Rural Health Clinic Annual Program Evaluation Inspection

Annual Rural Health Clinic (RHC) program evaluation template for reviewing utilization, medical records, policies, staffing, and compliance with OSHA and NFPA-related safety requirements.

Inspection Details

• Evaluation date recorded
• Clinic name and location documented
• Evaluator name and role documented
• Evaluation scope includes utilization, records review, and policy review

Utilization Review

• Patient visit volume reviewed for the evaluation period
  Review total visits, new vs. established patients, and monthly trends.
• Provider utilization patterns reviewed
  Assess scheduling patterns, appointment access, and staffing alignment.
• Unmet demand or access barriers identified and addressed
• Utilization summary includes trends and action items

Medical Records Review

• Sample size and selection method documented
  Document number of records reviewed and how records were selected.
• Required documentation elements present in sampled records
  Check for date, provider signature, diagnosis, treatment plan, and follow-up as applicable.
• Records show timely completion and authentication
• Deficiencies in documentation identified and tracked
• Medical record confidentiality and access controls reviewed

Policies, Procedures, and Staff Roles

• Policies and procedures reviewed for current year
• Policy updates reflect current operations and regulatory requirements
• Staff roles and responsibilities are documented
• Training or competency gaps identified
• Policy revision log or approval record attached

Safety, OSHA, and Fire-Life-Safety Walkthrough

• Emergency exits are unobstructed and clearly marked
• Fire extinguishers are accessible, mounted, and within inspection date
• Hazard communication labels and SDS access are available
• PPE availability matches identified hazards
• Electrical and general housekeeping hazards identified

Findings, Corrective Actions, and Approval

• Deficiencies and non-conformances documented
• Corrective action plan assigned with owner and due date
• Follow-up review date scheduled
• Inspector signature captured