Security and PHI Control

Security and PHI Control

Is the medical office secure?

Additional Comments

What type of security is in place for the medical office?

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Are keys used? If keys are used to access the Med Office, who has copies?

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Is there a paper shredder on site?

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Are all PHI documents removed and stored at the end of the work day? If yes, where are they stored (i.e. locked file cabinet)?

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Is the paper shredder used for destruction of the PHI that is not needed?

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Is the laptop or desktop computer secured at night?

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Is the laptop or desktop computer encrypted?

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Does the Medtech person have a current Hippa certificate?

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Is the laptop or desktop computer encrypted?

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Personal Certifications and Training

Personal Certifications and Training

Does the provider have a current EMT Card on their person? If so, Date of Expiration?

Additional Comments.

Does the provider have a current OSHA 10 card on their person? If so, Date of Expiration?

Additional Comments.

Does the provider have a current CPR Card on their person? If so, Date of Expiration?

Additional Comments.

List any other certification cards

Are these certifications entered into Sugar CRM and, subsequently, is HR made aware?

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Provider Appearance

Provider Appearance

Does the provider present neatly?

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Does the providers attire appear neat and professional?

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Is the provider wearing appropriate Medtech shirt or vest?

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Is the provider wearing competitor (of Client or of Medtech) apparel?

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Is the provider wearing appropriate PPE?

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Does the provider need replacement PPE?

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Medical Facility Exterior Appearance

Medical Facility Exterior Appearance

If in a trailer, is the exterior of the trailer clean and free of debris around it?

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Is the entrance way free of obstructions and staged materials?

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Is there identifying signage for the clinic posted on the exterior?

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Is the signage professional in appearance and clearly readable?

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Is there adequate lighting in the outside entrance area?

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Medical Facility Interior Appearance

Medical Facility Interior Appearance

Upon entering the Medical Trailer or Facility, does it appear professional?

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Is the floor surface clean and free of debris?

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Is the garbage receptacle clean and not over flowing?

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Is the regulated waste stored as per stericycle guidelines?

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Are personal effects and items stored properly?

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Is the exam table clean and papered?

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Are the microwave and refrigerator clean and in good repair?

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Are the medicine storage shelves clean, neat and organized?

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Are counter tops and or desktops free of debris, old food stuffs, wrappers etc.?

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Is the daily cleaning checklist being utilized?

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Is there an adequate supply of appropriate cleaning products on hand?

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MedTech Paperwork

MedTech Paperwork

Is there a digital copy of the MedTech protocols onsite?

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Are signatures being obtained on all PCR’s?

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Are PCR’s being fully completed?

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Are signatures being obtained on Hippa release forms?

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Are signatures being obtained on all RMA’s?

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Is the trauma bag check list being followed?

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Is the medication checklist being utilized?

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Are expired medications disposed of properly?

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Are copies of supply orders onsite?

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Is a digital copy of the TSC Field Manual available on site?

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Is a site specific operations manual on-site?

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Is all client related reports being completed in timely manner?

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Is the provider's daily log being completed?

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Are patient follow-up notes being properly recorded?

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Is the trauma bag checklist being used?

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Are patient return-to-work notes being obtained and filed?

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As per the PCR is treatment or referral in accordance with protocol?

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Signature

TSC
TSC Field Personnel Signature
Date and Time
Client

Client Representative Name

Client Representative Title

Client Representative Email

Client Representative Signature
Date and Time
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.