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Run: Chart Audit for Breast Cancer Screening Measure

Audit one chart against the UDS Breast Cancer Screening measure and document whether a qualifying mammogram is present within the 27-month lookback window. U...

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Audit Setup & Patient Identification

Auditor Name

Full name of the staff member conducting this chart audit.

Audit Date

Date on which this chart audit is being performed.

Measurement Period End Date

Enter the last day of the measurement period (typically December 31 of the measurement year). The 27-month lookback window is calculated from this date.

Note (optional)

Patient Record / Chart ID

Enter the de-identified patient record number or chart ID. Do NOT enter patient name or full date of birth in this field.

Site / Clinic Location

Name or code of the clinic site where the patient receives care.

Auditor has reviewed the measure specification (CMS0125v14 / UDS BCS) prior to beginning this audit

Confirm familiarity with the measure before proceeding. Reference: https://ecqi.healthit.gov/ecqm/ec/2026/cms0125v14

Yes No N/A

Patient Eligibility Verification

Patient sex recorded as female in the medical record critical (required)

The measure applies to patients with a recorded sex of female. Verify this is documented in the demographic record.

Yes No N/A

Patient age at end of measurement period critical (required)

Enter the patient's age as of the last day of the measurement period. Eligible range is 50–74 years (inclusive), per CMS0125v14 and NCQA BCS-E.

Patient was continuously enrolled / had at least one visit during the measurement period critical (required)

Confirm the patient had at least one qualifying visit or enrollment during the measurement period as required by the measure denominator criteria.

Yes No N/A

Exclusion: Bilateral mastectomy documented in the medical record critical (required)

If a history of bilateral mastectomy is documented, the patient is excluded from the denominator. Check problem list, surgical history, and procedure notes.

Yes No N/A

Exclusion reason (if applicable)

If the patient is excluded from the measure denominator, select the applicable exclusion reason.

Mammogram Documentation Review

Mammogram result or report is present in the medical record critical (required)

Confirm that at least one mammogram report, result, or documented order/referral with confirmed completion exists in the chart.

Yes No N/A

Photo evidence (optional)

Date of most recent mammogram on record critical (required)

Enter the date of the most recent mammogram documented in the chart. This date must fall within the 27-month lookback window.

Mammogram date falls within the 27-month lookback window critical (required)

Confirm the documented mammogram date is within 27 months prior to the measurement period end date, per CMS0125v14 and UDS BCS measure specifications.

Yes No N/A

Source of mammogram documentation

Select the source where the mammogram evidence was found in the chart.

Mammogram result / finding category documented

Is the mammogram result or BI-RADS category (or equivalent) documented in the record?

Yes No N/A

Additional notes on mammogram documentation

Record any clarifying details about the mammogram documentation, discrepancies found, or follow-up actions needed.

Measure Compliance Determination

Overall measure status for this chart critical (required)

Select the final compliance status for this patient record based on the audit findings.

Gap in care identified (patient due or overdue for mammogram)

If the numerator is not met and the patient remains eligible, flag this chart for outreach or care gap closure.

Yes No N/A

Recommended follow-up action

Select the recommended next step based on audit findings.

Auditor comments and findings summary

Summarize key findings, discrepancies, or actions taken during this chart review.

Auditor Sign-Off

All sections of this chart audit have been completed accurately and to the best of my knowledge critical (required)

Auditor attestation of completeness and accuracy.

Yes No N/A

Auditor Signature critical (required)

Electronic signature of the staff member who completed this chart audit.

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