SAMPLE CHART AUDIT TOOL Based on missing …

SAMPLE CHART AUDIT TOOLB ased on missing JCAHO standards when random AUDIT conductedDate of AUDIT : _____Auditor: _____Audit response codes: Yes =X No = OElement/CriteriaMR#MR#MR#MR#Evidence of Resident/Patient rightsdiscussed and donor identification Assessment Tool Completed w/in24 hr of Assessment Tool Management Flow Sheetcompleted per Education FlowSheet Progress notes are dated CHART AUDIT TOOLB ased on critical documentation JCAHO standardsDate of AUDIT : _____Auditor: _____Audit response codes: Yes =X No = OJCAHO StandardMR#MR#MR#MR# Informed consent was Initial assessments are performed asdefined by the Development of a plan for care, treatment,and services is Plan of care is appropriate to the patient sneeds, strengths, limitations and Medication orders are written clearly andtranscribed Records contain patient-specificinformation to the care, treatment, and Improve the effectiveness ofcommunication among caregivers:MD orders are verified and noted as read back.

SAMPLE CHART AUDIT TOOL Based on critical documentation JCAHO standards Date of Audit: _____ Auditor: _____ Audit response codes: Yes =X No = O

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