Style Guide

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To answer your writing and editing questions, consult these resources in this order, as appropriate:

  1. This style guide
  2. CHCF’s Almanac Style Guide
  3. The Chicago Manual of Style, 18th ed. (Numbers in parentheses link to CMOS Online.)
  4. Merriam-Webster Collegiate or Unabridged Dictionary (M-W)
  5. The Indigo Book, for legal citations

Table of Contents

Abbreviations, Acronyms, Initialisms | Academic Degrees | Ages | Almanacs | Authorship
Bias-Free and Person-First Language
Capitalization | Citations and References | Composition Titles
Dates
Footnotes | Fractions
Government
Headings
Hyphenation
Illustrations (Charts, Figures, Tables) and Appendices | Internet, Web
Job Titles
Lists
Money
Names | Numbers
Page Numbers, Chapters, and the Like | Percentages | Places | Punctuation and Spacing
Race/Ethnicity | Rankings
Subject/Verb Agreement
Time
Voice

Spelling and Vocabulary
0–9  A  B  C–Cl  Coa–Com  Con–Cu  D  E  F  G  H  I  K  L  M–Me  Mh–Mu  N  O  P–Po  Pr–Pu  Q  R  S  T  U  V  W  X  Y  Z

Abbreviations, Acronyms, Initialisms

An acronym is an abbreviation pronounced as a word (10.2) (HIPAA). An initialism is an abbreviation whose individual letters are pronounced (DHCS).

If a term or an organization’s name will be used roughly five times or more in an article or chapter, spell it out the first time, followed by its abbreviation in parentheses (10.3). But if an abbreviation is more familiar to readers than the spelled-out version, follow the abbreviation with its definition in parentheses.

  • I work at the California Department of Health Care Services (DHCS). DHCS headquarters are in Sacramento.
  • HIPAA (Health Insurance Portability and Accountability Act of 1996) defines, among other things, the conditions under which health information can be shared.

Afterward, use the abbreviation (10.3, 10.29, 10.31) in text and headings; you may occasionally use the spelled-out version for variety.

Treat an executive summary or a sidebar as an independent document for purposes of abbreviations. For example, if a term is defined in an executive summary, redefine it in the main text.

Possessive and Plural

When defining an initialism, rewrite to avoid making it possessive (7.17) {the policy of the Centers for Medicare & Medicaid Services (CMS)}, but if a term is introduced in the plural, write its abbreviation in the plural {health maintenance organizations (HMOs)}.

Exceptions

These abbreviations don’t need definitions, as they are commonly understood in context: ACA, AI, CEO, CFO, CHCF, CMO, COO, CTO, FY, HMO, OPEC, PCP, PPO.

See also Academic Degrees, Company Names, Names.

Academic Degrees

Lowercase degrees when referred to generically (8.30): an associate’s degree, a master’s degree, master of public health (MPH), a doctorate.

Omit internal punctuation (10.23) when abbreviating academic degrees (MD, MS, PhD, RN) and do not use other credentials (CMT, FACP) unless important to the topic.

Ages

Hyphenate an age as a noun or adjective (7.96).

  • an eight-year-old boy
  • 85-year-olds
  • 6- to 12-year-old kids

But:

  • people age 65 (not aged)
  • 65 and older
  • five years old
  • age 65+ (acceptable in graphics)

Almanacs

The CHCF Health Care Almanac is made up of two kinds of products. The first is a series of graphic publications that provide data and analysis on aspects of the health care market, such as costs, disparities, providers, quality of care, and insurance. These are data-heavy chartbooks. The second are market reports focused on particular regions in California that also contain data and analysis.

All Almanac products, and data snapshots not part of the Almanac series, should follow the Almanac style guide.

Authorship

On the title page, list only names, degrees {Madelyn Walters, MS, MPH}, and organization.

In the “About the Author” section, list names, appropriate degrees, title, and organization:

  • Al Malamute, PhD, MD, director of surgery, Stanford University Hospital

These brief, factual descriptions (up to 50 words) should not be promotional in tone.

Bias-Free and Person-First Language

To avoid gender bias when referring to people generally, avoid using him or her by using these strategies (see more at 5.255):

  • Use the plural {survey respondents must submit their answers by noon [instead of a survey taker must submit his responses by noon]}.
  • Use nonsexist words instead of “man-” words (people [not mankind]) (chair [not chairman]).
  • Use singular they {a doctor must wash their hands often}.

Usually, put the person first to avoid marginalizing and dehumanizing when writing about someone’s chronic illness, disability, economic circumstances, or other traits (5.261). Putting the person first prioritizes them as a human being and does not define or categorize people by condition, circumstance, or trait. But check with the person or group and use their preference, as some prefer identity-first language (e.g., some members of the Deaf community).

For example, use:

  • People who are homeless or people experiencing homelessness, not the homeless or homeless people
  • Californians with low incomes, not low-income Californians
  • Children of families with low incomes, not low-income children

It is acceptable to precede a noun with “low-income” and the like when writing about a region or population being defined by that characteristic, and when the phrase cannot be easily recast to put people first; for example:

  • The study found that people in low-income communities (defined as more than 50% of the population with incomes below 200% of the FPL) experience higher rates of chronic illness than the general population.
  • Community health centers and independent physician practices that predominantly serve low-income communities are eligible to apply.

When referring to someone with a disease or condition, emphasize the person {a patient with diabetes} (preferred) or {a diabetic patient}, and never employ it as a noun (diabetics, schizophrenics) (5.261).

Capitalization

Capitalize generic terms as part of proper names, but lowercase them in references (8.52, 8.67, 8.69):

  • California Health Care Foundation, the foundation
  • the Department of Disease Eradication, the department
  • Stanford University, the university

But see Places.

Names of companies or brands that start with a lowercase letter followed by a capital (eConsult) don’t need to be capped when they start a sentence, although some editors may want to reword (8.155).

Lowercase the names of seasons in running text (8.89) but cap them in journal issue dates (14.70) (see Citations and References).

Use these guidelines for headings and the titles of books, journals, articles, podcasts, etc. (8.160).

  • Always capitalize the first and last words of a title and subtitle, and capitalize all other major words, including nouns, pronouns, verbs, adjectives, adverbs, and some conjunctions, except as noted below.
  • Lowercase articles: a, an, the.
  • Lowercase prepositions of four or fewer letters: for, in, of, on, with but Above, Between, Through, Within.
  • Lowercase these conjunctions: and, but, for, nor, or.
  • Lowercase to as a preposition and as an infinitive {to Examine}.
  • Lowercase as.
  • For hyphenated words (8.162), capitalize both elements, even after a prefix {Pre-Authorization Slowdowns} {Follow-Up Report}.

Citations and References

Citations Table of Contents

For citations, use endnotes, not footnotes (except in Almanacs and when necessary in sidebars). Use Microsoft Word’s Endnote (or Footnote) feature, which handles note numbering automatically.

All endnote numbers in the text should be superscripted (13.27) and usually follow the sentence’s final punctuation (13.29).

Whenever possible, link to a landing page for a source and not directly to a PDF or other file. But if there are many files linked from the landing page, link directly to the file.

General format

Use this general format for endnotes (see below for details and examples):

[author(s)], [title], [publisher], [date].

Authors

For a book or report with up to two authors, list each, first names first, in the order they are found at the source {Luci Garcia and Karly Menheim}. For three or more, list the first author and add “et al.” (note that only al. takes a period and there’s no intervening comma) {Peri Alahar et al.}

Only people are authors, not organizations, so do not begin a citation with an org name. If no authors are specified, begin the endnote with the title (13.81).

Titles

Use italics for the titles of reports and landing pages (generally, pages that host a report with the same title), journals (14.69), newspapers (14.91), blogs (14.103), books (13.88), and podcasts (14.168) {New York Times} {JAMA} {The CHCF Blog} {Radiolab}.

Use roman type and quotation marks for journal (14.68) and news articles (14.89), blog posts (14.105), podcast episodes (14.168), and web pages {“Medi-Cal Enrollment Rose 14%”}.

Separate a title and any subtitle with a colon. Similarly, in news headlines, replace a period after a first sentence with a colon (14.90).

Also, replace hyphens in number ranges with en dashes (8.167).

Do not use italics or quotations marks for the names of websites (14.103) {Google Maps}.

Link the title of the first instance of a cited work (omit links in subsequent references to the same source).

Use Digital Object Identifiers (DOIs) whenever available (13.7), mostly for some journal articles. In endnotes, link the title using this format: https://doi.org/[DOI] (for example, https://doi.org/10.1377/hlthaff.2012.0332). See below for further examples.

For help with legal citations, consult The Indigo Book.

Publishers

For online sources, the organization that hosts the source is the publisher. Note that the publisher is not necessarily the source of the data being cited.

Dates

In decreasing order of preference, specify one of these dates:

  1. Date of publication
  2. Date the pub or web page was last updated, modified, etc.
  3. Date the web page was accessed by the author

For journals with both a volume and issue number, no month or season is required with the year (13.26).

Figures, illustrations, tables

When citing a figure, illustration, or table within a document, specify it at the end, after any page number (14.57) {Medi-Cal Enrollment by State, DHCS, September 2018, 163, figure 4.4}.

Repeated sources

Citations to sources already cited use a shortened form (13.32). Avoid ibid and use the shortened form instead (13.37).

The numbered endnote examples below are primary and subsequent citations of the same source. Consult Chapter 13 and Chapter 14 of CMOS for detailed coverage and extensive examples, and the Chicago-Style Citation Quick Guide and 13.21–6 for brief examples.

Multiple sources

Do not use multiple endnote numbers (13.31).1,2 Instead, use one endnote number, and in the endnote separate multiple sources with semicolons, including and before the final source:1

  1. Dan Forth, How Doctors Treat: A Survey (New York: Knopf, 1967), 48–52; and Jordan Futon, “Health Care in Rural Japan,” Asian Health 24, no. 3 (March 2011): 324.

Blog posts (14.105) and magazine or news articles (14.89–98)

  1. Robert Pear, “Cheaper Health Plans Promoted by Trump Have a History of Fraud,” New York Times, October 21, 2017.
  2. Pear, “Cheaper Health Plans.”

Books (14.2–62)

One or two authors

  1. Dan Forth, How Doctors Treat: A Survey (Knopf, 1967), 48–52.
  2. Forth, How Doctors Treat, 87.
  3. Ann Garth, and Lee Woods, Nurse Reference, 2nd ed. (NPC, 2009), 241–302.
  4. Garth and Woods, Nurse Reference, 122.

Three or more authors

  1. Faye Dunn et al., Therapist Field Guide (Freud & Sons, 2000), 64–68.
  2. Dunn et al., Therapist Field Guide, 65.

Cochrane database articles

  1. Mia Schmidt-Hansen et al., “Buprenorphine for Treating Cancer Pain,” Cochrane Database Systematic Reviews 3 (2015).
  2. Schmidt-Hansen et al., “Buprenorphine.”

Data requests

For special data requests by the author.

  1. Custom data request, California Dept. of Health Care Services, received August 16, 2017.

Journal articles (14.67–86)

Capitalize seasons that identify journal issues (14.70) {Health Journal 14 (Autumn 2017): 45–49}.

  1. Eva H. DuGoff et al., “Multiple Chronic Conditions and Life Expectancy: A Life Table Analysis,” Medical Care 52, no. 8 (Aug. 2014): 688–94.
  2. DuGoff et al., “Multiple Chronic Conditions.”

Legal (14.170–193) and legislative

Bills or resolutions (14.184)

Federal
  1. Safe and Accurate Food Labeling Act of 2015, H.R. 1599, 114th Cong. (2015).
State
  1. A.B. 1544, 2019–20 Leg., Reg. Sess. (Cal. 2019).

Court cases (14.178, 14.179, 14.180)

  1. Obergefell v. Hodges, 135 S. Ct. 2584 (2015). [US Supreme Court]
  2. Olmstead v. L.C., 527 U.S. 581 (1999). [lower federal court]
  3. Williams v. Davis, 27 Cal. 2d 746 (1946). [Cal. state court]

Federal Register (14.190)

Specify volume, page number, and abbreviated publication date.

  1. 79 Fed. Reg. 78954 (Dec. 31, 2014).

Laws, statutes (14.183), regulations

Federal
  1. Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, § 2404, 124 Stat. 119 (2010).
  2. Social Security Act of 1935, Pub. L. No. 74-271.49 Stat. 620 (1935).
  3. 26 C.F.R. § 1.501(c)(3)-1(d)(2).
  4. 42 C.F.R. part 431, subpart G.
State
  1. Cal. Health & Safety Code § 109.7.130290(h).

Letters

  1. Sarah Brooks (chief, Managed Care Quality and Monitoring Div., DHCS) to all Medi-Cal managed care plans, “Professional Fees for Office Visits Associated with Alcohol and Substance Use Disorder Treatment Services” (PDF), All Plan Letter 15-008, April 16, 2015.
  2. Brooks, “Professional Fees.”

Personal communications (14.111)

  1. Hospital palliative care managers, personal communication with author, July 9, 2023.
  2. Hospital palliative care managers.

Press (news) releases (14.98)

  1. Centers for Medicare & Medicaid Services (CMS), “Medicare Part D Overutilization Monitoring System (OMS) Summary,” press release, November 3, 2015.
  2. CMS, “Medicare Part D.”

Reports, brochures, pamphlets (14.117)

When a report is based on annual data (e.g., from government agencies), add the year(s) that the data are from in parentheses, in roman text, after the report title: (2017), (2013 and 2017), (2013–18). Also add the publication date, if available, in the usual place, after the publisher (see the first two examples under Online below). If multiple data years are specified, then for compactness, omit publication years.

Printed

  1. Chuck Babbage, Electronic Health Records (London: Analytical Press, 2000).
  2. Babbage, Electronic Health Records.

Online (no, one, two, three, and four+ authors)

  1. Behavioral Health Barometer: California, Volume 5: Indicators as Measured Through the 2017 National Survey on Drug Use and Health and the National Survey of Substance Abuse Treatment Services (PDF), Substance Abuse and Mental Health Services Administration (SAMHSA), 2019.
  2. Behavioral Health Barometer, SAMHSA.
  3. Padma Nagappan, How San Diego Is Protecting Its Homeless Population from COVID-19, California Health Care Foundation (CHCF), June 2020.
  4. Nagappan, How San Diego, CHCF.
  5. Priti Khanal and Kathy Moses, “How Destination Home Is Partnering with Santa Clara County to Care for Individuals Experiencing Homelessness Amid COVID-19,” Center for Health Care Strategies (CHCS), June 10, 2020.
  6. Khanal and Moses, “How Destination Home.”
  7. Mila Kofman, Eliza Bangit, and Kevin Lucia, MEWAs: The Threat of Plan Insolvency and Other Challenges (PDF), Commonwealth Fund, March 2004.
  8. Kofman, Bangit, and Lucia, MEWAs.
  9. Prashila Dullabh et al., Evaluation of the State HIE Cooperative Agreement Program: Final Report (PDF), NORC, March 2016.
  10. Dullabh et al., Evaluation.

Webinars (biblio 2.7), lectures or papers presented at a meeting (14.115)

  1. Gilson DaSilva, Keri Toback, and Karen Hatcher, hosts, “State Plan Amendment Submission and Processing for State Medicaid Agencies,” webinar, CMS, February 2024.
  2. DaSilva, Toback, and Hatcher, “State Plan.”
  3. Frances Isbell et al., “Beyond the Emergency of Homelessness: The Roles of HCH Programs in Planning for and Responding Strategically to Disasters and Emergencies” (PDF), 2018 National Health Care for the Homeless Conference and Policy Symposium, Minneapolis, Minnesota, May 15–18, 2018.
  4. Isbell et al., “Beyond the Emergency.”
  5. Vanda Chand, “Medi-Cal in 2030,” PowerPoint presentation, MCP Annual Conference (virtual), May 5, 2021.
  6. Chand, “Medi-Cal.”

Composition Titles

Use these guidelines for the titles of reports, books, articles, websites, web pages, etc.

Initial the. If an initial the appears in the title of a newspaper or periodical on its cover or masthead, capitalize and italicize it in running text (8.172) {appeared in The New York Times}.

Subtitles. Use a colon to separate a subtitle from a title (8.166) {Dually Eligible Enrollees: Navigating Two Health Care Programs}.

Reports, journals, newspapers, and other large works

Italicize, and do not use quotations marks for, the titles of works that are not parts of a larger work — reports, white papers, blogs (not blog posts), books, journals, magazines, newsletters, newspapers, movies, and TV shows (8.164, 8.194) {San Francisco Chronicle} {Journal of Oncology} {Health Affairs}.

Journal articles, blog posts, lectures, webinars, and other small works

Do not italicize, but use quotation marks for, titles that are parts of a larger work — journal articles, blog posts, newspaper and magazine articles, lectures at a conference, webinars, and the like (8.164, 8.179, 8.194) {“Medi-Cal Funding Increased”}.

Web pages

Surround the title of a web page with quotation marks (8.193):

Visit “2014 Postpartum Depression Survey Data” for more details.

Websites, webinar series, surveys, and databases

Capitalize, but do not italicize or surround with quotation marks (8.193):

The Healthnews site reports that, according to the American Telehealth Survey, Californians are expected to make more online appointments.

Exception: If the website is primarily a news site or blog, italicize the name (8.194): The Atlantic, Buzzfeed, California Healthline, California Health Report, CalMatters, Healthcare Dive, the Huffington Post, Modern Healthcare, Politico, Slate, Stat, The CHCF Blog, Vox. But news services and call letters are not italicized: Associated Press, Kaiser Health News, KQED, ProPublica, Reuters.

See also Capitalization.

Dates

  • Capitalize and spell out months in running text. In tables, notes, parentheses, and the like, use abbreviations, with periods, of months with more than four letters (10.44): Jan., Sept., June.
  • If no date is specified, do not use a comma after the month (6.41) {March 2001}.
  • If a date is specified, use commas after both the date and the year (6.41) {On April 2, 2001, the nurses met}.
  • Use cardinal numerals (9.33) {June 30 [not June 30th]}.
  • Centuries: Spell out and hyphenate (9.34) {the twenty-first century}.
  • Use apostrophes only to indicate missing numbers (9.32): the 1800s, the ’70s or the 1970s (not the 70’s and not the 1970’s).
  • For fiscal years, use FY followed by a (preferably nonbreaking) space and an en dash for a range (9.62) {FY 2016} {FY 2020–21}.

Footnotes

When explanatory footnotes are required, in the text use these symbols, superscripted, in this order, with no preceding space (13.52) (tip: copy and paste these characters from here): * (asterisk), † (dagger), ‡ (double dagger). If more footnotes are needed, double the symbols: **, ††, ‡‡.

The corresponding symbols that precede the footnotes themselves are also superscripted (3.80).

Fractions

Spell out and hyphenate simple fractions as nouns, adjectives, and adverbs (9.15).

  • four-fifths of the doctors
  • one-half complete
  • a two-thirds majority
  • one and three-quarters

Government

Capitalize and spell out the full names of legislative and administrative bodies, bureaus, centers, departments, and offices (8.63), including US or California.

  • US Census Bureau
  • US Congress
  • US Department of Health and Human Services (HHS)
  • US Departments of Defense and Veterans Affairs (VA)
  • US Centers for Disease Control and Prevention (CDC)
  • US Centers for Medicare & Medicaid Services (CMS)
  • US Health Resources and Services Administration (HRSA)
  • the House, the Senate
  • California Department of Finance (DOF)
  • California Department of Health Care Services (DHCS, poss.: DHCS’s)
  • California Department of Managed Health Care (DMHC)
  • California Health and Human Services Agency (CalHHS)
  • California Office of Health Information Integrity (CalOHII)
  • California State Assembly, California State Senate
  • California Office of the Patient Advocate (OPA)
  • California Department of Health Care Access and Information (HCAI) (until 10/2021, Office of Statewide Health Planning and Development)
  • San Francisco Board of Supervisors

Adjectives derived from such terms and paraphrased references to them are usually not capitalized (8.63).

  • administration (Biden administration)
  • assembly meeting
  • board of supervisors
  • California legislature
  • city council member
  • congressional but Congress
  • legislature agenda
  • state senate

Lowercase certain generic governmental terms (8.66) {administration} {city hall} {federal}.

Lowercase state when used generically {the state of California; the state of Washington [when differentiating it from Washington, DC]}. But the legal entity is the State of Washington (not Washington State).

Headings

Apply Word’s built-in styles to headings (Heading 1, Heading 2, etc.). For example, if you want to change the look of Level 1 headings, change the Heading 1 style, not all the individual Level 1 headings.

Style run-in headings like boldface sentences, using an initial capital letter, boldface, and a period (1.62):

Common DSA shared across all partners. In many communities data sharing agreements are shared.

Use Word’s built-in Title and Subtitle styles for the document’s title and subtitle.

Hyphenation

Consult the spelling list below, then CMOS 7.87–7.95, the Hyphenation Guide, and then M-W.

Illustrations (Charts, Figures, Tables) and Appendices

All illustrations require a title above and a source notation below that includes the year. For flexibility and ease of editing, titles and sources are embedded into the HTML of the page and not embedded into the graphic itself.

In tables, use these conventions:

  • Not applicable (measure doesn’t apply): leave blank
  • No data (measure applies but data unavailable): — (em dash) (Tip: copy and paste the dash from here.)
  • Zero: 0

If a dash is used, add this note: Where a dash appears, no data were available.

Illustrations should be numbered continuously. Tables are numbered separately from other figures such as graphs and illustrations: Table 1, Table 2, Figure 1, Table 3, Figure 2. Appendices are lettered: Appendix A, Appendix B. A table or figure within an appendix includes the appendix’s letter (3.11): Table A3, Figure B1.

Notes for illustrations belong below the illustration and not in the endnotes. Illustration notes use these symbols in this order (3.80) (tip: copy and paste these characters from here): * (asterisk), † (dagger), ‡ (double dagger), § (section symbol), ∥ (parallels), # (number sign). If more are needed, use double marks in the same order: **, ††, ‡‡, §§, ∥∥, ##.

Figure and table numbers, and appendix letters, are separated from titles by periods. Use title case. Use terminal punctuation if at least most illustration titles in a document are full sentences.

  • Figure 1. Care Connection Team
  • Table 2. Current Rural Palliative Care Pilots in California
  • Appendix B. Emerging Community-Based Palliative Care Models in Rural California

See also Citations and References and Page Numbers, Chapters, and the Like.

Internet, Web

Leave URLs intact. In production, they may be condensed.

Proper nouns spelled with an initial lowercase letter followed by a capital needn’t be capitalized at the beginning of a sentence or a heading (8.156).

  • iPads are growing more popular in hospitals.
  • eHealth sells thousands of items.

Job Titles

Capitalize a job title when it precedes a name. Normally, lowercase a job title after a name or when used alone (8.20, 8.23, 8.28).

  • President Beam; Jed Beam, the president; the president
  • Governor Newsom; the governor, California Governor Newsom (8.22)
  • Assemblymember Julio Jimenez; the assemblymember
  • Kim Chou, director of funding; the director

Lists

Use parallel construction for list items, whether in running text or as bulleted or vertical lists — all nouns or all verbs (6.138).

  • internists, general practitioners, and physician assistants
  • greet the patient, consult the chart, wash your hands, and examine the patient

Use the serial comma before the conjunction in a list of three or more items (6.19). If any item has internal punctuation, separate the items with semicolons (6.64).

  • The administrator ordered cotton balls, gloves, and x-ray film.
  • The administrator ordered cotton balls; small, medium, and large gloves; and x-ray film.

A list is best introduced by a complete grammatical sentence, followed by a colon (6.141).

Use closing punctuation only if at least most of the items are complete sentences (6.141).

In a numbered list, follow each numeral with a period and a capital letter (6.141).

These areas need continued attention:

  • Prioritizing equity
  • Ensuring county capacity
  • Using data transparency to flag problems

Every morning, perform these steps:

  1. Boot up your computer.
  2. Log in.
  3. Check your email.

Money

Use the currency symbol and numerals (9.26) {$21.09} {$3 million}.

Names

Company

Use the full name, including ampersands and abbreviations, but you usually may omit Inc., & Co., LLC, and the like (10.28) {Merck [not Merck & Co. Inc.]}. If the context requires such specificity, omit any preceding comma (6.47) {WeCare Health Plan Inc.}.

Personal

Use periods and a space between initials {A. B. Cooper} but omit periods and spaces in names replaced by initials (10.14): FDR.

On first reference, use a person’s first and last names. In subsequent references, use only the last name {Jan Jackson then Jackson} {Mortimer Brown, MD, then Brown [not Dr. Brown]}.

Numbers

Charts

In charts, use symbols to denote “less than,” “through,” “and above,” and the like: <18, 18–25, 26+.

Commas

Use commas for numbers of four digits or more except page numbers, addresses, and years (9.56) {1,541 therapists agree} {23502 Cleary Avenue}.

Equations

Use spaces around equal signs, arithmetic operators, and the like (6.130) {adjusted patient days = total gross patient revenue / gross inpatient revenue x number of patient days}.

Spelling Out versus Using Numerals

  • For decimal numbers, even large ones, always use numerals (9.21) {2.53}, (9.9) {4.1 million}.
  • For whole numbers (9.3):
    • Spell out one through nine {nine patients} {three million members}.
    • Use numerals for 10 and up {200,000} {11 million}.

Exceptions to the general rule:

  • At the beginning of a sentence — unless it’s bulleted — either spell out a number or reword the sentence (9.5):
    Eighty-six respondents answered every question.
    Every question was answered by 86 respondents.
    but
    • 86 respondents answered every question.
  • In tables, especially where many numbers are present, numerals can be used for values under 10.
  • When a cluster of numbers near one another all refer to the same thing, and any of the numbers are 10 or more, use numerals for all the numbers (9.7) {3 in 14 enrollees in the southern part of the state, and 5 in 11 in the northern part}.
  • In describing dosing, use numerals and spell out to {take 1 pill every 3 to 4 hours}.

Statistics

Use an italicized capital N to represent population size, an italicized lowercase n to represent subpopulation size (3.86).

  • Californians with cancer (N = 15,578)
  • Lung cancer diagnoses (n = 4,137)
  • Central Coast (n = 338)

To represent significance level, use an italicized p and no leading zero (3.81): (p <= .05).

See also Ages, Dates, Fractions, Money, Percentages, Rankings, Time.

Page Numbers, Chapters, and the Like

Spell out and uppercase references to parts of a document, tables, figures, charts, appendices, and the like: Chapter 9, Section 2.38, Part 3, Table 2, Figure 4, Appendix B.

But lowercase references to pages (8.182): page 26.

Percentages

Percent is an adjective that follows a number {Twelve percent}, while percentage is a noun {the percentage of respondents increased} (9.20).

When specifying a percentage, spell out the number at the beginning of a sentence that’s not bulleted (see below). Otherwise, use numerals and the percent sign (%) (9.20). Use less than and more than as modifiers.

  • Less than 27% of enrollees responded.
  • The proportion of patients agreeing was 26%.
  • 26% of patients agreed.
    but
    Twenty-six percent of patients agreed.

Places

In running text, spell out the names of states (10.32): California, United States (or US). In bibliographies, addresses, tables, etc., use two-letter postal abbreviations (10.32): CA, DC, and US.

Words such as state, county, city, and so forth are capitalized when they are used as an accepted part of a proper name, even when pluralized (8.52, 8.54) {Alameda County, Marin and Napa Counties} {Washington State} {Southern California} {southern Idaho}.

Punctuation and Spacing

Colons

Capitalize a word that follows a colon only if it is a proper noun or it starts a complete thought (6.67).

  • The survey included these professionals: doctors, nurses, and psychiatrists.
  • The reason is simple: There aren’t enough doctors.

Dashes

For number ranges, use an en dash (6.83): 2004–2007, pp. 4–9.

Windows users can form an en dash in Word with Ctrl+Numpad minus.

Windows users can form an em dash with Ctrl+Alt+Numpad minus, and add a space before and after: Several sources — Health Affairs, TIME, and Newsweek.

Ellipsis points

Ellipsis points represent text omitted from a quoted passage. Within sentences, use three spaced periods (12.59), Between sentences, add three spaced periods after the first sentence’s terminal punctuation (12.62).

  • I will apply . . . all measures that are required. . . . I will remember that there is art to medicine as well as science.

Parentheses and brackets

Always use in pairs, even in run-in lists (6.140): (1) California, (2) New York, and (3) Texas.

When making a parenthetical statement within another one, use brackets for the innermost set (6.107).

  • (For details, see Tyson [2003] and Anderson [2005].)

Periods

Use i.e. and e.g. only inside parentheses, add periods, and follow with a comma (6.54) (i.e., like this). Otherwise, use that is or for example, respectively.

Quotation marks

Place commas and periods inside quotation marks (6.9), colons and semicolons outside (6.10).

Place question marks and exclamation marks inside only if they are part of the quotation (6.10).

  • “I had to wait too long,” the respondent said.
  • “Respect”: It’s my all-time favorite song.
  • “What did the doctor say?” he asked.
  • Did he say, “The doctor went home”?

Slash/Solidus

The meaning of a slash (/) is often unclear — or, and, both, or something else? Given this lack of clarity, try to avoid the slash and instead use words to make meaning clear: Californians can apply for Medicare or Medi-Cal or both or Californians can apply for Medicare, Medi-Cal, or both.

Likewise, minimize use of the awkward and sometimes ambiguous and/or construction by either simply using or, or by spelling out the options: Members receive care through a commercial health plan, Medi-Cal, or both.

Spacing

Use only one space between sentences and after colons (2.11). Avoid using more than one space in a row for any reason. To align columns, for example, use tabs (2.14).

Race/Ethnicity

Unless dictated otherwise by the source material (8.39), use the terms below. Where a source’s terms differ, either add a note {data source uses African American, Hispanic, and Native American} or paraphrase results {Latinos/x were 12% less likely to be insured}.

  • American Indian and Alaska Native (AIAN)
  • Asian
  • Asian, Native Hawaiian, and Pacific Islander (ANHPI)
  • Black (adj.)
  • Black people (not Blacks)
  • Latino/x or Latina/x (sing.), Latinos/x or Latinas/x (pl.) (people of Latin American ancestry)
  • Multiracial
  • Native Hawaiian and Pacific Islander (NHPI)
  • White (adj.)
  • White people (not Whites)

Not all Black people (e.g., Caribbean Americans and those born outside the US) are African Americans. In a publication in which race is relevant and there is no stated preference, use Black.

Where a source uses Alaskan Native or separates American Indian and Alaska Native, or Native Hawaiian and Pacific Islander, with a slash or with or (e.g., Alaska Native / American Indian), simply replace it with the standard wording above, without comment.

If used by the source material or preferred by the subject, African American should not be hyphenated even as an adjective; Indigenous should be capitalized.

Avoid using minority or Black, Indigenous, and other people of color and BIPOC (use people of color) or brown as race categories except in a direct quote.

Rankings

Use ordinal numbers (9.6): they came in 57th in the state.

Subject/Verb Agreement

Refer to this table for help with subject/verb agreement.

SubjectVerbExamples
amount of,
group of (5.192)		agrees with noun before of-phrasethe group of patients is
the groups of patients are
fractionsagrees with noun in of-phrasetwo-thirds of the public says so
one-fourth of respondents say yes
majority of (5.192)singular with no of-phrase
plural with of-phrase and plural noun		a majority is
a majority of respondents are
one in (CMOS Q&A)singularmore than one in four enrollees is
one of the few,
one of those,
one of … that/which/who (5.66)		pluralone of those physicians who are
one of the physicians who are
one of eight states that are
number of (5.192)singular with the
plural with a		the number of EDs is
a number of EDs are
percent of,
% of		agrees with noun in of-phrase40% of the electorate is Asian
56% of participants are women
percentage of (5.192)singular when alone
plural with of-phrase and plural noun		a percentage is
a percentage of HMOs are

Time

Use AM or PM with a leading space (10.46) and time zone (but without Daylight/Standard designation): 8:00 AM (PT), 2:30 PM (PT). Use Noon where appropriate but avoid the redundancy 12 noon.

For ranges, separate the times with an en dash but no surrounding spaces: Noon–1:30 PM (PT), 10:30 AM–1:00 PM (PT).

Voice

Except in articles and blog posts, use the third person, avoiding I, we, and us {the authors found [not we found]}.

Avoid language that suggests that organizations can talk {the health plans stated}. Instead, identify the person or people who did the speaking {health plan interviewees stated} {health plan representatives said} {a health plan rep reported}.

Spelling and Vocabulary

If a term is not in this list, consult M-W. If an entry has more than one spelling, use the first one.

0–9, A

24/7
501(c)(3)
911, 988 (phone numbers)

A

AB nnnn or SB nnnn (use a nonbreaking space, e.g., AB 5410)
accountable care organization
acknowledgments
acute care (n. and adj.)
administrative services only (ASO)
adult residential facilities
advance care planning
Advanced Planning Document
advance health care directive
adverse childhood experiences (ACEs)
adviser (not advisor)
Affordable Care Act (ACA)
African American (n. and adj.)
Agency for Healthcare Research and Quality (AHRQ)
all-payer claims database (APCD)
All Plan Letter
Alternative Benefit Plan
alternative payment method
alternative payment model
ambulatory care–sensitive conditions (note en dash)
anti-racism
anti-racist
antivaccine
appendices (not appendixes)
application (or app)
ASAM criteria

B

back office (n.), back-office (adj.)
behavioral health (includes mental health & addiction)
behavioral health transformation
beneficiary (avoid; use enrollee)
biannual (avoid; use either biennial [every two years] or semiannual [twice a year])
bio-sketch
birthing people* (add this footnote: * We use “birthing people” to recognize that not all people who become pregnant and give birth identify as women or mothers.)
birthweight
board-certified
brand name (n.), brand-name (adj.)
bronze (ACA plan level)
buy-in (n.), buy in (v.)

C–Cl

CalAIM (California Advancing and Innovating Medi-Cal)
California Children’s Services (CCS)
CalHEERS (California Healthcare Eligibility, Enrollment, and Retention System)
California Exchange
California Health Benefit Exchange
California Health Care Foundation (CHCF, the foundation)
California-wide
Cal MediConnect Program (or plan)
CalPERS (California Public Employees’ Retirement System)
carve-out (n. and adj.), carve out (v.)
US Center for Medicare and Medicaid Innovation (CMMI)
US Centers for Disease Control and Prevention (CDC)
US Centers for Medicare & Medicaid Services (CMS, poss.: CMS’s)
certified nurse-midwife
cesarean section
changemaker
chartbook
checkup (n.), check up (v.)
Children’s Health Initiative
Children’s Health Insurance Program (CHIP)
chronic care (n. and adj.; in general, do not hyphenate modifiers of care except long-term care)
clinic (avoid; generally refers to non-FQHC clinics; the distinction should be made clear)

Coa–Com

co-adviser
coauthor
co-brand
cochair
cocreate
codesign, codesigner
codirect, codirector
cofund
cohost
co-insurance
co-invest
colead
coleader
Collaborative Care Model (CoCM)
colocate, colocation
comanage
community-based organization
community health center (CHC or health center) (On first use, add a footnote identifying the types of included organizations; e.g.: “In this publication, CHCs include FQHCs, FQHC Look-Alikes, and other health center program grantees, as well as non-FQHC clinics.” For example, some data sets do not include non-FQHC clinics or may not include FQHC Look-Alikes, in which case the footnote should be clear about which data are or are not included.)
community health worker/promotor (sing.), community health workers/promotores (pl.)
Community Supports (use initial caps for individual Community Supports)
comorbidity

Con–Cu

consumer (avoid except in stock phrases such as consumer research; use [singular] person, enrollee, member, client, resident, Californian, [a pronoun]; [plural] people, the public, those)
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Continuum of Care (CoC), Continuums of Care (CoCs)
continuums (avoid except in direct quotes and proper names; use continua)
coordinated care organization
Coordinated Entry
co-owner
co-ownership (n. and adj.)
copay
copayment
co-prescribe
Coronavirus Aid, Relief, and Economic Security (CARES) Act
cost containment (n.), cost-containment (adj.)
cost cutting (n.), cost-cutting (adj.)
cost-effective
cost-effectiveness
cost sharing (n.), cost-sharing (adj.)
County Organized Health System (COHS)
countywide
COVID-19 (not COVID; disease caused by SARS-CoV-2 virus)
critical access hospital
c-section
cutoff (n. and adj.), cut off (v.)

D

data (plural: data are) (5.254)
Data Exchange Framework
dataset
data sharing (n. and adj.)
decisionmaker
decisionmaking
Delivery System Reform Incentive Payments (DSRIP)
California Department of Health Care Services’s, DHCS’s (poss.)
designated public hospital
Designated State Health Program
Direct secure messaging (Direct is a brand name)
disproportionate share hospital
District of Columbia (spelled out in list of states)
district/municipal hospital
doctor of osteopathic medicine (not doctor of osteopathy)
Drug Medi-Cal Organized Delivery System (DMC-ODS)
DSM-IV, DSM-IV-TR, DSM-5
Dual Eligible Special Needs Plan (D-SNP)
dually eligible enrollees (not duals or dual eligibles) (define term first — e.g., people eligible for and enrolled in both Medicaid and Medicare, or dually eligible enrollees.)

E

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
ebook
electronic consultation (eConsult)
email (7.96)
emergency medical services agency (used generically)
Enhanced Care Management (ECM)
e-prescribing
essential health benefits (EHBs)
exchange (when referring to California’s ACA exchange)
Exclusively Aligned Enrollment (EAE)
External Quality Review Organization

F

face mask
fact sheet
fall (season)
Family PACT (Family Planning, Access, Care, and Treatment)
federal
Federal Employees Health Benefits Program (FEHBP)
Federally Qualified Health Center (FQHC) (an FQHC) (specifically, FQHC program 330 grantees; if including Look-Alikes, use FQHCs and FQHC Look-Alikes)
Federally Qualified Health Center Look-Alike
Federal Medical Assistance Percentage (FMAP)
federal poverty guidelines
federal poverty level (FPL)
fee-for-service, Fee-for-Service (in titles) (n. and adj.)
first-line (adj.)
fiscal year
follow-up (n. and adj.), follow up (v.)
for-profit
front line (n.), frontline (adj.)
front office (n.), front-office (adj.)
Full Integration Plan
Full Service Partnership
full time (n.), full-time (adj. and adv.)
full-time equivalent

G

general fund
Geographic Managed Care Model or GMC Model
gold (ACA plan level)
graduate medical education
grandfathered (avoid — use legacy or reword)
grantmaker
grantseeker

H

handoff (n.), hand off (v.)
hardwired
HbA1c
Healthcare Effectiveness Data and Information Set (HEDIS)
health care, health care plan (n. and adj.)
Healthforce Center at UCSF (do not precede with the)
Health Homes Program (HPP)
health information exchange (an HIE)
health information organization or health information exchange organization (an HIO)
health plan
Health Professional Shortage Area
health savings account
heat map
hepatitis C
Hernández, Sandra R. (note accent)
high-need, high-cost population (avoid; use more descriptive and specific language such as patients with multiple chronic conditions who account for a disproportionate share of health care spending)
HIPAA (Health Insurance Portability and Accountability Act)
HITECH (Health Information Technology for Economic and Clinical Health) Act
home and community-based services (HCBS)
Homeless Management Information System (HMIS)
hospital-acquired infection
hospital fee program
hot spot
hub and spoke program (or system)

I

independent medical review
independent practice association
Indigenous (capitalize when referring to people)
individual (avoid unless comparing to families, groups, or organizations; use person, patient, enrollee, member, Californian, etc.)
individual program plan
in-home (adj.)
In-Home Supportive Services (IHSS)
in-house (adj. and adv.)
In Lieu of Services (ILOS)
in-network (adj.), in network (adv.)
inpatient
in-person (adj.), in person (adv.)
in situ (not italicized)
institutional review board
internet (7.85)
intranet
iPhone

K

key informant
KFF (not Kaiser Family Foundation)
kickoff (n.), kick off (v.)
knowledge base
Knox-Keene (formally Knox-Keene Health Care Service Plan Act of 1975)

L

La Clínica de la Raza (note accent)
large-employer (adj.)
learnings (avoid — use lessons, discoveries, findings, insights, takeaways)
Level I, Level II trauma center
LGBTQ (not LGBT)
LifeLong Medical Care (note second capital L)
local initiative
long COVID (define and use quotation marks on first use; leave off “-19”)
long-lasting
long-standing
long-term care (n. and adj.)
long-term services and supports (LTSS)
Low Income Health Program

M–Me

managed care plan (an MCP)
managed care organization (an MCO offers MCPs)
Managed Long-Term Services and Supports (MLTSS)
marketplace
market-wide
meaningful use (use quotations marks on first use)
Medicaid
Medicaid and CHIP Payment and Access Commission (MACPAC)
Medicaid Home and Community-Based Services
Medicaid managed care
Medicaid.org (in citations, avoid — use CMS)
Medicaid State Plan
Medi-Cal (always refer to Medicaid in California as Medi-Cal)
Medi-Cal 2020 waiver
Medi-Cal Access Program (MCAP)
Medi-Cal enrollee (not beneficiary)
Medi-Cal managed care
Medi-Cal managed care program
medical doctor (avoid — use doctor of medicine)
medical loss ratio
Medicare Medi-Cal Plan (Medi-Medi Plan)
Medicare Part D
medication-assisted treatment
methodology (generally avoid — use method)

Mh–Mu

mHealth (mobile health)
mid-career
migrant health center
mindfulness-based stress reduction
mini-med plan
minority (avoid)
morphine equivalent dose (avoid — use MME)
morphine milligram equivalents (MME)
multicultural
multidisciplinary
multihospital
Multipurpose Senior Services Program (MSSP)
multiracial
multispecialty
multistakeholder
multistate
multiyear

N

National Committee for Quality Assurance (NCQA)
nationwide
non-dually eligible
nonelderly
nongroup
nonlicensed
non-marketplace
non-palliative care
nonpartisan
nonphysician
nonpreferred
non-primary
nonprofit (not not-for-profit)
non-specialty mental health services
number one, number one–rated (note en dash)
nurse-midwife (sing.), nurse-midwives (pl.)
nurse practitioner (an NP)

O

ob/gyn (title case form: Ob/Gyn)
Office of Statewide Health Planning and Development (avoid, now Department of Health Care Access and Information (HCAI))
Office of the National Coordinator for Health Information Technology (ONC)
online
on-site (adj. and adv.)
opioid-dependent, frequent [ED or services] user (not frequent user or high utilizer/user)
opioid treatment program
opioid use disorder
osteopathic medicine (not osteopathy)
osteopathic physician (not osteopath or osteopathic doctor)
out-of-network (adj.), out of network (adv.)
out-of-pocket (adj.), out of pocket (adv.)

P–Po

PACE (Program of All-Inclusive Care for the Elderly)
Pacific Business Group on Health (avoid; now Purchaser Business Group on Health)
Partnership HealthPlan of California (note capped P, no space in HealthPlan)
part time (n.), part-time (adj. and adv.)
PATH CITED
patient-centered medical home
payer (not payor)
pay for performance (n.), pay-for-performance (adj.) (P4P)
paywall
peer support specialist (PSS, PSSs)
per-member per-month or per-person per-month (adj.)
per member per month or per person per month (adv.)
persons (avoid, use people, populations, enrollees, members, those, or the like)
per user per month (avoid per utilizer per month)
pharmacological (not pharmacologic)
physician assistant
Physician Orders for Life-Sustaining Treatment (POLST)
platinum (ACA plan level)
policyholder
policymaker
policymaking
population health management (concept)
Population Health Management (CalAIM program)
populations of focus
pop-up (n. and adj.)
postacute
postdischarge
posthospital

Pr–Pu

preadmission
pre-authorization
preexisting
pre-hospital
prelicense
prelicensure
prepandemic
Prescription Drug Monitoring Program (PDMP)
preventive (not preventative)
primary care, primary care physician (no hyphen even as adj.)
Primary Care Health Professional Shortage Area (HPSA)
program (not program area)
program-related (adj.)
Project Homekey
Project Roomkey
promotor (sing.), promotores (pl.)
prospective payment system (PPS)
psychiatric/mental health nurse practitioners
public health emergency
Public Housing Primary Care program

Q

qualified health plan
Quality Improvement Organization
quick reference guide

R

race/ethnicity
racial/ethnic group
RAND Corporation
readmission
real time (n.), real-time (adj.)
reengineer
reenroll
reexamine
regional center
Regional Model (Medi-Cal managed care)
rehospitalize
request for proposals (an RFP)
request for quotation (an RFQ)
residential care facilities for the elderly
road map
rollout (n.), roll out (v.)
routine care, signs, and symptoms
rulemaking
Rural Health Clinic

S

safety net (n.), safety-net patient (adj.)
Schedule I, Schedule II (drug)
scope of practice (n. and adj.)
Screening, Brief Intervention, and Referral to Treatment (SBIRT) services
Section 1115 waiver
seniors and people with disabilities (not persons)
serious emotional disturbance (a SED)
serious mental illness (a SMI)
shared savings (n. and adj.)
share of cost (a SOC)
shelter-in-place (n. and adj.), shelter in place (v.)
sign-up (n. and adj.), sign up (v.)
silver (ACA plan level)
skilled nursing facility (SNF, pronounced “sniff” so a SNF)
small-employer (adj.)
smartphone
social determinants of health (SDOH)
specialty mental health services
spring (season)
stage I, stage II (cancer)
stakeholder
stand-alone
start-up (n. and adj.)
state exchanges
State Plan, State Plan Amendment (a SPA)
statewide
US Substance Abuse and Mental Health Services Administration (SAMHSA)
substance use disorder (an SUD)
summer
systemwide

T

takeaway
take-up (n.), take up (v.)
Targeted Case Management
task force
Teaching Health Center
telehealth
televisit
time frame
timeline
time span
toolkit
topline (n. or adj.)
trade-off (n.), trade off (v.)
transgender on first use; transgender or trans thereafter
treatment authorization request
triple aim
Two-Plan Model (Medi-Cal managed care)
type 1, type 2 diabetes (7.96)

U

UC campuses: UCLA, UCSF, UC Berkeley (other campuses spelled out on first mention, with commas before and after city when used alone, but University of California Davis School of Medicine; in lists, use consistent format)
underserved
up-front (adj.), up front (adv.)
up-to-date
the Urban Institute
US

V

value-based payment
versus (spell out in running text; vs. can be used in tables, heads, etc.; use v. for legal cases)
Veterans Administration (avoid except for historical references; use US Department of Veterans Affairs)
voicemail

W

web (7.85)
webinar
web page (7.85)
website (7.85)
well-being
whole-person care (health care concept)
Whole Person Care Pilot program, WPC pilots (DHCP program)
winter
workers’ compensation insurance
workflow
workgroup
workplace (n. and adj.)
workspace

X

x-ray (n. and adj.)
X-waiver (DEA license)

Y

year-end (n. and adj.)
yearlong
year-round

Z

zip code
zip file