ICF Monthly Medical Audit
Park West Court Apartments
Email of person completing audit:
Staff name completing audit:
General Medical Checklist:
explanation of concern, action needed :
Check for expired medication?
Check for discontinued medications?
Meds properly stored?
Check MAR for any errors?
Check med cards for any errors?
Any other issues with medications noted?
Infection control monthly log complete?
Qtrly infection control, pharm, lab, xray mtg and notes complete?
Individual Checklist - Chart Review:
Explanation of concern; action needed
Annual Physical form present and current?
Annual assessment and IPP in place/CFA/ current?
Quarterly assessment IPP in place/CFA/current?
Current signed physician orders?
ALL labwork current per all follow-up orders?
Female: OB/GYN current screenings?
Monthly nursing summary current 12 months prior?
ALL x-ray/radio. current?
Qtrly Pharm review current?
Pharm review response current?
Qtrly psych review current?
Titration plan review current?
Medication consents current?
Medical care plan current?
Hospital log and records current?
Any other medical concerns?
Nursing notes present?
Dr. 60 day note/consult?
IPP done within 30 days of admission, including assessments?
TB test current?
Admission record present?
Skin issues - pictures, wound nurse notes, and follow-up present?
Chart organized and documents filed correctly?
Other notations or additional information for follow-up:
Should be Empty: