Information
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Document No.
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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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Practice Name
- Alnwick
- Beeston
- Blackpool
- Cirencester
- Conisbrough
- Eastleigh
- Edinburgh
- East Park
- Garforth
- Gloucester
- Havant
- Huddersfield
- Hull
- Kiverton
- Leicester
- Market Weighton
- Marske
- Mexborough
- Middlesbrough 222
- Middlesbrough 226
- Morley
- Skelton
- Tickhill
- Whitley Bay
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Auditor / Compliance Manager
- Yes
- No
- N/A
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Cluster Manager
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PM Name
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PM Assistant Name
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Date of first visit
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Date of update visit/next visit
Practice Appearance & Patient Journey
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Disability access appropriate / free from blockages / pathway clear and even
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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NHS Charges posters clearly displayed and up to date
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
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Private fee scale clearly displayed
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Complaints procedure clearly displayed and up to date
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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NHS paperwork in use (FP17PR, FP17DC) and MH forms being updated rather than new for each patient
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Patient records available (duplicates not in use)
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
Staff
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Uniform clean and presentable
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Name badges worn/identification of team role
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
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Emergency drugs checked daily (time/date and signatures -2 checks inc. one clinician)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Check contents against list-all present /in date
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
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Oxygen cylinders full (gauge in green)
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
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Therapeutic/BVM masks available in adult/child sizes
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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DE Fib light green (Rescue Ready) or equivalent
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Pocket masks in each surgery and visible
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Training record of CPR with attendance list
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
Health & Safety - Radiation check
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Signage
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Use of rectangular collimators
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Procedural checks - patient
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Panels seen during exposure
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Local rules and Risk Assessment
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
Health & Safety - Sharps Avoidance
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Risk Assessment completed
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Use of re-sheathing device in absence of "safer sharp"
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Dentists managing sharps
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Occupational Health Advice notice clearly displayed
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Staff awareness of process
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Inoculation records seen
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
Fire Safety
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Fire exits clear
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Fire doors unlocked
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
Practice Audits
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IPS tool completed within last 6/12 (PM)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Radiation audits seen at least 12/12 (Dentists)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Record keeping audit in last 6/12 (PM)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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DBOH audit by dentist within 12/12 (Dentists)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Referral audit by PM within 6/12 (PM)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Prescription audit by PM within 6/12 (PM)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Recalls interval audit within 6/12 (Dentist)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Waiting times audit 6/12 (PM)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Missing Signage/ Certificates/ Leaflets
Cross Infection & Decontamination
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Decon log books completed appropriately
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Observation of procedure
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Staff awareness of process
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
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Clinical waste appropriately stored
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Sharps disposal appropriate (container/contents/position)
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
Clinical Records checked against FGDP (UK) Gold Standard
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Radiographs in line with FGDP (UK) guidelines
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Treatment planning and delivery meeting including choices
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Private treatment
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Claiming pattern
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Laboratory issues
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
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Complaints
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Comments & Actions
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Add media
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Responsible
-
Date to be completed
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Completed
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Communication
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Comments & Actions
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Add media
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Responsible
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Date to be completed
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Completed
Summary
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I fully understand the audit as completed the auditor.
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Practice Manager / Asst Practice Manager
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Auditor
