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Clip and Copy: Medical record evaluation form


This form can improve your efficiency and your bottom line.

This form can improve your efficiency and your bottom line.

Paperwork. Since there's no escaping it, the next best thing is to handle it as proficiently as possible. Forms that are easy to use and clearly designed can help you practice more efficiently, save time, and increase profitability, while making life a bit easier for you and your employees.

The form, the second in our "Clip and Copy" series, is one of several we'll reprint from Medical Practice Forms: Every Form You Need to Succeed, by Keith C. Borglum and Diane M. Cate, consultants with Professional Management and Marketing in Santa Rosa, CA. (The entire book sells for $59.95. To order, call 800-MED-SHOP. The authors can be reached at 707-546-4433.)

Use this medical record compliance evaluation form to prepare for insurance company audits. "HMOs, PPOs, and other payers have the right to review your clinical records and grade you," says Borglum. "A poor grade could mean lower reimbursements, other financial penalties, or your name on a public list available to colleagues and patients.

"Because each company has its own standards, we've pieced together a generic form that includes components from different evaluations. Do a self-rating, or have a staffer or colleague review your records, to see how you would fare in an actual evaluation—and to implement improvements well in advance of a records inspection."

—Gail Garfinkel Weiss
Senior Editor

To view the form in Word you must have Word 2000 or better. If you don't have this program you can download the free Microsoft Word 97/2000 Viewer. (You cannot edit an open document in Word Viewer. However, you can copy text to the Clipboard to paste it in other applications).

Other forms and patient handouts are available in the Clip and Copy section of our Web site at .


Gail Weiss. Clip and Copy: Medical record evaluation form.

Medical Economics

May 23, 2003;80:92.

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