Record Review Worksheet

RECORD REVIEW WORKSHEET Page 1
0
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ies
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dy
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/Co
ME
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ent
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ort
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cal
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e
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.&
Record Review Worksheet June 2016
0
eD
on
or
ID
dd
0
Re
se
Date of Death
arc
h
e, A
Sub Total
Tra
nsp
lan
t
Donor Number
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roc
INSTRUCTIONS:
1. Review at least one record per month dating from the time of the last inspection.
2. Enter "0" for any item present and/or in compliance with the EBAA Medical Standards
and enter "1" for any applicable item absent and/or not in compliance.
3. The results for each column will be automatically totaled as the numbers are entered. Then enter the totals on the Record Review Summary Form.
Submit the Summary and this worksheet with the Inspection Questionnaire.
0
0
COMMENTS
RECORD REVIEW WORKSHEET Page 2
Subtotal
0
Record Review Worksheet June 2016
0
0
0
0
0
0
0
ort
ed
s if
ver
se
rea
ctio
n
ativ
e
ery
0
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me
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io
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rg
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ery
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gn
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cip
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nd
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pie
nt
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me
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rge
on
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0
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ien
t
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me
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ide
nce
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0
/or
ty
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gn
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cea
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/ co
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g
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me
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qu
ee
ain
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e:
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est
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, tr
rt
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cle
ato
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val
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or
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u
me
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tur
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and
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age
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plic
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etr
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dis
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#
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roc
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exc
.&
add
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lar
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Sp
Sli
0
ost
st e
xc.
&
po
t la
mp
ht
nlig
Donor Number
Pe
ISB
T1
28
Tis
sue
Ide
nt.
per
Gra
ft
exa
mp
enu rior t
cle o ex
atio
c
n ision
o
r
ute
d
INSTRUCTIONS:
1. Review at least one record per month dating from the time of the last inspection.
2. Enter "0" for any item present and/or in compliance with the EBAA Medical Standards
or enter "1" for any applicable item absent and/or not in compliance.
3. The results for each column will be automatically totaled as the numbers are entered. Then enter the totals on the Record Review Summary Form.
Submit the Summary and this worksheet with the Inspection Questionnaire.
0
COMMENTS