UDS Patient Count Unduplication Reconciliation Worksheet

Worksheet to reconcile unduplicated patient counts across EHR, billing, and multiple sites for consistent UDS reporting.

Reconciliation Details

• Reporting Period Start Date
  Start date for the UDS reporting period.
• Reporting Period End Date
  End date for the UDS reporting period.
• Reporting Cycle
  Select the reconciliation cycle.
• Reconciliation Owner
  Name or team responsible for preparing the reconciliation.
• Submission Date
  Date the worksheet is completed and submitted.

Source Totals

• EHR Unduplicated Patient Count
  Aggregate unduplicated patient count from the EHR extract.
• Billing Unduplicated Patient Count
  Aggregate unduplicated patient count from the billing system.
• Multi-site Rollup Count
  Combined unduplicated count across all sites before duplicate adjustment.
• Primary Source of Truth
  Select the source used as the primary reference for reconciliation.
• Other Source Name
  Specify the alternate source used as the reference.

Duplicate Adjustment Review

• Duplicate Adjustment Count
  Number of duplicate records removed from the rollup or source total.
• Duplicate Driver Types
  Select all known causes contributing to duplicate counts.
• Other Duplicate Driver
  Describe any duplicate driver not listed above.
• Variance Reason Summary
  Briefly explain why the source totals differ and how the final adjustment was determined.

Final Count and Approval

• Final Unduplicated Patient Count
  Final reconciled unduplicated patient count to be used for UDS reporting.
• Count Verified Against Source Reports
  Confirm that the final count was checked against the source reports and supporting documentation.
• Reviewer Name
  Name of the reviewer completing approval.
• Review Date
  Date the reconciliation was reviewed.
• Approval Notes
  Optional notes from the reviewer, including any follow-up actions or exceptions.