Which of the following is true about collection notes?

The correct statement about collection notes is that they can only be changed before filing. This emphasizes the importance of finality in the documentation process once the notes are officially filed. The integrity and accuracy of records are crucial in many settings, especially in healthcare and financial documentation. Once collection notes are filed, they often enter a formal record-keeping system where alterations may not be permissible, ensuring accountability and traceability in the documentation.

In contrast, the other choices misrepresent the nature of collection notes. While confidentiality is important, it's not an absolute requirement that applies to every situation, depending on specific regulations and policies in place. The idea that they can be amended at any time is misleading because once filed, they are generally stable entries. Lastly, the notion that they are automatically updated does not reflect the reality of how documentation is managed; updates require deliberate action often governed by established procedures.