| CRITERIA MEASURE |
Met |
Not Met |
Comments |
Refer to Department |
 Most recent regulatory survey completed and corrected |
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| All corrections documented and filed with administration |
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| Corrections implemented are currently in place and continue to be in compliance |
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| Fire Marshal report current; corrections completed and currently in compliance |
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| Health Department report current; corrections completed and currently in compliance |
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| CPR Licensure is current and documented in Personnel files |
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| All staff have licensure verification |
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| All staff have criminal background checks |
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| Nurse Practitioner is affiliated with the consulting physician; documentation is current and accurate |
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| Medical Assistant is affiliated with the consulting physician |
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| Physician Assistant is affiliated with the consulting physician; documentation is current and accurate |
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| Consulting Physician licensure is current and accurate: |
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| Liability Insurance |
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| DEA Licensure |
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| State Medical License |
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| Annual background check |
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| Specialized designations current |
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| Hospital privileging is current |
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| Vendors provide proof of liability insurance: |
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| Oxygen supplier |
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| Ambulance |
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| Pharmaceutical |
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| Labor Pool |
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| Durable Medical Equipment |
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| Medical Equipment |
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| Medical Supplies |
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| Toxic Waste Removal |
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| Medical Record Storage |
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| Records Destruction Service |
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| Pest Control |
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| Vendor contracts are evaluated for compliance |
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| Each employee receives a job description and company handbook |
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| Drug testing is conducted for all employees |
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| Staff evaluations are written at least annually |
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Copyright © OmniSure Consulting Group, Inc., 2008
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