Medical Facility Compliance Audit

Guide auditors through a patient record review at skilled nursing facilities. It captures facility details, admission and discharge dates, payer type and whether record retention policies are being followed.

Use this template

In the Claude connectors directory

Page 1

Facility Location

Street Address

City

State / Province

ZIP / Postal Code

Audit Type

Initial audit Follow-up audit Annual review Complaint-based Random sample

Page 2

Section

Payer Type

Medicare Part A Medicare Advantage Medicaid Private insurance Self-pay

Face Sheet Diagnosis

Hospital Discharge Diagnosis

Hospital Admission Date

Hospital Discharge Date

Skilled Nursing Facility Admission Date

Skilled Nursing Facility Discharge Date

Does the patient have other skilled nursing stays?

Yes No

Discharge Location

Any missed days on Medicare Part A?

Yes No

A complete inquiry form or adequate intake information was found for each reviewed patient

Yes No Not applicable

Records are kept at least six years after discharge, per facility policy (HIPAA)

Yes No Not applicable

The facility is in compliance with its own policy

Yes No Not applicable

Related templates

Browse all assessments templates →

	Column 1	Column 2	Column 3
Row 1
Row 2

	Column 1	Column 2	Column 3
Row 1
Row 2

	Column 1	Column 2	Column 3
Row 1
Row 2

	Column 1	Column 2	Column 3
Row 1
Row 2