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Sample Medical Chart Peer Review Evaluation Form

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On a monthly basis, one of 17 physicians at Orthopedic Surgery Center of Orange County in Newport Beach, Calif., is chosen to peer review 30 medical charts for accuracy and completeness. The only caveat is that the reviewing physician cannot have one of his own medical charts included in the batch.

The ASC created a formal template that acts as a checklist for reviewing physicians to use. If the reviewing physician finds a physician's medical chart has a deficiency, he or she can forward the medical chart onto the medical advisory committee for further review.

In most cases, the committee reviews are used as an educational opportunity to make certain physicians better maintain complete and accurate medical charts in the future.

To download a sample copy of the medical chart peer review evaluation form you can adapt for use in your ASC, click here (doc).

Learn more about Orthopedic Surgery Center of Orange County.

Download other sample forms for adaptation and use in your ASC:

- Sample Incomplete Biological Result Form

- Sample Warming Cabinet Temperature Checklist

- Sample Wound infection/Unexpected Outcome Report

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