SAMPLE CHART AUDIT TOOL Based on missing JCAHO …

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

SAMPLE CHART AUDIT TOOL Based on missing JCAHO standards when random audit conducted Date of Audit: _____ Auditor: _____ Audit response codes: Yes =X No = O

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