Run Chart Audit for Tobacco Use Screening and Cessation Intervention — Free

Audit Scope and Patient Eligibility

Patient age is 12 years or older on the date of service critical (required)

Verify the patient met the age threshold for the measure at the time of the encounter.

Yes No N/A

Encounter falls within the audit period and is a qualifying visit critical (required)

Confirm the chart contains a qualifying encounter within the selected reporting period.

Yes No N/A

Chart contains sufficient documentation to evaluate tobacco screening

The record should include enough clinical documentation to determine whether screening and intervention were completed.

Yes No N/A

Audit reviewer notes

Optional notes about chart selection, exclusions, or documentation limitations.

Tobacco Use Screening Documentation

Tobacco use screening documented during the encounter critical (required)

The chart should show that tobacco use status was assessed during the visit.

Yes No N/A

Screening result documented as current user, former user, or never user critical (required)

Select the documented tobacco use status from the chart.

Screening method or source is documented

Examples include intake questionnaire, nursing assessment, rooming note, or provider documentation.

Yes No N/A

Date and location of screening are documented

Verify the chart identifies when and where the screening occurred.

Yes No N/A

Cessation Intervention for Identified Tobacco Users

Patient identified as a current tobacco user critical (required)

This item determines whether cessation intervention is required for the chart.

Yes No N/A

Brief counseling or cessation advice documented critical (required)

Verify the chart documents advice to quit tobacco use or brief cessation counseling.

Yes No N/A

Cessation medication, referral, or quitline resource documented

Select all cessation interventions documented in the chart.

Follow-up plan for tobacco cessation documented

Confirm the chart includes a follow-up plan, reassessment, or next-step counseling related to tobacco cessation.

Yes No N/A

Intervention documentation is attributable to a licensed clinician or authorized staff member

Verify the intervention note is signed or clearly attributable to the appropriate staff role.

Yes No N/A

Audit Findings and Corrective Action

Deficiency identified in screening documentation

Mark yes if the chart is missing or incomplete for tobacco screening documentation.

Yes No N/A

Deficiency identified in cessation intervention documentation

Mark yes if a current tobacco user did not have documented cessation intervention.

Yes No N/A

Corrective action needed

Select the follow-up action required to address any audit findings.

Reviewer comments and evidence summary

Summarize key evidence, deficiencies, and any relevant chart references.

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Run: Chart Audit for Tobacco Use Screening and Cessation Intervention

Audit Scope and Patient Eligibility

Tobacco Use Screening Documentation

Cessation Intervention for Identified Tobacco Users

Audit Findings and Corrective Action

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