Chart Audit for Cervical Cancer Screening Measure

Chart review template to verify whether women ages 21 to 64 received cervical cancer screening consistent with the measure: cervical cytology within 3 years, or HPV testing within 5 years for ages 30 to 64, with age-appropriate exceptions documented.

Audit Setup and Patient Eligibility

• Patient is within the eligible age range for the measure
  Verify the patient is a woman age 21 through 64 on the measurement date.
• Measurement period and chart reviewed are documented
  Confirm the audit includes the correct measurement period and the chart review date or encounter date used for the determination.
• Eligible screening denominator status confirmed
  Confirm the chart supports inclusion in the screening denominator, including active patient status or qualifying encounter per local measure rules.
• Relevant exclusions or exclusions screening completed
  Check for documented exclusions such as total hysterectomy with no cervix, cervical cancer history, or other measure-specific exclusions.
• Source documents available in chart
  Confirm the chart contains source documentation such as lab results, pathology reports, outside records, or scanned reports supporting the screening status.

Cervical Cytology (Pap Test) Review

• Most recent cervical cytology date identified
  Record the date of the most recent Pap test or cervical cytology result found in the chart.
• Cervical cytology performed within the last 3 years
  Verify cervical cytology was completed within 3 years of the measurement date, if this is the qualifying screening method.
• Cytology result is documented and interpretable
  Confirm the result is present in the chart and can be interpreted as a completed screening test, not merely an order or referral.
• Pap test source is from a valid clinical record
  Confirm the result came from a lab report, pathology report, or other acceptable clinical documentation rather than patient recall alone.
• Cytology interval exception documented when not current
  If the Pap test is outside the 3-year interval, document whether a valid exception or alternate qualifying screening method applies.

HPV Testing and Co-Testing Review

• Patient age supports HPV-based screening pathway
  Verify the patient is age 30 through 64 if HPV testing or co-testing is being used to satisfy the measure.
• Most recent HPV test date identified
  Record the date of the most recent HPV test or co-test result found in the chart.
• HPV testing performed within the last 5 years
  Verify HPV testing was completed within 5 years of the measurement date for patients age 30 through 64.
• Co-testing result documented when applicable
  If co-testing was performed, confirm both cervical cytology and HPV results are documented in the chart.
• HPV result is from an acceptable clinical source
  Confirm the HPV result is supported by a lab report, pathology report, or other acceptable clinical documentation.

Measure Determination and Documentation Quality

• Measure is met based on reviewed evidence
  Determine whether the chart supports compliance through cervical cytology within 3 years or HPV testing within 5 years for eligible patients.
• Documentation clearly supports the final audit conclusion
  Confirm the chart contains enough detail to support the pass/fail decision without relying on assumptions.
• Deficiency or non-conformance noted when applicable
  If the measure is not met, document the specific deficiency, such as missing date, outdated screening, absent result, or unsupported exclusion.

Audit Summary and Sign-Off

• Final audit outcome recorded
  Record whether the chart passes, fails, or requires follow-up based on the evidence reviewed.
• Corrective action or follow-up plan documented
  If deficiencies were found, document the follow-up action, responsible owner, and target completion date.
• Inspector notes and sign-off completed
  Enter any final notes and the reviewer name or electronic sign-off if required by local workflow.