QAPI Program Utilization_Manual

AGENCY POLICY AND PROCEDURES ARE FOLLOWED IN FURNISHING SERVICES LOG CONTROL Quarter: 9 I 9 II 9 III 9 IV Year: ___________ Item Month 1__________ % Chart Reviewed Month 2__________ % Chart Reviewed Month 3__________ % Chart Reviewed % Compliance total Comments Sign Up Package Reviewed Assessment Reviewed Weekly Progress Notes Reviewed Service Provided: SN, Therapy, Aide, MSW Followed Policies, QA Standards Goals Met Recertification Documentation Discharge Documentation: Instruction, Non Coverage, Goals Reached Reporting Guidelines Coordination of Care, Case Conference Team Communication Physician Coordination Medication Regimen reviewed, Reconcilliated, verified Active Patient/Family Participation in POC Rights explained to patients Complaints, Grievance addressed Delivery on Time: Assessments, Notes Other: Comments: ____________________________________________________________________________ Report Completed by (Name/Title/Signature): ________________________________ Date:_________ 23