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MSQH/MedClin/Std&Tools/2/2011
Criterion
Survey Item
No.
Std 1 ACCESS TO CARE
Evidence of Compliance
(Completed by the Medical Clinic
Self
Rating
Surveyor's Comments
1.
2.
3.
4.
5.
6.
Page 1 of 20
Surveyor
Rating
Criterion
No.
Survey Item
Evidence of Compliance
(Completed by the Medical Clinic
Self
Rating
Surveyor's Comments
enables
the
practitioner
to
accommodate patients with urgent,
non-urgent, complex, planned chronic
care and preventive health needs.
Criteria for compliance:
i)
Practice policy or other
documentation is available.
1.
2.
3.
4.
1.3 APPOINTMENT
There is an appointment system
available in the practice.
Criteria for compliance:
i)
A patient register is practiced
and made available.
1.
2.
1.
Page 2 of 20
Surveyor
Rating
Criterion
No.
Survey Item
hours is available.
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
Evidence of Compliance
(Completed by the Medical Clinic
2.
Self
Rating
Surveyor's Comments
Page 3 of 20
Surveyor
Rating
Criterion
Survey Item
No.
Std 2 PRACTICE
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
1.
2.
3.
2.2 EQUIPMENT
All equipment for the provision of the
level of services shall be adequate,
appropriate and well maintained.
Criteria for compliance:
There is evidence of compliance where
appropriate to:
i)
Scheduled maintenance.
ii)
Calibration.
iii)
Certification.
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
1.
Page 4 of 20
Surveyor
Rating
Criterion
Survey Item
No.
2.3 LEGAL REQUIREMENTS
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
1.
2.
3.
4.
2.4 INFORMATION
Patient health records contain
sufficient information to identify the
patient and to document reasons for
visit, assessment, management,
progress and outcome.
Criteria for compliance:
i)
The
Registered
Medical
Practitioner maintains a system
of creating and updating
medical information on every
patient.
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
1.
2.
3.
Patient register
Page 5 of 20
Surveyor
Rating
Criterion
No.
Survey Item
ii)
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
1.
2.
1.
2.
3.
Page 6 of 20
Surveyor
Rating
Criterion
No.
Survey Item
Evidence of Compliance
(Completed by the Medical Clinic)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Self
Rating
Surveyor's Comments
1.
2.
be
Page 7 of 20
Surveyor
Rating
Criterion
No.
Survey Item
Criteria for compliance
i)
Appropriate assessment is
conducted to support care of
the patient.
ii)
All patients are reassessed at
each appointment or at
appropriate
intervals
to
determine their response to
treatment and to plan for
continued treatment or referral.
Evidence of Compliance
(Completed by the Medical Clinic)
1.
2.
3.
4.
1.
2.
3.
4.
1.
Self
Rating
Surveyor's Comments
2.6.2 TRAINING
Procedures are carried out by trained
personnel.
Criteria for compliance:
i)
There shall be documented
evidence
of
appropriate
training.
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
Page 8 of 20
Surveyor
Rating
Criterion
Survey Item
No.
2.6.3 PATIENT CARE
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
Page 9 of 20
Surveyor
Rating
Criterion
No.
Survey Item
iv)
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
Surveyor
Rating
1.
2.
3.
4.
2.6.6 FEEDBACK
Where cases have been referred to
the practice, there should be a
system of feedback to the referring
doctor.
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
Page 10 of 20
Criterion
No.
Survey Item
Evidence of Compliance
(Completed by the Medical Clinic)
2.6.7 HEALTH
PROMOTION
PREVENTION
Self
Rating
1.
1.
2.
- videos
- immunisation services
Surveyor's Comments
Surveyor
Rating
AND
immunisation services
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
Page 11 of 20
Criterion
Survey Item
No.
Std 3 HUMAN RESOURCE
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
Surveyor
Rating
1.
2.
3.
1.
2.
Page 12 of 20
Criterion
No.
Survey Item
ii)
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
Surveyor
Rating
FOR
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
1.
Page 13 of 20
Criterion
No.
Std 4 SAFETY
Survey Item
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
Surveyor
Rating
1.
3.
4.
5.
- Radiation risks
- Laboratory hazards
Availability of sterilizer
1.
2.
Page 14 of 20
Criterion
No.
Survey Item
i)
ii)
Evidence of Compliance
(Completed by the Medical Clinic)
2.
Self
Rating
Surveyor's Comments
Surveyor
Rating
1.
2.
3.
4.
5.
6.
1.
2.
Page 15 of 20
Criterion
No.
Survey Item
iii)
iv)
v)
vi)
vii)
viii)
Evidence of Compliance
(Completed by the Medical Clinic)
3.
4.
5.
6.
7.
8.
Self
Rating
Surveyor's Comments
Surveyor
Rating
appropriate
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
1.
Page 16 of 20
Criterion
Survey Item
No.
Std 5 ETHICAL PRACTICE
Evidence of Compliance
(Completed by the Medical Clinic
Self
Rating
Surveyor's Comments
Surveyor
Rating
patients
1.
2.
1.
2.
3.
4.
5.
Page 17 of 20
Criterion
No.
Survey Item
Evidence of Compliance
(Completed by the Medical Clinic
Self
Rating
Surveyor's Comments
Surveyor
Rating
1.
1.
2.
Page 18 of 20
Criterion
No.
Survey Item
i)
ii)
Evidence of Compliance
(Completed by the Medical Clinic
1.
2.
Self
Rating
Surveyor's Comments
Surveyor
Rating
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
1.
2.
Page 19 of 20
Criterion
Survey Item
No.
Std 6 QUALITY IMPROVEMENT
ACTIVITIES
Evidence of Compliance
(Completed by the Medical Clinic)
Self
Rating
Surveyor's Comments
Surveyor
Rating
1.
2.
3.
MSQH/MedClin/Std&Tools/2/2011
Standards and Assessment Tool for Medical Clinic
Page 20 of 20