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

PHYSICIAN REVIEW Study #1 Study #2 Report Format Interpretation Accuracy Study #1 Study #2. ... Peer Review QI Form (SAMPLE) Title:

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

Date added: March 7, 2013 - Views: 11

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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: 44

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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: 78

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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: 59

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

Date added: February 14, 2015 - Views: 1

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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: 249

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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/?wpfb_dl=380

Date added: September 25, 2014 - Views: 1

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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: 28

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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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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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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: 24

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

The form . MUST. be completed by the physician as there are questions that only the physician can ... Did the Peer Review explain rationale for denying or approving ...

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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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: 23

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UNIVERSITY OF MICHIGAN HEALTH SYSTEM

The manager will review the peer review form, peer summary and self-evaluation and then complete the manager section of the ... University of Michigan Medical Center

http://www.med.umich.edu/NURSING/jit/forms/PerformanceEvaluationInstructions.doc

Date added: May 30, 2013 - Views: 10

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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: 45

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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: 15

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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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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: 27

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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: 16

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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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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://50.194.94.117/pdfs/Peer_Review_Form.docx

Date added: February 14, 2015 - Views: 1

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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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Fall Prevention and Management Program - MN hospitals

DO NOT INCLUDE THIS FORM IN THE PATIENT’S ... Interdisciplinary Fall Prevention Care Plan implemented & communicated ... (check type) Physician Peer 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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<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: 23

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Validation, Verification, and Testing Plan Checklist - HUD/U.S.

This checklist is provided as part of the evaluation process for the Validation, Verification, and Testing Plan. The checklist assists designated reviewers in ...

http://portal.hud.gov/hudportal/documents/huddoc?id=DOC_15153.doc

Date added: May 8, 2012 - Views: 71

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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: 115

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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: 45

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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: 22

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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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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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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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SANTA CLARA COUNTY

medical examiner-coroner office. performance appraisal (appendix a) _____autopsy report physician peer review_____ physician of record _____

http://www.sccgov.org/sites/led/appraisal/Documents/Medical-Examiner_Coroner-Office-(UAPD)-Peer-Review-Attachment-A.doc

Date added: February 20, 2014 - Views: 1

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Medical Staff Peer Review Policy - Ohio Hospital Association

Title: Medical Staff Peer Review Policy Author: sally.cohen Last modified by: Koblitz, Jan Created Date: 3/15/2011 6:12:00 PM Company: HCPro Other titles

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 - MHA > Home

A Fall Incident Report Form, ... No further action Investigation indicated: (check type) Physician Peer Review . Mortality & Morbidity Review.

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

Date added: March 4, 2013 - Views: 31

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PARAMOUNT REVIEW SERVICES, LLC

This form is automated for editing on your desktop and can be printed ... IME / RME Peer Review ... Attending Physician / Provider: Specialty ...

http://paramountreview.com/docs/prs-ime-and-peer-request-form.doc

Date added: September 11, 2014 - Views: 6

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Criteria - sccgov.org

If Advance Directive exists, but is not available, signs the Advance Directive Alert form completed by Social Services. 15. S&R ... Physician Peer Review ...

http://www.sccgov.org/sites/led/appraisal/Documents/In-Patient-MH-BAP-Peer-Review_Attachment-A.doc

Date added: July 26, 2013 - Views: 4

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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: 32

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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: 24

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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: 15

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Peer Evaluation Form for Pre-Tenure/Promotion Review

Peer Evaluation Form for Mid-Cycle Review. School of Medicine. ... Co-Investigator on a peer-reviewed extramural national, ... Physician relations.

https://www.ttuhsc.edu/som/facultydevelopment/documents/mid-cycle-review/PeerEvaluationForm.doc

Date added: October 30, 2011 - Views: 24

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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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Urban Indian Health Program On-Site Review Manual

URBAN INDIAN HEALTH PROGRAM. ON-SITE REVIEW MANUAL. April 2004. Revised April 19, 2011. Urban Indian Health Program Office. Indian Health Service Headquarters

http://www.ihs.gov/Urban/documents/Urban_Indian_Health_Program_Review_Manual.doc

Date added: May 2, 2013 - Views: 50

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FPPE proctor evaluation form.

CONFIDENTIAL PEER REVIEW DOCUMENT. This form is provided for the proctor’s convenience to document appropriate proctoring and findings as they relate to patient ...

http://blogs.hcpro.com/credentialing/wp-content/uploads/2012/03/FPPE-form.doc

Date added: May 17, 2013 - Views: 5

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POLICY: Operative & Invasive Procedures Appropriateness Review

The reviews shall be conducted as part of the peer review and quality ... The initial review is completed by a non-physician, ... External Cardiovascular Review Form

https://www.tenethealth.com/docs/default-source/policies/policies---mn/policy---co-5-006_policy_operative_and_invasive.doc?sfvrsn=2

Date added: November 3, 2014 - Views: 1

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American Health Information Management Association

Health records in any available form are essential for ... processes and procedures encountered in the physician office management ... Peer Review of all ...

http://library.ahima.org/xpedio/groups/public/documents/internalproject_coding/bok1_035490.doc

Date added: March 25, 2013 - Views: 33

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Enter Policy # in FILE - PROPERTIES - SUMMARY - 'Title:'

Independent Review by a Qualified Physician. ... a medical review or physician peer review of the death may be conducted as part of ... Initial Agency Death Review Form.

http://www.tn.gov/didd/provider_agencies/policies/Death%20Review%20Policy%205-31-2012.doc

Date added: June 20, 2013 - Views: 27

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• PIP Pre-Service Appeals Form

Physician Name: ... unless it is determined that a peer review or an IME is appropriate. ... If a provider misses the deadline to submit a Pre-Service Appeal, ...

http://www.njguaranty.org/home/Docs/Form/PIP_Pre-Service_Appeals_Form.doc

Date added: November 10, 2013 - Views: 1