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

This chart audit template checks whether patients with a new HIV diagnosis had documented linkage to care within 30 days. Use it to capture the diagnosis dat...

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Audit Scope and Patient Eligibility

Patient has a documented new HIV diagnosis date in the audit period critical (required)

Verify the record contains a clear date of HIV diagnosis or first confirmed positive HIV test that defines the start of the linkage window.

Yes No N/A

Diagnosis date is documented clearly enough to calculate the 30-day linkage window critical (required)

The chart should allow the reviewer to determine whether follow-up occurred within 30 days of diagnosis without ambiguity.

Yes No N/A

Patient is eligible for the linkage-to-care measure based on available chart information

Confirm there is no documentation indicating the patient should be excluded from the measure based on the program's measure specifications.

Yes No N/A

Audit period and chart identifier recorded

Document the audit period, chart number or encounter identifier, and reviewer notes needed for traceability.

Follow-Up Visit Within 30 Days

Follow-up HIV care visit occurred within 30 days of diagnosis critical (required)

Confirm at least one documented follow-up treatment, intake, or HIV care visit occurred on or before day 30 after diagnosis.

Yes No N/A

Date of first follow-up HIV care encounter critical (required)

Enter the date and time of the first documented follow-up encounter related to HIV care.

Note (optional)

Days from diagnosis to first follow-up encounter critical (required)

Calculate the number of days between diagnosis and the first HIV care follow-up.

Follow-up encounter type documented

Identify the type of encounter used to establish linkage to care.

Evidence of Treatment Linkage

HIV treatment plan, referral, or care linkage documented critical (required)

Verify the record includes evidence of treatment planning, referral completion, or linkage to an HIV care provider.

Yes No N/A

Antiretroviral therapy discussion or initiation documented

Check whether ART was discussed, prescribed, or initiated when clinically appropriate and documented in the chart.

Yes No N/A

Referral destination or receiving provider documented

Record the clinic, provider, or program to which the patient was linked for HIV care.

Evidence of appointment scheduled or completed

Document whether the chart shows a completed visit, scheduled appointment, or outreach-only attempt.

Documentation Quality and Exceptions

Documentation is sufficient to support the measure result critical (required)

The chart should contain enough evidence for a reviewer to determine pass or fail without inference.

Yes No N/A

Any barriers to linkage documented

Select any documented barriers that may have affected timely linkage to care.

Reviewer notes and corrective action recommendations

Summarize deficiencies, non-conformances, and recommended follow-up actions for care coordination or documentation improvement.

Final Determination

Chart meets HIV linkage-to-care within 30 days measure critical (required)

Final determination based on diagnosis date, follow-up timing, and documentation evidence.

Yes No N/A

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