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THE JOURNAL OF THE AMERICAN BOARD OF FAMILY PRACTICE

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THE JOURNAL OF THE AMERICAN BOARD OF FAMILY PRACTICE

Peer Review Volunteer Form . Journal of the American Board of Family Medicine. Name, Academic Degrees: Email (preferred, then alternate, if any): Phone:

http://www.jabfm.org/site/misc/PeerReviewForm.doc

Date added: November 18, 2011 - Views: 43

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Should we include something about the Board Members need to ...

Vascular Laboratory. Peripheral Venous Peer Review. Reviewing Physician (Initials): Date of Completion: TECHNICAL REVIEW Criteria Study #1 Study #2 Type of Exam ...

http://www.intersocietal.org/vascular/forms/Peer_Review_QI_Form.doc

Date added: March 7, 2013 - Views: 11

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Peer Review Policy and Procedure/Hendricks Community Hospital ...

Medical Staff Peer Review Policy. Subject: Peer Review Activity. Policy: Review of circumstances as outlined in this policy will be conducted by a peer physician(s ...

http://www.hendricks.org/upload/docs/MedStaff/PeerReview.doc

Date added: October 13, 2011 - Views: 74

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Physician Peer Review in a Just Culture

Disruptive Physician Policy. Physician Peer Review. It is important to realize that Physician Peer Review does not replace the managerial responsibilities of the HCO.

http://www.mha-apps.com/media/maps/Physician%20Peer%20Review%20in%20a%20Just%20Culture.doc

Date added: October 13, 2011 - Views: 56

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SAMPLE POLICY AND PROCESS FOR CREDENTIALING AND PRIVILEGING ...

Medical Staff Coordinator Sample Peer Recommendation Form. CONFIDENTIAL Professional Peer Reference & Competency Validation. Page 1 of 2. Name of Applicant: ...

http://www.kathymatzka.com/Downloads/Peer_Reference_Letter.doc

Date added: December 16, 2011 - Views: 247

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Sample Peer Review Worksheet - Grand Valley State University

Title: Sample Peer Review Worksheet Author: kurthenh Last modified by: loseyk Created Date: 3/12/2007 8:57:00 PM Company: GVSU Other titles: Sample Peer Review Worksheet

http://www.gvsu.edu/cms3/assets/23DA1DF1-0559-5DE9-97EA72378EBE5C1D/workshops/sample-peer-review-worksheet.doc

Date added: November 5, 2011 - Views: 20

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COPE Behavioral Services, Inc

PHYSICIAN PEER-REVIEW FORM. Patient ID#: Name of reviewer: Name of clinician: REASON(S) FOR PEER REVIEW. Random chart audit Referred by QM department Complaint Staff ...

http://www.copecommunityservices.org/cmmanual/QM%20physician%20peer-review%20form.doc

Date added: September 18, 2013 - Views: 20

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QA/I QUARTERLY PEER REVIEW WORKSHEETS - Ohio

QA/I QUARTERLY PEER REVIEW WORKSHEETS Author: Humenay Last modified by: Dietz Created Date: 7/19/2011 3:30:00 PM Company: ODADAS Other titles:

http://mha.ohio.gov/Portals/0/assets/Regulation/LicensureAndCertification/approvedForms/2012%20Peer%20Records%20Review%20Worksheet.doc

Date added: December 5, 2013 - Views: 2

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North County Health Services - Osteopathic Medical School ...

NORTH COUNTY HEALTH SERVICES. Physician/Mid-Level Provider Peer Review Audit Form. Center: Chart#: Provider: Date of Index Visit: Date of Audit:

http://www.atsu.edu/wcn/Provider%20Peer%20Review/NCHS_Peer_Audit_Tool.doc

Date added: November 22, 2012 - Views: 27

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Quality Assurance Log - IAC | Improving Health Care Through ...

Peer Review Quality Improvement Log (Peer review worksheets should be used and maintained to document complete review. Sample is available on the website.)

http://intersocietal.org/vascular/forms/Peer_Review_QI_Log.doc

Date added: October 24, 2013 - Views: 12

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ED PHYSICIAN PEER EVALUATION - Jay Kaplan

ED PHYSICIAN PEER EVALUATION. Date ... Review of this physician’s charts when performing follow ... Please comment on the back of this form any concerns or problems ...

http://jaykaplanmd.com/tools/ed_physician_peer_evaluation_kaplan.doc

Date added: April 1, 2013 - Views: 24

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NEW PHYSICIAN

Physician Preceptor . Checklist ... Inform Medical Staff/Peer Review Coordinator and Director of Managed Care that new physician has signed contract for ...

http://c.ymcdn.com/sites/www.aspr.org/resource/resmgr/imported/Form-New%20Physician%20Orientation%20Checklist.doc

Date added: May 5, 2014 - Views: 26

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WC Peer to Peer Review Form - Fax From - TOA - Welcome to the ...

TOA wishes to give members a forum to document their Peer to Peer Reviewer complaints so that we can carefully analyze those complaints before sending them to TDI/DWC.

http://www.toa.org/ecard/2006/09-2006/5th/Forms/PEER%20REVIEWER%20ID%20Survey-printout-form.doc

Date added: October 27, 2011 - Views: 26

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peer chart review form

Medical Staff Quality of Care / Peer Review Form. This report is a peer review junction and, as such, ... Proctor Proctor Internal Review (by 2nd peer)

http://blogs.hcpro.com/credentialing/wp-content/uploads/2011/02/ChartReviewForm.doc

Date added: March 21, 2013 - Views: 2

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The Orthopedic Surgery Center of Orange County

PEER REVIEW surgeon. 9/21/2010. Source: Alan Beyer, Orthopedic Surgery Center of Orange County. Adapted and reprinted with permission. Title:

http://www.beckersasc.com/docs/accreditation/Surgeon%20medical%20chart%20peer%20review.doc

Date added: January 15, 2015 - Views: 1

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Trauma Case Review - Montana Performance Improvement Network

Trauma Team: Trauma Form used? ... Physician / Surgeon Time: ... Refer to Multidisciplinary Trauma Committee or Medical Staff Peer Review Process)

http://www.mtpin.org/docs/Peer%20Review%201%20Trauma%20Case%20Review%20Form.doc

Date added: March 6, 2012 - Views: 28

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Policy: Administrative - NAHQ.org

DO NOT PHOTOCOPY. Peer Review information is maintained . solely in the Quality & Patient Safety Office. Case #: A. PATIENT INFORMATION Patient Initials: Medical ...

http://www.nahq.org/uploads/appsfiles/UPDATED_GENERAL_peer_review_worksheet.doc

Date added: August 15, 2013 - Views: 11

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Peer Review letters - Oregon State University

BASICS. In general, students find peer letters extremely helpful to the development of their essays. In order for the peer review process to work it’s best, it is ...

http://people.oregonstate.edu/~petersp/ORST/WR121_files/Course%20Resources%20Documents/Guidelines%20for%20writing%20Peer%20Review%20letters,%20Kathryne%20TafollaYoung.doc

Date added: October 8, 2011 - Views: 36

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Policy and Procedure Approval Form - HCA Ethics & Compliance ...

CMS memorandum to the Peer Review Organizations entitled “Use of Physician Query Form” with Policy Clarification of Temporary Suspension of January 22, ...

http://ec.hcahealthcare.com/CPM/REGSCOD012%20Rev%2012-1-2007.doc

Date added: September 25, 2011 - Views: 17

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HOSPITAL CHART REVIEW FORM - National POLST

I want tube feedings only as my physician recommends. ... HOSPITAL CHART REVIEW FORM: page 1. Created on 12/14/2012 . Title: HOSPITAL CHART REVIEW FORM Author: hickmans

http://www.polst.org/wp-content/uploads/2013/02/Instrument-V-WI-Hospital-Chart-Review-Form.doc

Date added: June 17, 2013 - Views: 1

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PEER REVIEW - Medical Communications Corporation

PA Auto. What is a Peer Review? A Peer Review conducted under Act 6 of the Pennsylvania Automobile Reform is a review of a Health Care Professional by a reviewer of a ...

http://mccime.com/medmail/Pennsylvania%20Peer%20Review.doc

Date added: October 3, 2011 - Views: 9

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Trauma Center Performance Improvement and Patient Safety Plan

Trauma PI issues will be documented on the “Trauma Review Form ... Provider Peer Review-issues identified in the review ... Trauma Director/Other Physician Review:

http://www.healthy.arkansas.gov/programsServices/injuryPreventionControl/TraumaticSystems/Documents/trauma/Resources/StateTraumaPerformanceImprovementSafetyPlan.doc

Date added: July 29, 2012 - Views: 44

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Peer Review Guidelines - Home | Office of the Chief ...

Purpose: The purpose of this document is to implement the Office of Management and Budget’s (OMB) Final Information Quality Bulletin for Peer Review (hereafter ...

http://www.ocio.usda.gov/sites/default/files/docs/2012/FINAL_Peer_Review_Guidelines.doc

Date added: June 15, 2013 - Views: 1

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<apn_num>Appendix A: <apn_tit&gt;ASC Paperwork Templates

Any practitioner initially applying for membership on the medical staff shall file a written application form and ... a peer on the ASC ... Peer review will consist ...

http://www.aao.org/aaoe/upload/ASC-Module-Appendix-B-Policies-and-Procedures-Manual-2011-American-Academy-of-Ophthalmic-Executives.doc

Date added: May 8, 2013 - Views: 21

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Clinical Appeals Process - CignaBehavioral.com

peer-to-peer review, in which. ... CIGNA Behavioral Health’s Formal Appeals Committee reviews all . 2nd level appeals. at your written request only.

http://www.cignabehavioral.com/web/basicsite/professional/formsAndComplianceDocs/Forms/Clinical_Appeals_Process.doc

Date added: October 9, 2011 - Views: 25

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Sample Peer Review Questions - Amazon Web Services

by Ann Bomberger. Peer reviews, a staple of many writing classes, encourage students to look at their writing as a work in progress. During a peer review session ...

http://sitesmedia.s3.amazonaws.com/facultyresources/files/2012/10/Sample-Peer-Review-Questions-2.doc

Date added: May 6, 2013 - Views: 25

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www.stlukesonline.org

Create a culture with a positive approach to peer review by recognizing physician excellence as well as ... A “peer” is an individual practicing in the same ...

http://www.stlukesonline.org/for_physicians/committees/documents/PeerReviewPolicy3.08.doc

Date added: September 30, 2013 - Views: 5

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Performance Improvement Peer Review Process

The original PEC members are those who remained involved in the process and dedicated their time to help form ... The physician feedback ... of peer review at ...

http://www.stlukesonline.org/for_physicians/committees/documents/PECFAQ.doc

Date added: September 30, 2013 - Views: 3

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Random Case Review

RANDOM CASE REVIEW FORM. Period I – January 1 to June 30. Period II – July 1 to December 31. Period: _____Year: _____ Reviewing Physician ...

http://50.194.94.115/pdfs/Peer_Review_Form.docx

Date added: September 30, 2013 - Views: 8

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Drug Regimen Review Request Form

... Review, Peer to Peer Outreach provides a telephonic meeting with the treating prescriber(s) by a specialist physician to review ... Regimen Review Request Form

http://painmanagement.pmsionline.com/Documents/MedAssess_Care_Management_Services%20Request_Form_8-24-2012_(Locked).docx

Date added: November 21, 2013 - Views: 15

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Medicine

After physician review, SFs 600, Telephone Triage Encounter ... This will be accomplished utilizing the attached Telephone Triage Peer Review Form AF Form 3137 ...

http://www.awhonn-af.org/awhonn-af/wp-content/uploads/2010/12/MGI-44-118-Nurse-Telephone-Triage-Advice-Program2.doc

Date added: March 26, 2013 - Views: 19

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ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK

EXTERNAL PEER REVIEW NETWORK. PHYSICIAN REPORT FORM - RADIOLOGY CONFIDENTIAL. Part I – to be completed by the requesting hospital and ICAHN office and sent to the ...

http://www.icahn.org/files/EPRN_Library/radiologist_eprn_report_form.doc

Date added: September 30, 2013 - Views: 2

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Confidential For Peer Review Purposes Only

form:_____ MR Number ... **ALL “YES” RESULTS ARE FALLOUTS AND REQUIRE REVIEW. Physician reviewer ... Confidential For Peer Review Purposes Only ...

http://www.gcrac.org/wp-content/uploads/2009/05/stroke_pi_indicators_12-09.doc

Date added: September 30, 2013 - Views: 20

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GEORGIA REGIONAL HOSPITAL AT AUGUSTA - East Central Regional ...

The Physician Advisor acts as a peer review specialist for any ... and recommendations on the Utilization Management form for review by the Utilization Management ...

http://www.augustareg.dhr.state.ga.us/Manuals/UMPLAN.doc

Date added: September 25, 2012 - Views: 12

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Session Review Form - Good Samaritan Hospital Los Angeles ...

Were the physician attributes designated for the series ... did a pre-activity peer review of materials take ... Session Review Form, Page-1. Title: Session ...

https://goodsam.org/classes/rss/RSS-Session-Review-Form.doc

Date added: August 8, 2014 - Views: 4

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Chart Review Template - Oregon Health &amp; Science University ...

Chart Review Protocol Template Instructions. The protocol template is a tool to facilitate protocol development. It is not intended to supersede the role of the ...

http://www.ohsu.edu/xd/health/services/cancer/research-training/shared-resources/upload/Chart-Review-Template.doc

Date added: October 26, 2011 - Views: 110

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Medical Staff Peer Review Policy - Ohio Hospital Association

A member of the peer review committee performs the ... of Peer Review Case to MSQC’ form and submit to ... including coded physician-specific ...

http://www.ohiohospitals.org/OHA/media/Images/Patient%20Safety%20and%20Quality/Documents/39Weeks/TCH-OPPE-POLICY.doc

Date added: January 5, 2015 - Views: 1

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Fall Prevention and Management Program - MN hospitals

FALL INCIDENT REPORT ... DO NOT INCLUDE THIS FORM IN THE PATIENT’S MEDICAL RECORD. ... (check type) Physician Peer Review . Mortality & Morbidity Review.

http://www.mnhospitals.org/Portals/0/Documents/ptsafety/falls/NCPS_Fall_Incident_Report.doc

Date added: April 5, 2013 - Views: 26

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TRAUMA ED CHART REVIEW

Documentation may be in Medhost or other special care documents such as the conscious sedation form. ... Peer Review and ... TRAUMA ED CHART REVIEW ...

http://www.traumanurses.org/_resources/resource_library/forms/trauma_ed_nursing_chart_review.doc?phpMyAdmin=YUKhXpm3NuRfJ3YccE22H8dYHvf

Date added: May 9, 2013 - Views: 23

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Attachment G: - Footwear Solutions - Color Coding Risk Alert ...

Post Fall Documentation. Use the following forms to document a fall. ... Physician Peer Review . Mortality & Morbidity Review. Root Cause Analysis.

http://www.pillowpaws.com/files/forms/Post%20Fall%20Documentation%20Forms.doc

Date added: May 10, 2012 - Views: 9

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Articulated Plan Sample Template Instructions

The Nurse-Physician Advisory Taskforce for ... has created a template to help Advance Practice Nurses create an articulated plan for safe ... peer review, periodic ...

http://www.coloradoafp.org/pdf/Articulated_Plan_Sample_Template.doc

Date added: September 1, 2011 - Views: 41

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Referral Notification Form - ReMed Casualty Consultants, Inc.

Independent Medical Evaluation by Physician with IME Recommendations . Chiropractic Peer Review with Chiropractor’s ... Referral Notification Form Author: Connie ...

http://remedcasualty.com/images/Referral_Notification_2009.doc

Date added: January 30, 2012 - Views: 14

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COMMUNITY CLINICS HEALTH NETWORK - Osteopathic Medical School ...

DENTAL PATIENTS PEER REVIEW AUDIT FORM. NORTH COUNTY HEALTH SERVICES. Provider: _____ Site: _____ Auditor: _____ Date of Index Visit ...

http://www.atsu.edu/wcn/Provider%20Peer%20Review/NCHS_Dental_PR_Audit_Tool-Revised_1_06.doc

Date added: October 26, 2011 - Views: 20

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A License to Harm or Good Public Policy: An Ethical Analysis ...

A nurse in the Cardiac Catheterization Lab filled out a Committee Event Report Form ... Physician Peer Review: Serving The Patient or The Physician, ...

http://works.bepress.com/context/lamar_odom/article/1000/type/native/viewcontent/

Date added: October 3, 2011 - Views: 34

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COMMUNITY HEALTH CARE, INC - Homepage - Aspirus Medical Staff

Peer Review: The term “peer ... (e.g., physician, ... documentation will include the elements described in 8.2 accompanied by a final copy of an Initial Review form ...

http://www.aspirusmedicalstaff.org/media/MedicalStaffPeerReviewProcess2011.doc

Date added: May 2, 2013 - Views: 31

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CodingCompliancePlan - Indian Health Service

... PCC encounter form, physician ... file and use by peer review organizations will ... to query the physician and research the coding problem ...

http://www.ihs.gov/HIM/documents/CodingCompliancePlan.doc

Date added: October 24, 2011 - Views: 187

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CME Application Form - Legacy Health - Portland and Vancouver ...

APPLICATION FORM – AMA PRA Category 1 Credit™ The CME application and ... Peer Review / Direct Observation Patient Feedback Physician/Patient Surveys and ...

http://www.legacyhealth.org/~/media/Files/PDF/Health%20Professionals/CME%20Planning%20Resources/CME%20Planning%20Resources/Application%20Form.ashx

Date added: October 24, 2013 - Views: 23

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Peer Review for Group Presentation

Peer Review for Group Presentation. Your name: _____ Your. Team: _____ F. ormat for scoring group members

http://wweb.uta.edu/management/Dr.Quick/courses/3318/Quick%20Presentation%20Rubric%20Peer.docx

Date added: December 7, 2012 - Views: 21

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Missouri State Medical Association

Commercial Support Disclosure Form. Peer Review for Resolution of Conflict. ... Physician Certificate ... Published by the Missouri State Medical Association.

http://www.msma.org/docs/education/cme%20handbook/CME%20Provider%20Handbook%20Table%20of%20Contents.doc

Date added: June 29, 2013 - Views: 18