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Run: Chart Audit for HIV Linkage to Care Within 30 Days

Use this chart audit template to verify whether newly diagnosed HIV patients were linked to care within 30 days and whether the chart contains enough documen...

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Audit Setup and Patient Eligibility

Patient is newly diagnosed with HIV for the audit period critical (required)

Confirm the chart belongs to a patient with a new HIV diagnosis during the selected measurement period.

Yes No N/A

Diagnosis date is documented in the chart critical (required)

Record the HIV diagnosis date used for the measure.

Measurement period is documented and matches the audit scope

Document the audit measurement period used for this review.

Source documentation for diagnosis is present

Identify the chart source that supports the diagnosis date.

Yes No N/A

Linkage to Care Within 30 Days

First HIV follow-up visit occurred within 30 days of diagnosis critical (required)

Verify that the patient was seen for follow-up treatment within 30 days of the diagnosis date.

Yes No N/A

Date of first HIV follow-up visit is documented critical (required)

Record the first follow-up treatment visit date.

Follow-up visit type is documented

Identify the type of encounter used to establish linkage.

Evidence of treatment initiation or HIV care plan is present

Confirm the chart shows treatment initiation, referral completion, or a documented HIV care plan.

Yes No N/A

Referral or appointment scheduling documented

Verify that referral, appointment scheduling, or navigation support is documented.

Yes No N/A

Exceptions, Exclusions, and Barriers

Documented refusal of follow-up care

Identify whether the patient refused follow-up care.

Yes No N/A

Transfer of care or external linkage documented

Confirm whether the patient transferred care or linked externally.

Yes No N/A

Loss to follow-up or inability to contact documented

Verify whether the chart documents loss to follow-up or unsuccessful outreach.

Yes No N/A

Clinical or administrative exclusion documented

Capture any documented exclusion that affects measure inclusion.

Documentation Quality and Reporting Readiness

Chart documentation is internally consistent

Rate whether diagnosis date, follow-up date, and supporting notes are consistent across the chart.

Audit evidence is sufficient to support reporting

Confirm the chart contains enough evidence to support the audit result.

Yes No N/A

Corrective action needed for missing or unclear documentation

Indicate whether follow-up is needed to resolve documentation gaps.

Yes No N/A

Close-Out and Reviewer Sign-Off

Overall audit result critical (required)

Select the final audit outcome.

Reviewer comments

Summarize findings, deficiencies, and any follow-up actions.

Reviewer signature

Sign off on the completed audit.

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