Attachment_2_-_Ongoing_Provider_Performance_Evaluation_review_form.xlsx

XLSX spreadsheet 14 KB Posted

Attached to
Memphis Ortho Surgery Svcs - Base Plus 4 OYs Federal contract opportunity
Solicitation number
36C24919R0005
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9

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36C24919R0005 Attachment 2 - Ongoing Provider Performance Evaluation review form.xlsx

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Other files attached to Memphis Ortho Surgery Svcs - Base Plus 4 OYs, newest first.
File Type Posted
36C24919R0005_0002.docx DOCX document
36C24919R0005_0001.docx DOCX document
Attachment_3_-_Ortho_Contractor_Rules_of_Behavior.docx DOCX document
Attachment_1_-_QASP.docx DOCX document
36C24919R0005.docx DOCX document
Attachment_5-_Ortho_Contractor_Cert_of_Immigration.docx DOCX document
Attachment_6_-_Ortho_Past_Performance_Questionnaire.docx DOCX document
Attachment_4_-_Ortho_VHA_COMMITMENT_OF_UNDERSTANDING.docx DOCX document
36C24919R0005_1.docx DOCX document

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review form

36C24919R0005 ATTACHMENT 2 - CLINICAL CARE AND DOCUMENTATION REVIEW
Provider ---Excellent = 65 - 75
ReviewerGood - 55 - 64
Date:______________________________________Feb-17Unsatisfactory 54 or less
ED Evaluation NoteChart # 1Chart # 2Chart # 3Chart # 4Chart # 5
Patient ID
Date of Note
YESNOYESNOYESNOYESNOYESNO
1Reason for visit documented
2appropriate documentation for complaint
3appropriate ancillary studies (labs/Imaging)
4procedures acceptable to complaint and documented
5assessment appropriate to presenting complaint
6treatment plans consistent with findings and complaint
7medication mangement appropriate
8encounter form completed
9discharge instructions provided
10documentation completed timely and with no unauthorized abbreviations noted in review of notes
11follows accepted management guidelines for standards of care
12hospital admission within 3 days of ED visit (if yes, must answer # 13)
13was this admission clinically related to the ED visit as shown in # 12
14meets admission criteria >80% (to be completed by AO)
15EDIS - meets all EDIS adoption/reliability metrics (to be completed by AO)
SCORES (to be completed by AO)
Remarks

Sheet2

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