To answer your writing and editing questions, consult these resources in this order:
- This style sheet
- Chicago Manual of Style, 17th ed. (Numbers in parentheses link to CMOS Online.)
- Merriam-Webster Collegiate Dictionary, 11th ed. (herein M-W)
- The Indigo Book, for legal citations
Table of Contents
Abbreviations, Acronyms, Initialisms | Academic Degrees | Ages | Almanacs | Authorship
Capitalization | Citations and References | Company Names | Composition Titles
Illustrations (tables and figures) | Internet, Web
Names | Numbers
Page Numbers, Chapters, and the Like | Percentages | Places | Punctuation and Spacing
Race/Ethnicity | Rankings
Abbreviations, Acronyms, Initialisms
If a term or an organization’s name will be used more than once, spell it out the first time, followed by its abbreviation in parentheses. Afterward, use the abbreviation (10.3, 10.24, 10.26) in text and heads.
I work at the California Health Care Foundation (CHCF). The CHCF office is in Oakland.
But treat an executive summary or a sidebar as an independent document for purposes of abbreviations.
Rewrite to avoid making an acronym possessive, but if a phrase is introduced in the plural, write its acronym in the plural: Health Maintenance Organizations (HMOs).
Omit internal punctuation (10.20) with academic degrees (MD, MS, PhD, RN) and generally do not use other credentials (CMT, FACP, etc.) unless important to topic of report.
an eight-year-old boy
six- to 12-year-old kids
people age 65 (not aged)
65 or older
five years old
age 65+ or >65 (okay in graphics)
Spell out terms in titles only if space allows. If an abbreviated term is used in the sidebar, define the term there. Even if a term is defined in the sidebar, if it’s abbreviated in the chart, also define it in the footnotes.
For data gathered through unadjusted sources, such as CHIS or CPS (but not CalSIM or enrollment data from administrative agencies such as DHCS), to each applicable chart page add this note:
The survey data used in this chart rely on self-reported insurance status. See the Methods / About the Data section elsewhere in this report for a full explanation of how this could impact findings.
Also, to the Methods / About the Data section add this note:
The survey data used in this publication rely on self-reported insurance status. When asked by survey researchers about health coverage, some undocumented immigrants who have restricted-scope Medi-Cal may respond that they have Medi-Cal coverage. Restricted-scope Medi-Cal, which covers only emergency and pregnancy-related services, is not comprehensive coverage. If these undocumented adults reporting Medi-Cal were instead considered uninsured, the number of Californians without insurance would be higher.
On 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
Any brief, factual description (up to 50 words) should not be promotional in tone.
To avoid gender bias, use these strategies (5.252):
- If possible, rewrite to avoid him and her, or recast in the plural: a doctor must wash his hands often becomes doctors must wash their hands often.
- Use nonsexist words instead of “man” words: people not mankind, chair not chairman.
When referring to someone with a disease, emphasize the person, not the disease (5.260): a patient with diabetes (preferred) or a diabetic patient. Never employ as a noun: diabetics, schizophrenics, or the like.
Capitalize generic terms as part of proper names, but lowercase them in references (8.51, 8.66, 8.68): 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 (8.154).
Use these guidelines for headings and the titles of books, journals, articles, etc. (8.159).
- 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 the conjunctions and, but, for, nor, and or.
- Lowercase to as a preposition and as an infinitive (to Examine); lowercase as.
- For hyphenated words (8.161), capitalize both elements: Follow-Up Report.
- Lowercase words in parentheses.
Citations and References
For citations, use endnotes, not footnotes (except in almanacs and when necessary in sidebars). Apply arabic numbering (1, 2, 3) and use Microsoft Word’s Reference feature, which will number notes automatically.
All endnote numbers should be superscripted and usually follow the sentence’s final punctuation.
Use italics for report titles and any landing pages; use roman type and quotation marks for other kinds of web pages.
When citing a table within a document, specify the table number but omit its title: “Table 34B,” in Medi-Cal Enrollment by State, DHCS, Sept. 2018.
Use Digital Object Identifiers (DOIs) whenever available (14.8), mostly for some journal articles. Use them both in External Links and in reports. In notes, append “doi” with a colon and the DOI, with no intervening space: doi:10.28530/fj05472g. For links, use this format: https://dx.doi.org/[DOI] (https://dx.doi.org/10.28530/fj05472g).
For help with legal citations, consult The Indigo Book.
The numbered examples below are of primary notes and subsequent references to the same notes. Consult Chapter 14 of CMOS for detailed coverage and extensive examples, and the Chicago-Style Citation Quick Guide and 14.23 for brief examples.
Blog entry (14.205–8)
- Robert Poser, “Doctors Find New Treatment for Cataracts,” The Medicine Today Blog, September 10, 2011.
- Poser, “Doctors Find New Treatment.”
- Dan Forth, How Doctors Treat: A Survey (New York: Knopf, 1967), 48–52.
- Forth, How Doctors Treat, 87.
Two or three authors
- Ann Garth, Lee Woods, and Fred Smith, Nurse Reference, 2nd ed. (Stamford, CT: NPC, 2009), 241–302.
- Garth, Woods, and Smith, Nurse Reference, 122.
Four or more authors
- Faye Dunn et al., Therapist Field Guide (Waco, TX: Freud & Sons, 2000), 64–68.
- Dunn et al., Therapist Field Guide, 65.
Cochrane database article
- Nicholas Henschke et al., “Behavioral Treatment for Chronic Low-Back Pain,” Cochrane Database of Systematic Reviews 7 (2005): CD002014, doi:10.1002/14651858.CD002014.pub3.
Journal article (14.164–187)
Cap seasons that identify journal issues (14.171): Health Journal 14, no. 2 (Autumn 2017): 45–49.
- Jordan Futon, “Health Care in Rural Japan,” Asian Health 24, no. 3 (Spring 2011): 324.
- Futon, “Health Care,” 325–27.
- Glinda Lee and Dorothy Gale, “Health Care Costs Plummet in Oz,” Journal of Health Finances 15, no. 42 (2004): 54, accessed March 3, 2009, doi:10.5438/8795426.
- Lee and Gale, “Health Care Costs,” 56.
Lecture or paper presented at a conference (14.217)
- Rachel Adams, “The Ideal Aspirin Dosage for Blood Thinning” (paper presented at the annual meeting for the Society of Pharmacists, Fayetteville, Louisiana, April 21–24, 2001).
- Adams, “Ideal Aspirin Dosage.”
- Sarah Brooks (chief, Managed Care Quality and Monitoring Div., DHCS) to all Medi-Cal Managed Care Plans, all-plan letter 15-008, April 16, 2015, www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2015/APL15-008.pdf (PDF).
- Centers for Medicare & Medicaid Services (CMS), “Medicare Part D Overutilization Monitoring System (OMS) Summary,” press release, November 3, 2015, www.cms.gov.
- CMS, “Medicare Part D.”
Report, brochure, pamphlet (14.220)
- Weight Loss: Should I Have Laparoscopic Surgery? (Boston: Health Dialog, 2009).
- Weight Loss, Health Dialog.
- Chuck Babbage, Electronic Health Records (London: Analytical Press, 2000).
- Babbage, Electronic Health Records.
- All About Knee Replacement Surgery, University of Pittsburgh Hospitals, accessed March 18, 2011, www.uph.org/knee-replacement-surgery.html.
- Knee Replacement Surgery, Univ. of Pittsburgh Hospitals.
Avoid using multiple endnote numbers.1,2 Instead, use one endnote number, and separate multiple sources with semicolons: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.
Use the full name, including ampersands and abbreviations, but you usually may omit Inc., & Co., LLC, and the like (10.23): Merck not Merck & Co. Inc. If the context requires such specificity, omit any preceding comma (6.44): WeCare Health Plan Inc.
Use these guidelines for the titles of books, articles, websites, etc.
Initial the: An initial the in the title of a newspaper or periodical is lowercased (unless it begins a sentence) and not italicized (8.170): the New York Times.
Subtitles: Use a colon to separate a subtitle from a title (8.164): The Avocado Diet: Lose Weight and Help California’s Economy.
Websites, surveys, and databases
Capitalize, but do not italicize or surround with quotation marks (8.191):
This year, PubMed is expected to serve up a billion page views.
Surround the title of a web page with quotation marks (8.191):
Visit “2014 Postpartum Depression Survey Data” for more details.
See also Capitalization.
- Capitalize and spell out months in running text. In tables, notes, and the like, use three-letter abbreviations with periods (10.39): (November, Nov.).
- If no date is specified, do not use a comma after the month (6.38): March 2001.
- If a date is specified, use commas after both the date and the year (6.38): On April 2, 2001, the nurses met.
- Use ordinal numerals (9.31): June 30 not June 30th.
- Centuries: Spell out and hyphenate (9.32): the twenty-first century.
- Use apostrophes only to indicate missing numbers (9.33): the 1800s, the ’70s, the 1970s not the 70’s and not the 1970’s.
When explanatory footnotes are required, use these symbols in this order (14.49): * (asterisk), † (dagger), ‡ (double dagger). If more footnotes are needed, double the symbols: **, ††, ‡‡.
Spell out and hyphenate simple fractions as nouns, adjectives, and adverbs (9.14).
four-fifths of the doctors
a two-thirds majority
one and three-quarters
Singular subjects take singular verbs (one in four counties is rural; more than one in five participants is unmarried; two-thirds of the public says so); plural subjects take plural verbs (one-fourth of respondents say yes). With that or who, use a plural verb: California is one of five states that do fund GME programs.
Capitalize the full names of legislative and administrative bodies, bureaus, centers, departments, and offices (8.62), including US or California, where appropriate.
US Department of Health and Human Services
Centers for Disease Control and Prevention
the House, the Senate
California Department of Health Care Services (DHCS)
California Health and Human Services Agency (CHHS)
Office of Statewide Health Planning and Development (OSHPD)
California State Assembly
San Francisco Board of Supervisors
Adjectives derived from them and paraphrased references to them are usually not (8.62).
congressional but Congress
city council member
Lowercase certain generic governmental terms (8.65): administration, city hall, federal.
Lowercase state when used generically: the state of California.
Illustrations (Tables and Figures)
All illustrations require a title at top and a source notation at the bottom that includes the year. For flexibility, titles and sources are embedded into the HTML of the page and not embedded into the graphic itself.
Illustrations should be numbered continuously. Tables are numbered separately from other figures such as graphs and illustrations. Appendices are lettered. (Table 1, Table 2, Figure 1, Table 3, Figure 2. Appendices A, B, C.) A table or figure within an appendix includes the appendix’s letter (Table A1, Figure B1).
Notes for illustrations belong below the illustration and not in the endnotes. Illustration notes use these symbols in this order (3.79) (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 are separated from captions by periods, appendices by colons. Use title case for captions. Use terminal punctuation if at least most captions 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
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 (8.154).
iPads are growing more popular in hospitals.
eHealth sells thousands of items.
Capitalize a job title when it precedes a name: Vice President Barnes, Dean Gomez.
Jed Beam, president; the president
Jesus Gomez, dean of students; the dean
Governor Brown; the governor
Assemblymember Julio Jimenez; the assemblymember
Kim Chou, director of funding; the director
Use parallel construction for list items, whether in running text or as bulleted or vertical lists — all nouns or all verbs (6.127).
internists, general practitioners, and physician assistants
greet the patient, consult the chart, wash your hands, and examine the patient
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 (6.130).
Use closing punctuation only if the items are complete sentences (6.130).
In a numbered list, follow each numeral with a period and a capital letter (6.130).
Order these supplies weekly:
Every morning, perform these steps:
1. Boot your computer.
2. Log in.
3. Check your email.
Use the currency symbol and numerals (9.24): $21.09, $3 million.
Use periods and a space between initials (A. B. Cooper) but omit periods and spaces in names replaced by initials (10.12): JFK.
On first reference, use the 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].
See also Company Names.
When designating a range, use to if the second entity is not included and through if it is: 2011 to 2015 does not include 2015 whereas 2011 through 2015 does include 2015.
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.
- 86 respondents answered every question.
Use commas for numbers of four digits or more except page numbers, addresses, and years (9.54): 1,541 therapists agree but 23502 Cleaver Avenue.
Use spaces around equal signs, arithmetic operators, and the like (12.16): Adjusted patient days = total gross patient revenue / gross inpatient revenue x number of patient days.
In graphs and charts, use symbols to denote “less than,” “through,” “and above,” and the like: <18, 18–25, 26+.
Use an italicized capital N to represent population size, an italicized lowercase n to represent subpopulation size (3.85).
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 (3.78): (p <= .05).
The one in construction takes a singular verb, as one is the subject (one in four counties is rural; more than one in five participants is unmarried).
The one of construction takes a plural verb, as that or which is the subject (one of eight states that don’t dedicate funding).
Spell out and uppercase references to parts of a document, tables, figures, charts, appendices, and the like: Chapter 9, Section 2.38, Table 2, Figure 4, Appendix B. But lowercase references to pages: page 26.
Use numerals, except at the beginning of a sentence (unless it’s bulleted), and don’t hyphenate even in adjectival form. Use the percent symbol (%) throughout except at the beginning of a sentence (9.18); use less and more as modifiers.
Less than 35.6% responded.
Twenty-six percent of patients agreed.
The proportion of patients agreeing was 26%.
- 26% of patients agreed.
Use a singular verb if the noun is collective (40% of the electorate is Latino); use a plural verb if the noun is an ordinary plural (15% of participants are women).
In running text, spell out the names of states and of the country (10.27): California, United States (or US). In bibliographies, addresses, tables, etc., use two-letter postal abbreviations (10.27): CA, DC, and the 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 (8.51, 8.53): Alameda County, Marin and Napa Counties, Washington State, Southern California but southern Idaho.
Punctuation and Spacing
Capitalize a word that follows a colon only if it starts a complete thought (6.63).
Include these items: aspirin, gauze, and tape.
Here’s the reason: Many nurses wear soft-soled shoes.
For number ranges, use an en dash: 2004–2007, pp. 4–9.
Form an en dash in Word with Ctrl+Numpad minus.
Form an em dash with Ctrl+Alt+Numpad minus, and add a space before and after: Several sources — Health Affairs, TIME, and Newsweek.
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 (6.129): (1) California, (2) New York.
When making a parenthetical statement within another one, use brackets for the innermost set (6.99).
(For details, see Tyson  and Anderson .)
Use i.e. and e.g. only in parentheses, add periods, and follow with a comma (10.42): (i.e., this way).
Place question marks and exclamation marks inside only if they are part of the quotation (6.10).
“That’s what I thought,” she said.
“Respect”: my all-time favorite song.
“What did the doctor say?” he asked.
Did he say, “The doctor went home”?
Use these preferences unless dictated otherwise by the source material (8.38).
black people (not blacks)
Latino (referring to people of Latin American ancestry)
white people (not whites)
Unless the author or researcher makes a strong case otherwise, black and white are lowercased.
If African American is used by the source material or preferred by the subject, it should not be hyphenated even as an adjective.
Not all black people (i.e., those born outside the US) are African Americans. Let a subject’s preference or the source material determine which term is to be used. In a publication in which race is relevant and there is no stated preference, use black because it is an accurate description of race.
Use cardinal numbers (9.6): they came in 57th in the state.
Use AM or PM with a leading space (10.41) and time zone (but without Daylight/Standard designation): 8:00 AM (PT), 2:45 PM (PT).
Except in articles and blog posts, use the third person, avoiding I, we, and us: the institute found not we found.
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.
911 (phone number)
AB nnnn or SB nnnn (use a nonbreaking space, e.g., AB 5410)
accountable care organization
acute care (n. and adj.)
advance care planning
advance health care directive
African American (n. and adj.)
all-payer claims database (APCD)
Alternative Benefit Plan
ambulatory care–sensitive conditions (note en dash)
appendices (not appendixes)
application (or app)
back office (n.), back-office (adj.)
behavioral health (incl. mental health & addiction)
board certified (n.), board-certified (adj.)
brand name (n.), brand-name (adj.)
bronze (ACA plan level)
California Health Benefit Exchange
California Health Care Foundation (CHCF, the foundation)
Cal MediConnect Program
Centers for Medicare & Medicaid Services (note plurals and ampersand)
Children’s Health Initiative
chronic care (n. and adj.; in general, do not hyphenate modifiers of “care.”)
community health center
cost containment (n.), cost-containment (adj.)
cost sharing (n.), cost-sharing (adj.)
County Organized Health System (COHS)
critical access hospital
cutoff (n. and adj.), cut off (v.)
data (plural: data are) (5.250)
Delivery System Reform Incentive Payments (DSRIP)
designated public hospital
disproportionate share hospital
doctor of osteopathic medicine (not doctor of osteopathy)
Drug Medi-Cal Organized Delivery System (DMC-ODS)
DSM-IV, DSM-IV-TR, DSM-5
eConsult (brand name)
e-consult (generic term)
essential health benefits
exchange (when referring to CA’s exchange)
Federal Medical Assistance Percentage (FMAP)
federal poverty guidelines
federal poverty level
Federally Qualified Health Center
Federally Qualified Health Center Look-Alike
fee-for-service (n. and adj.)
follow-up (n. and adj.), follow up (v.)
front line (n.), frontline (adj.)
front office (n.), front-office (adj.)
Full Service Partnership
full time (n.), full-time (adj. and adv.)
gold (ACA plan level)
graduate medical education
handoff (n.), hand off (v.)
health care, health care plan (n. and adj.)
Health Homes Program (HPP)
health information exchange
Health Professional Shortage Area
health savings account
hospital fee program
independent medical review
independent practice association
individual(s) — avoid except when comparing to families or groups. Use person/people or patient(s), as appropriate.
in-home supports and services (IHSS)
in-person (adj.), in person (adv.)
La Clínica de la Raza (note accented i)
Latino (not Hispanic)
Level I, Level II trauma center
LGBTQ (not LGBT)
long-term care (n. and adj.)
Low Income Health Program
KFF (Kaiser Family Foundation) not Kaiser Family Foundation (KFF)
Medicaid and CHIP Payment and Access Commission (MACPAC)
“meaningful use” (use quotations marks for first instance)
Medi-Cal (always refer to Medicaid in California as Medi-Cal)
Medi-Cal 2020 waiver
Medi-Cal managed care
medical doctor (avoid — use doctor of medicine)
Medicare Part D
memorandums of understanding
mHealth (mobile health)
mindfulness-based stress reduction
morphine equivalent dose (avoid — use MME)
morphine milligram equivalents (MME)
nonprofit (not not-for-profit)
number one, number one–rated (use en dash)
ob/gyn (not OB/gyn or OB/GYN)
on-site (adj. and adv.)
opioid-dependent, frequent [ED or services] user (not frequent user or high utilizer/user)
opioid use disorder
osteopathic medicine (not osteopathy)
osteopathic physician (not osteopath or osteopathic doctor)
out of pocket (adv.), out-of-pocket (adj.)
part time (n.), part-time (adj. or adv.)
patient-centered medical home
payer (not payor)
pay for performance (n.), pay-for-performance (adj.) or P4P
persons — avoid except in SPDs. Use people or populations.
pharmacological (not pharmacologic)
Physician Orders for Life-Sustaining Treatment (POLST)
platinum (ACA plan level)
preventive (not preventative)
primary care, primary care physician (no hyphen even as adj.)
program (not program area)
psychiatric/mental health nurse practitioners
qualified health plan
real time (n.), real-time (adj.)
Rural Health Clinic
safety net, safety-net patient
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 persons with disabilities (not people)
silver (ACA plan level)
skilled nursing facility
SNF (skilled-nursing facility, pronounced “sniff” so a SNF)
specialty mental health services
stage I, stage II (cancer)
start-up (n. and adj.)
state exchanges, exchanges in general
substance use disorder (an SUD)
Targeted Case Management
Teaching Health Center
trade-off (n.), trade off (v.)
transgender on first use; transgender or trans thereafter
treatment authorization request
type 1, type 2 diabetes (7.89)
UC campuses: UCLA, UCSF, UC Berkeley (other campuses spelled out on first mention, with commas before and after city: The University of California, San Diego, has a nice campus; in lists, use consistent format for all.)
versus (spell out in running text, vs. can be used in tables, heads, etc., v. for legal cases)
web, the (7.80)
web page (7.80)
Whole Person Care Pilot program, WPC pilots (DHCP program)
whole-person care (health care concept)
workplace (n. and adj.)
x-ray (n. and adj.)
X-waiver (DEA license)