Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Vendor Name:
Review Period:
Date of Review:
Reviewer:
Participating Vendor Staff Member:
Agency For Health Care Administration
Managed Care Organizations
Medical Record Audit Tool
Medical Record Review Tool
Item Number Contents of the Medical Record: Found in Record Reference Comments
1
Contains member identifying information:
a. Name
Managed Care Organizations Page 1
Medical Record Audit Tool F1_03_10
Florida Medicaid
Y N
b. Member identification number Y N
c. Date of birth Y N
d. Sex Y N
e. Legal guardianship, if any Y N N/A
2. Is legible and maintained in detail
3
4
Contains:
a. A summary of significant surgical procedures
Y N N/A
b. Past and current diagnoses or problems Y N
c. Allergies Y N
d. Untoward reaction to drugs Y N N/A
e. Current medications Y N N/A
Contains entries that are:
a. Dated
Y N
b. Signed by the appropriate party Y N
42 CFR 456
CC-VII.J.1.a
42 CFR 456
CC-VII.J.1.a
42 CFR 456
CC-VII.J.1.a
42 CFR 456
CC-VII.J.1.a
42 CFR 456
CC-VII.J.1.a
42 CFR 456
CC-VII.J.1.b
42 CFR 456
CC-VII.J.1.c
42 CFR 456
CC-VII.J.1.c
42 CFR 456
CC-VII.J.1.c
42 CFR 456
CC-VII.J.1.c
42 CFR 456
CC-VII.J.1.c
42 CFR 456
CC-VII.J.1.d
42 CFR 456
CC-VII.J.1.d