Run Rural Health Clinic Annual Program Evaluation Inspection — Free

Inspection Details

Evaluation date recorded critical (required)

Note (optional)

Clinic name and location documented critical (required)

Evaluator name and role documented critical (required)

Evaluation scope includes utilization, records review, and policy review critical (required)

Yes No N/A

Utilization Review

Patient visit volume reviewed for the evaluation period critical (required)

Review total visits, new vs. established patients, and monthly trends.

Yes No N/A

Provider utilization patterns reviewed

Assess scheduling patterns, appointment access, and staffing alignment.

Yes No N/A

Unmet demand or access barriers identified and addressed

Yes No N/A

Utilization summary includes trends and action items critical (required)

Yes No N/A

Medical Records Review

Sample size and selection method documented critical (required)

Document number of records reviewed and how records were selected.

Required documentation elements present in sampled records critical (required)

Check for date, provider signature, diagnosis, treatment plan, and follow-up as applicable.

Yes No N/A

Records show timely completion and authentication critical (required)

Yes No N/A

Deficiencies in documentation identified and tracked

Yes No N/A

Medical record confidentiality and access controls reviewed critical (required)

Yes No N/A

Policies, Procedures, and Staff Roles

Policies and procedures reviewed for current year critical (required)

Yes No N/A

Policy updates reflect current operations and regulatory requirements critical (required)

Yes No N/A

Staff roles and responsibilities are documented

Yes No N/A

Training or competency gaps identified

Yes No N/A

Policy revision log or approval record attached

Yes No N/A

Safety, OSHA, and Fire-Life-Safety Walkthrough

Emergency exits are unobstructed and clearly marked critical (required)

Yes No N/A

Fire extinguishers are accessible, mounted, and within inspection date critical (required)

Yes No N/A

Hazard communication labels and SDS access are available critical (required)

Yes No N/A

PPE availability matches identified hazards

Yes No N/A

Electrical and general housekeeping hazards identified

Yes No N/A

Findings, Corrective Actions, and Approval

Deficiencies and non-conformances documented critical (required)

Corrective action plan assigned with owner and due date critical (required)

Follow-up review date scheduled

Note (optional)

Inspector signature captured critical (required)

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Run: Rural Health Clinic Annual Program Evaluation Inspection

Inspection Details

Utilization Review

Medical Records Review

Policies, Procedures, and Staff Roles

Safety, OSHA, and Fire-Life-Safety Walkthrough

Findings, Corrective Actions, and Approval

Get your results