Internal Mental Health Private Practice Audit Checklist

Does the client have informed consent on practices?

Does the client have authorization of release form signed?

Does the client have payment authorization on file?

Does the client have identification on file?

Does the client have history form on file?

Does the client have client information form on file?

Does the client have client contacts form on file?

Does the client have identification on file?

Does the client have intake form on file?

Does the client have credit card authorization form on file?

Does the client have policies and services agreement form on file?

Does the client have hippa agreement form on file?

Does the client have client insurance form on file?

Does the client have insurance cards front and back on file?

Does the client have telehealth consent form on file?

Does the client have prescriptions on file?

If the client is a minor; does the file have photo of the minor?

If the client is a minor; does the file have legal guardian's identification?

If the client is a minor with separated/divorced etc.; Is there a Custodial Agreement form - Joint, Legal and Custodial on file?

Does the chart have written consent to discuss matters on behalf of the client?

Does Clinician have consultation note on file?

Does Clinician have intake note on file?

Does Clinician have treatment plan on file?

Does treatment plan have at least 3 objectives?

Does treatment plan have at least 3 goals?

Is there a termination note if applicable?

Does intake note have diagnosis and justification?

Does progressnote have diagnosis and justification?