Information
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Audit Title
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Document No.
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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
1.0 Key Rounding Questions
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1.1 What is going well today?
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1.2 What could we be doing better?
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1.3 Do you have the tools and equipment you need to do your job?
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1.4 Are the clinical team members and providers aware of the Chaperone Policy?
2.0 Outer Building Appearance
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2.1 Are the hours of operation posted?
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2.2 Are hedges neatly trimmed around the building?
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2.3 Are the flower beds neat and free of trash and debris?
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2.4 Does the building need to be pressure washed?
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2.5 Are the tobacco free signs posted for the public to see?
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2.6 Are all signs appropriate and in good condition?
3.0 Patient Waiting Area
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3.1 Are the Notice of Privacy Practice booklets available for patients?
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3.2 Are the CHSI and SGHS pamphlets displayed in a brochure rack?
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3.3 Is there a hand sanitizer with drip tray in waiting area?
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3.4 Is the patient waiting area clean and free of clutter?
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3.5 Is the television turned to an appropriate channel?
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3.6 Is the Missed Appointment Policy displayed for patient review?
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3.7 The Patient Bill of Rights with the HIPPA contact is posted in plain view for patients?
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3.8 Are there drug company pamphlets and/or advertisements in the waiting area?
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3.9 Does the practice have a clock in the patient waiting area?
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3.10 The "No Cell Phone" or "Silence Your Cell Phone" sign is posted in patient waiting area?
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3.11 The "Co-Payment is Due at the Time of Service" sign is posted at patient check-in?
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3.12 Are magazine subscriptions out of date?
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3.13 Is the furniture in good repair?
4.0 Reception Area
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4.1 Are team members wearing identification badges?
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4.2 Are signs and notices taped to the glass or walls?
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4.3 Is the approved Return Check notice affixed to window?
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4.4 Are team members aware of prompt pay discount? Employee discount?
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4.5 Are patients greeted promptly and cheerfully?
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4.6 Are team members familiar with the Financial Assistance program for self pay patients?
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4.7 Are patients notified appropriately of provider delays?
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4.8 Is there a patient sign-in sheet available?
5.0 Patient Exam Rooms
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5.1 Are there locks on the exam room doors?
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5.2 Are the walls / floors scuffed and dirty?
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5.3 Are there signs taped to the walls in the exam rooms?
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5.4 Are there clocks in the exam rooms?
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5.5 Are the equipment and furniture in good repair?
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5.6 Are the exam rooms stocked with supplies?
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5.7 Do the exam rooms appear to be clean and clutter free?
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5.8 Are there Sharps Containers in each exam room?
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5.9 Are the Sharps Containers full?
6.0 Nurses Station and Hallways
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6.1 Are computer screens turned away from patient view?
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6.2 Food at workstations?
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6.3 Are clinicians dressed in appropriate uniforms? Are scrubs neat and clean?
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6.4 Are team members wearing identification badges?
7.0 Bathrooms
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7.1 Are bathrooms cleaned and stocked?
8.0 Other
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8.1 Are team members familiar with MSDS?
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8.2 Is Team Talk posted in break room?
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8.3 Is the correct Emergency Response poster posted for team members?
