MEDICAL AUDIT CHECK LIST (POST DISCHARGE)
Reg. No
Date
Particulars Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
1 Admission Paper :
Consent have writtent risk, benefits and alternatives
Informed Written Consent :
High risk Consent : (If Applicable)
Surgery/Procedure consent Consent : (If Appicable)
2 Aneathesia consent
Cath lab procedure consent
BT consent
Dialysis consent
Any other consent
Consent have SNDTR
Informed Written Consent :
High risk Consent : (If Applicable)
Surgery/Procedure consent Consent : (If Appicable)
Aneathesia consent
3
Cath lab procedure consent
BT consent
Dialysis consent
Any other consent
Surgery / procedure documents with SNDT of concern person
PRE OP Check list with diagnosis
Pre Op Anaesthesia Remarks & Investigation :
Procedure / Inj. / Opertion Notes:
Anaesthesia Notes with post op orders
4
Post Op Doctor's Progress Notes
PERFUSION DATA SHEET
Endoscopy surgical safety checklist with SNDTR of concern person
Surgical safety checklist OT/ CATH LAB Procedure with SNDTR of concern person
Anaesthesia aldert score
Medication Orders / Treatment Orders
Legible letter( Capital)
Mentioned Dose
5 Mentioned frequency
Mentioned route
Administration of nursing staff
5
SNDTR of doctor
Medical officer form
Progress note
Medication reconcilation form
6 Pain assessment sheet
Over sheet
PSYCHIATRY EVALUAION FORM
History sheet with SNDTR and traige code
7 Consutant note with SNDTR
Plan of care
Transfer Note : (If Applicable)
Transfer to the other hospital
Inter departmental transfer checklist Nurses
8
Inter departmental transfer checklist Doctor
Transfer to the other hospital
Transfer from one conultant to another
Discharge Summary
Signature of concerned personnel :
9
File movement record for patient to be discharged
Mentioned consition in case of emergency situation occur
Nursing note with SNDT of nurses
Nursing assessment form
Nursing Daiy sheet
Pain assessment sheet
10
EWS monitoring chart
Fall risk assessment
Nursing over
I/O chart
Other documents
ER assessment form with SNDTR and traige code
BT vital chart
Blood requisition form
Blood component sticker Record
CAUTI bundles checklist
VAP bundles checklist
CLABSI budles checklist
Bed sore form
SSI bundles checklist
11
Dialysis doctor order sheet
Dialysis vital chart
Cross referance form
Surgical safety checklist for bed side Procedurewith SNDTR of concern person
11
Patient counselling form
Rdiology Screening Form
Patient education form
ICU chart
DVT Assessment Form
Restrain chart with consent
Nutritional sheet
Nurtional screening form
12
Nutritional assessment
Nutritional reassement
Death Patient
13 Death summary
Death certificate
MLC patient
14 MLC intimation form with Discharge details
MLC patient assessment form
Physiotherapy
15 Physiotherapy assessment form
Physiotherapy reassessement form
16 Completeness of Medical Record :
17 All Pages Present (No Missing Pages) :
Signature of MRD person
MEDICAL AUDIT CHECK LIST (ACTIVE AUDIT)
Reg. No
Date
Particulars Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
1 Admission Paper :
Consent have writtent risk, benefits and alternatives
Informed Written Consent :
High risk Consent : (If Applicable)
Surgery/Procedure consent Consent : (If Appicable)
2 Aneathesia consent
Cath lab procedure consent
BT consent
Dialysis consent
Any other consent
Consent have SNDTR
Informed Written Consent :
High risk Consent : (If Applicable)
Surgery/Procedure consent Consent : (If Appicable)
Aneathesia consent
3
Cath lab procedure consent
BT consent
Dialysis consent
Any other consent
Surgery / procedure documents with SNDT of concern person
PRE OP Check list with diagnosis
Pre Op Anaesthesia Remarks & Investigation :
Procedure / Inj. / Opertion Notes:
Anaesthesia Notes with post op orders
4
Post Op Doctor's Progress Notes
PERFUSION DATA SHEET
Endoscopy surgical safety checklist with SNDTR of concern person
Surgical safety checklist OT/ CATH LAB Procedure with SNDTR of concern person
Anaesthesia aldert score
Medication Orders / Treatment Orders
Legible letter( Capital)
Mentioned Dose
5 Mentioned frequency
Mentioned route
Administration of nursing staff
5
SNDTR of doctor
Medical officer form
Progress note
Medication reconcilation form
6 Pain assessment sheet
Over sheet
PSYCHIATRY EVALUAION FORM
History sheet with SNDTR and traige code
7 Consutant note with SNDTR
Plan of care
Transfer Note : (If Applicable)
Transfer to the other hospital
Inter departmental transfer checklist Nurses
8
Inter departmental transfer checklist Doctor
Transfer to the other hospital
Transfer from one conultant to another
Discharge Summary
Signature of concerned personnel :
9
File movement record for patient to be discharged
Mentioned consition in case of emergency situation occur
Nursing note with SNDT of nurses
Nursing assessment form
Nursing Daiy sheet
Pain assessment sheet
10
EWS monitoring chart
Fall risk assessment
Nursing over
I/O chart
Other documents
ER assessment form with SNDTR and traige code
BT vital chart
Blood requisition form
Blood component sticker Record
CAUTI bundles checklist
VAP bundles checklist
CLABSI budles checklist
Bed sore form
SSI bundles checklist
11
Dialysis doctor order sheet
Dialysis vital chart
Cross referance form
Surgical safety checklist for bed side Procedurewith SNDTR of concern person
11
Patient counselling form
Rdiology Screening Form
Patient education form
ICU chart
DVT Assessment Form
Restrain chart with consent
Nutritional sheet
Nurtional screening form
12
Nutritional assessment
Nutritional reassement
Death Patient
13 Death summary
Death certificate
MLC patient
14 MLC intimation form with Discharge details
MLC patient assessment form
Physiotherapy
15 Physiotherapy assessment form
Physiotherapy reassessement form
16 Completeness of Medical Record :
17 All Pages Present (No Missing Pages) :
Signature of MRD person
