JAI KAMAL EYE HOSPITAL, CHHEHARTA, AMRITSAR

PASSIVE AUDIT CHECKLIST

TOTAL ACHIEVED
PARAMETERS
SCORE UHID NO: PARAMETERS SCORE
ACC 8
I. PATIENT DETAILS: II. PATIENT SIGN/THUMB IMP: III. ATTENDANT SIGN/THUMB IMP: IV. TIME & DATE MENTIONED:
SC 8 I. PATIENT PARTICULARS: II. PATIENT SIGN/THUMB IMP: III. DATE MENTIONED: IV. DOCOTOR SIGN:
POA 8
I. DIAGNOSIS: II. EYE & OB DATA III. GEN. HOSTORY: IV. DOCOTOR SIGN:
PACF 8
I. PATIENT PARTICULARS: II. PATIENT SIGN/THUMB IMP: III. DATE MENTIONED: IV. ANAESTHETIST SIGN:
PAC 8
I. C/CPUPILS/VITAL: II. ANY CURNT MED: III. SYST. HISTRY: IV. DOCOTOR SIGN:
SSC 8
I. SURGICAL SITE: II. ALLERGY MENT: III. IOL DETAILS: IV. DOCOTOR SIGN & DATE:
IOAR 8 I. PPARE: II. ANAESTHESIA TECH: III. VITAL TREADS: IV. ANAESTHETIST SIGN:
PAR 8 I. VITALS: II. PAT MENTIONED:
OPR 8
I. IOL STICKER: II. SURGEON NAME/SIGN: III. OP. NOTES:
DIS. (SUMM) 8
I. MEDIC. MENTIONED: II. DOCTOR SIGN/DATE: III. DISCHARGE DATE & TIME:
I. PATHO. : III. OCT: V. ECG:
INVEST. 8
II. A-SCAN: IV. B-SCAN: VI. CT/MRI/USG:

OPD SLIP COPY 8

DIS. © 8 I. IOL STICKER: II. DOCTOR SIGN/DATE: III. FOLLOW UP:

REMARKS: