# Medical malpractice chart review questions > The questions risk managers and physician reviewers ask in a med mal chart review: standard of care, causation, missing records, late entries and time. Canonical page: https://medrecords.ai/guides/medical-malpractice-chart-review-questions/ --- **Med mal:** a 2,000-page chart drafted and cited in about 20 minutes. [Book a demo →](https://medrecords.ai/demo/) [Guides](https://medrecords.ai/guides/) › Medical malpractice chart review: the questions reviewers ask ## Medical malpractice chart review: the questions reviewers ask Standard of care, causation, missing records and late entries Medrecords AI reads about 100 pages a minute, so a 2,000-page chart comes back as a chronology with every line cited to its source page in about 20 minutes. By [Ahmed Jemaa](https://medrecords.ai/authors/ahmed-jemaa/), Co-Founder & CEO of Medrecords AI · Published 3 Nov 2026 · Updated 3 Nov 2026 ### How do you review a chart in a medical malpractice claim? Start with a cited timeline of the care, then test it against 4 questions: what the standard of care required, whether the care deviated from it, whether that deviation caused the harm, and what the harm looked like over time. Software can draft and cite the timeline; the reviewing physician answers the 4 questions. ### The 4 review questions and who answers them Every med mal chart review comes back to the same 4 questions. The chart supplies the facts for each; a person supplies the answer. | Question | What the chart shows | Who answers it | | --- | --- | --- | | Standard of care | What was known, when, and what was done next, with times | Reviewing physician | | Deviation | The interval between order, result and response | Reviewing physician | | Causation | The sequence of events and any competing cause | Reviewing physician | | Damages timeline | Every encounter after the event, in date order | Risk manager and reviewer | The rest of this page takes the questions risk managers and physician reviewers ask most, 1 at a time. It builds on our [guide to AI medical chronologies for med mal cases](https://medrecords.ai/guides/ai-medical-chronology-medical-malpractice/). ### What does a standard-of-care review need from the chart? It needs the care in order, with times, and a page behind every entry, so the reviewing physician can see what was known at each point and what was done next. Medrecords AI drafts that timeline and cites each line to its source page; the physician decides what the standard required. The standard is judged against the guidelines and practice in force on the date of care, not today. Our guide to [clinical practice guidelines and the standard of care](https://medrecords.ai/guides/clinical-practice-guidelines-standard-of-care/) covers how reviewers date a guideline. The chart's job is narrower: show the facts the opinion rests on. ### How do you show a deviation in the record? You show the interval: the order, the result and the response as separate, timed entries, each cited. A lactate ordered at 21:04, resulted at 21:52 and acknowledged hours later is 3 events, and the time between them is the fact a reviewer weighs. Whether that interval is a deviation is an opinion. The chronology gives the times and the pages and does not call anything a breach. A silence in the charting, such as 2 hours 40 minutes with no vitals, should appear as its own row, with the last entry before it and the first entry after. ### How does the chart support or undercut causation? Causation turns on sequence: whether the harm followed the deviation, and whether the record shows another cause first. A cited timeline puts pre-existing conditions, competing explanations and the onset of harm on 1 line, so the reviewer can test each one against its page. Watch for findings copied forward from earlier notes. A page citation proves the note says it, not that anyone observed it that day. The causation opinion stays with the physician who signs it. ### How do you build a damages timeline from the records? List every encounter after the event in date order: readmissions, procedures, therapy, prescriptions and the last treating note, each with its page. The damages timeline is the same cited chronology, filtered to what came after the event. Billing pages often repeat clinical pages, so collapse exact duplicates before anyone counts visits or procedures. ### How should a physician prepare for a deposition from the chart? Prepare from the cited timeline, not from memory: the physician should be able to open the page behind every time and statement they may be asked about. A time that cannot be traced to a page is a time someone else gets to move. Check 3 things on your own entries: the time printed on each page, any note labeled late entry or addendum, and what the chart shows on either side of a gap. [Page citations](https://medrecords.ai/product/citations/) make each of those checks 1 click. ### What if records are missing from the chart? List each one with the page that implies it exists: a consult referenced but never produced, a medication administration record that stops on day 3 of a 5-day stay, a rapid response note marked "see attached" with nothing attached. Medrecords AI flags these with the page that points to them. A missing record may never have existed, may sit in another system, or may not have been produced. The flag cannot tell those apart; a records request can. See [missing records identification](https://medrecords.ai/product/missing-records-identification/). ### How do you handle late entries and possibly altered records? Cite every printed late entry, addendum and "entered on" label to its page, flag entries with no time or signature, and compare 2 versions of the same note side by side when you hold both. Whether a record was altered is a question for the EHR audit trail, which no printed page shows. Hospital entries must be dated, timed and authenticated under [42 CFR 482.24(c)(1)](https://www.ecfr.gov/current/title-42/section-482.24), so an untimed entry is a flag, not a gap to fill in. Certified EHR technology must keep an audit log under [45 CFR 170.315(d)(2)](https://www.ecfr.gov/current/title-45/section-170.315). Medrecords AI does not parse audit trail exports. [Record alteration detection](https://medrecords.ai/product/record-alteration-detection/) puts 2 versions side by side, and a changed line is a reason to ask, not proof. Our [EHR audit trail guide](https://medrecords.ai/guides/ehr-audit-trail-medical-malpractice/) covers the export itself. ### How long does a 2,000-page chart take to review? About 20 minutes for the draft. Medrecords AI reads about 100 pages a minute, so a 2,000-page chart comes back as a cited chronology in about 20 minutes, and the reviewer's time goes to checking the rows the opinion depends on. Your own review does not shrink to 20 minutes, and it should not. What changes is where the hours go: checking and deciding, not sorting pages. ### What do duplicate pages do to a chart review? They inflate the page count and can put the same note on the timeline twice. In a sample 342-page, 2-packet production, 11 duplicate pages were collapsed to 1 canonical record, and billing counted unique pages only. Exact duplicates are never charged. See [medical record deduplication](https://medrecords.ai/product/medical-record-deduplication/) for how repeats are logged so you can see what was removed. ### What does a chart review cost? Medrecords AI starts at 10 cents per deduplicated page, down to 5 cents with volume, billed per page and not per case. A 2,000-page chart costs at most $200 at the list rate, and less once exact duplicates are removed. There is no subscription and no seat fee, and credits never expire. First case is free on us. ### Who decides breach and causation? The reviewing physician. Medrecords AI drafts and cites; the physician or reviewer reviews and signs. It does not state breach, causation or merit, and a flag is a prompt for review, never a finding. ### Is it safe to upload a hospital chart for review? Only under a signed business associate agreement. Medrecords AI is SOC 2 and HIPAA compliant and signs a BAA at signup, so the agreement is in place before the first page is uploaded. See [HIPAA at Medrecords AI](https://medrecords.ai/hipaa/) for the details. Bring 1 real chart Send your longest chart to a demo and see it drafted as a cited chronology, with duplicates removed and missing records flagged. First case is free on us. [Book a demo →](https://medrecords.ai/demo/) [See pricing](https://medrecords.ai/pricing/) ### Related reading [Medical malpractice record review →](https://medrecords.ai/solutions/medical-malpractice/) [AI medical chronology for med mal cases →](https://medrecords.ai/guides/ai-medical-chronology-medical-malpractice/) [Altered medical records →](https://medrecords.ai/guides/altered-medical-records/)