36C25618R0078-009.docx

ATTACHMENT D3 - HOUMA

CBOC - LIST OF REPORTS AND DUE DATES

(Not all inclusive)

1. Licenses and Certifications (that expire within 30 Days).

2. Performance Improvement

a. Plan, Do, Check, Act (Performance Model) PI presentation

3. Patient Visit Reports

(a) # ER (by patient name, SSN, date, location of ER)

(b) Hospitalizations outside of SLVHCS - by patient Name, SSN, date, location of facility.

(c) Number and percentage of Scheduled Appointments that were “No Shows”

(d) Walk-in and Telephone Triage Logs

Daily Daily

Daily

Daily

Next Business day by 8 AM

SLVHCS Director’s Morning Report or as otherwise directed

4. Waiting Times

(a) Actual waiting time for Scheduled Appointments (Appointment time to time seen by provider – Minutes).

(b) Actual waiting time for Unscheduled Walk-in visit by enrollee (Time of clinic check-in to start of triage)

As Directed

COR

5. Staff Education Completed – By type of Training & number of hours

6. Patient Grievances – Number filed by name, SSN, date, description of complaint and resolution action Day of Receipt Entered into VA Patient Advocate Tracking Package// Monthly Summary

Monthly Or As Directed

Customer Service Manager

7. Patient Written Compliments – copies to be submitted Day of Receipt Entered into VA Patient Advocate Tracking Package// Monthly Summary

Monthly Or As Directed

Customer Service Manager

9. New patient listing: Name: (last, first middle), Full SSN (xxx-xx-xxxx) and date of first primary care vesting visit at the CBOC.

10. Listing of Annual Vesting visit: Name: (last, first middle), Full SSN (xxx-xx-xxxx) and date of visit.

11. Death of enrolled patient: Name, SSN, and date of death

12. Veteran disenrollment from the CBOC: Name, SSN and reason for disenrollment.

13. Competency assessment findings

(a) Provision of retraining for identified deficiencies;

(b) Reassessment following retraining;

(c) Performance evaluation aggregate data, by staff position.

Annual Annual Annual

14. Inspection Compliance - addressing

(a) Preventative Maintenance Inspections

(b) Safety/Environmental/Infection Control Inspections

Annual Annual

15. Environment of Care

(a) Updated listing of Material Safety Data Sheets

(b) Documentation of Disaster Drills

(c) Annual Compliance Report of Preventive Maintenance and Safety Inspections

(d) Documentation of Safety and Infection Control education and training

(e) Summation of Fire Drill Activities

(f) Documentation of Fire Suppression System testing and maintenance.

Annual Annual Annual

Annual

Quarterly Quarterly

Safety Manager and Chief, FMS

16. Infection Control Infection Control Reports

17. Radiology

(a) Equipment Maintenance

(b) Radiation Safety Inspection

(c) Competency Reports for Radiology Staff

Annual

Annual Annual

As Directed

Biomedical Engineering Radiation Safety Radiology AO