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REPORTCONTINUITYDOCUMENTDateReportRun: DateReportComplete: ReportTimeFrame: To PersonManagingReport: PeopleDoingAudit: TypeofReportUsed: Numerator: Denominator: Exclusions: DenominatorSampleSize: NumeratorSampleSize: UniverseSize: MethodofSampleSelection: PercentageCompliant: HEALTHCENTERGOAL: OUTCOMELASTYR: % TypeofReport: OtherNotes:

KeyForAudit ChecklistForReports

Agestillininclusionarygroup? Gendercorrectininclusionarygroup? Numberapproximatelyballpark? Exceptionsexcluded? Visitrequirementsconsidered/met? Deceasedpatientsexcluded? Includesallsites? Duplicates? Test/samplepatientsremoved?

QUALITYIMPROVEMENTEFFORTS

Policy Process PointofCareAlerts Documentation RetroactiveReporting InterventionHistory References

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