g. hang loose, stay loose
to become free
E.g. to let loose
Lose (looz) (verb) means opposite of win; to fail inadvertently to retain
E.g.: to lose a job
to lose one’s life
the watch loses three minutes a day
to lose balance
to get rid of
E.g. to lose weight
Passed/Past:
Passed (adjective) is the past tense and past participle of pass and means having completed the act of passing
E.g. I passed the test.
Past (adjective) refers to time gone by or elapsed
E.g. It was a bad time, but it has all past now.
Past (noun) means the time gone by
E.g. Try to forget the past, now that your troubles are over.
Past (adverb) means so as to pass by or beyond
E.g. The troops marched past.
Past (preposition) means beyond in time
E.g. half past six
TIP: In the past decade, I passed over countless opportunities; I was determined not to let them get past me again.
Plain/Plane:
Plain (adjective) means clear or distinct to the eye or ear
E.g.: a plain trail to the river
to stand in plain view
with little or no embellishment, decoration, or enhancing elaboration
E.g. a plain blue suit
Plain (adverb) means clearly and simply.
E.g. He’s just plain stupid.
Plain (noun) means an area of land not significantly higher than adjacent areas and with relatively minor differences in
elevation.
E.g. The buffalo roam on the plain.
Plane (noun) an airborne vehicle, or a carpenter's tool.
Precede/Proceed:
Precede (verb) means to go or come before; to introduce by something preliminary; preface.
E.g.: a. She will precede her statement with a qualification. b. He always precedes his lectures with a joke.
Proceed (verb) means to move forward or onward.

Grammer for medical transcription

Grammer for medical transcription

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