Attachment 8 - ANP-RPT-6 INTRADEPARTMENTAL CONSULT FORM.pdf
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- Attached to
- NWI Offsite Pathology Services
- Solicitation number
- 36C26326R0063
About this file
This document is a template form for Quality Assurance Intradepartmental Consultations within the Surgical Pathology department of the Nebraska-Western Iowa Health Care System. The form is designated ANP-RPT-6 (version 1.0) and became effective March 3, 2017.
The form provides a structured framework for documenting pathology case reviews and consultations. It includes fields for the primary pathologist's identification, case number, and date of submission. The form requires documentation of primary opinions and questions requiring consultation. It accommodates two consultant reviews, each with designated sections for the consultant's name, date of review, materials reviewed, written opinion, and signature. The template is designed to facilitate quality assurance through peer review processes within the surgical pathology department, ensuring documented consultation and consensus on diagnostic or technical pathology matters.
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Text version
QUALITY ASSURANCE INTRADEPARTMENTAL CONSULTATIONS
SURGICAL PATHOLOGY
NEBRASKA-WESTERN IOWA HEALTH CARE SYSTEM
Primary Pathologist:
Case Number: Date:
Primary Opinions/Questions:
Consultant #1: Date of Review:
Materials Reviewed:
Opinion:
Signature:
Consultant #2: Date of Review:
Materials Reviewed:
Opinion:
Signature:
Approved and current. Effective starting 3/03/2017. ANP-RPT-6 (version 1.0) INTRADEPARTMENTAL CONSULT FORM
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