Information
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
Medication Administration FFAC (local)
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Principal designee for medication administration form completed and filed in Medication binder
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Permission forms from parent/MD completed and filed in Medication binder
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Medications organized and stored according to CFISD policy
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Epinephrine auto-injectors stored in unlocked cabinet marked "Emergency Medications"
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Permission for self-administration of medication completed and filed in appropriate binder
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Administration of medication is documented daily in electronic medical record (EMR)
Office Visit Documentation
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Thorough and appropriate documentation of assessment in narrative section of daily log entries
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Thorough and appropriate documentation of interventions in narrative section of daily log entries
Immunization Documentation
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Immunization compliance report is up to date (as medically possible)
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Immunization exemption certificates and MD letters are filed in Exemption binder and documented in EMR
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Documented parent/guardian notification of immunization requirements
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Documented notice to campus administration concerning immunization non-compliance
Screening
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Vision and hearing screening completed 120 days from student enrollment
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Spinal and Acanthosis Nigricans screening completed by Spring break
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Screening results documented in EMR
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Documented monthly biological calibration of audiometer
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Demonstrated knowledge of community assistance for vision exams including documented referrals when appropriate
Clinic Management
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Clinic is orderly and free of clutter
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Supplies are easily accessible
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Otoscope, pulse ox., thermometer, and sphygmometer are in working order
Substitute Notebook
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Organized according to CFISD guidelines found in health services handbook
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Updated with current campus specific information including substitute spare key location
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Current telephone lists with nearest campus RN phone numbers included
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Current campus Alert & Disability roster included
Special Services
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Documented campus staff health awareness education
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Documented transportation health awareness education
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Current IHPs for identified students
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Current orders (updated annually) for special procedures in appropriate binder
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Documented training for delegated procedures<br>
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Documented supervision of delegated procedures
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Principal UDCA delegation form signed and filed in Diabetes binder
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Documented UDCA training filed in Diabetes binder
Emergency Preparedness
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Evacuation plan in place
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Emergency trauma bag properly stocked and easily accessible
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Rolling cart to evacuate medications is easily accessible
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AED checklists current (inspected monthly)
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Documented evacuation training on file for 2 story campuses
Audit Results
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Is follow up audit necessary?
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When will follow up audit take place?
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Auditor's Signature
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Additional Remarks
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Campus Registered Nurse Signature