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FACULTY PEER REVIEW FORM - University of South...

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FACULTY PEER REVIEW FORM - University of South...

Faculty Peer Review Form April 2000. Title: FACULTY PEER REVIEW FORM Author: Academic Affairs Last modified by: Network Services Created Date: 4/9/2003 6:52:00 PM

https://www.uscupstate.edu/uploadedFiles/Faculty_and_Staff/Faculty_Governance/library_review.doc

Date added: May 5, 2013 - Views: 37

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COPE Behavioral Services, Inc

PHYSICIAN PEER-REVIEW FORM. Patient ID#: Name of reviewer: Name of clinician: REASON(S) FOR PEER REVIEW. Random chart audit Referred by QM department Complaint Staff ...

http://www.copecommunityservices.org/cmmanual/QM%20physician%20peer-review%20form.doc

Date added: September 18, 2013 - Views: 20

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THE JOURNAL OF THE AMERICAN BOARD OF FAMILY...

Peer Review Volunteer Form . Journal of the American Board of Family Medicine. Name, Academic Degrees: Email (preferred, then alternate, if any): Phone:

http://www.jabfm.org/site/misc/PeerReviewForm.doc

Date added: November 18, 2011 - Views: 60

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Sample Format for Peer Review Letter - Penn State...

Sample Format for Peer Review Letter Author: Berks - Lehigh Valley College Last modified by: Berks-Lehigh Valley College Created Date: 9/17/2007 1:02:00 AM Company:

http://www.bk.psu.edu/Documents/SampleFormatforPeerReviewLetterFinalDraft_v01.doc

Date added: December 4, 2011 - Views: 128

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Peer Review Policy and Procedure/Hendricks...

Medical Staff Peer Review Policy. Subject: Peer Review Activity. Policy: Review of circumstances as outlined in this policy will be conducted by a peer physician(s ...

http://www.hendricks.org/upload/docs/MedStaff/PeerReview.doc

Date added: October 13, 2011 - Views: 134

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Physician Peer Review in a Just Culture -...

Disruptive Physician Policy. Physician Peer Review. It is important to realize that Physician Peer Review does not replace the managerial responsibilities of the HCO.

http://www.mha-apps.com/media/maps/Physician%20Peer%20Review%20in%20a%20Just%20Culture.doc

Date added: October 13, 2011 - Views: 112

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North County Health Services - ATSU

NORTH COUNTY HEALTH SERVICES. Physician/Mid-Level Provider Peer Review Audit Form. Center: Chart#: Provider: Date of Index Visit: Date of Audit:

http://www.atsu.edu/wcn/provider%20peer%20review/nchs_peer_audit_tool.doc

Date added: November 22, 2012 - Views: 44

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Physician Performance Evaluation - ww2.nasbhc.org

Physician Under Review: Date of Review: / / Section 1 ... Physician Date. Form originally supplied by PhysiciansPractice.com. Title: Physician Performance Evaluation

http://ww2.nasbhc.org/RoadMap/HumanResources/Physician%20Review%20Form.doc

Date added: May 2, 2015 - Views: 9

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SAMPLE POLICY AND PROCESS FOR CREDENTIALING AND...

Medical Staff Coordinator Sample Peer Recommendation Form. CONFIDENTIAL Professional Peer Reference & Competency Validation. Page 1 of 2. Name of Applicant: ...

http://www.kathymatzka.com/Downloads/Peer_Reference_Letter.doc

Date added: December 16, 2011 - Views: 283

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Peer Review for Group Presentation

Peer Review for Group Presentation. Your name: _____ Your. Team: _____ F. ormat for scoring group members

http://wweb.uta.edu/management/Dr.Quick/courses/3318/Quick%20Presentation%20Rubric%20Peer.docx

Date added: December 7, 2012 - Views: 38

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Medical Staff Peer Review Policy - Ohio Hospital...

PI Nurse will complete the ‘Presentation of Peer Review Case to MSQC’ form and ... coded physician ... Medical Staff members is not peer review.

http://www.ohiohospitals.org/OHA/media/Images/Patient%20Safety%20and%20Quality/Documents/39Weeks/TCH-OPPE-POLICY.doc

Date added: January 5, 2015 - Views: 6

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Peer Review letters - Oregon State University

BASICS. In general, students find peer letters extremely helpful to the development of their essays. In order for the peer review process to work it’s best, it is ...

http://people.oregonstate.edu/~petersp/ORST/WR121_files/Course%20Resources%20Documents/Guidelines%20for%20writing%20Peer%20Review%20letters,%20Kathryne%20TafollaYoung.doc

Date added: October 8, 2011 - Views: 216

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Should we include something about the Board...

Cardiac Electrophysiology Facility. Peer Review Quality Improvement (QI) Form. Reviewing Physician (Initials): Date of Completion: PHYSICIAN REVIEW Criteria Procedure ...

http://intersocietal.org/ep/forms/Cardiac_Electrophysiology_Peer_Review_QI_Form.doc

Date added: March 25, 2016 - Views: 1

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FLORIDA

Physician Peer Review Form Date: _____ Revised 11/09/12. Page 1 of 1. FLORIDA. Therapy Services, Inc. Title: FLORIDA Author: Jennifer Last modified by: Anita Meeks

http://www.flatherapy.com/therapy/wp-content/uploads/2010/05/Physician-Peer-Review-Form-11-12.doc

Date added: September 20, 2014 - Views: 1

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The Orthopedic Surgery Center of Orange County

PEER REVIEW surgeon. 9/21/2010. Source: Alan Beyer, Orthopedic Surgery Center of Orange County. Adapted and reprinted with permission. Title:

http://www.beckersasc.com/docs/accreditation/Surgeon%20medical%20chart%20peer%20review.doc

Date added: January 15, 2015 - Views: 9

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SANTA CLARA COUNTY - sccgov.org

medical examiner-coroner office. performance appraisal (appendix a) _____autopsy report physician peer review_____ physician of record _____

https://www.sccgov.org/sites/led/appraisal/Documents/Medical-Examiner_Coroner-Office-(UAPD)-Peer-Review-Attachment-A.doc

Date added: August 31, 2015 - Views: 1

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www.med.umich.edu

The manager will review the peer review form, peer summary and self-evaluation and then complete the manager section of the evaluation form.

http://www.med.umich.edu/umhshr/doc/RN_LEVEL_A_PERF_EVAL_FORM.doc

Date added: February 8, 2012 - Views: 98

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Sample Peer Review Questions - Amazon Web Services

Sample Peer Review Questions. by Ann Bomberger. ... Fill out a form for each paper you read. 3. Read the entire peer review sheet before doing anything else. 4.

http://sitesmedia.s3.amazonaws.com/facultyresources/files/2012/10/Sample-Peer-Review-Questions-2.doc

Date added: May 6, 2013 - Views: 133

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Quality Department Assessment – completed before ...

Morbidity and Mortality Review Form. ... \physician peer review\qi forms\m&m conference\mm conference form_update 12.10.14.docx. Patient Demographics: Patient Initials:

https://www.aquanw.nhs.uk/Downloads/building-capability/Board%20Development%20Programme/OSU%20Resource%20Morbidity%20and%20Mortality%20Review%20Form.docx

Date added: March 20, 2016 - Views: 1

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ED PHYSICIAN PEER EVALUATION - Jay A. Kaplan

ED PHYSICIAN PEER EVALUATION. Date ... Review of this physician’s charts when performing follow ... Please comment on the back of this form any concerns or problems ...

http://www.jaykaplanmd.com/tools-files/ed_physician_peer_evaluation_kaplan.doc

Date added: February 22, 2015 - Views: 1

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Patient Name: - Advancing Quality Alliance (AQuA)

Peer Review. er. Form. Page 2 of 2. p:\physician peer review\qi forms\quality inquiry form_peer review only 12.02.14 final for smb.docx. Physician Review Comments:

https://www.aquanw.nhs.uk/Downloads/building-capability/Board%20Development%20Programme/OSU%20Resource%20Peer%20Reviewer%20Form.docx

Date added: March 25, 2016 - Views: 1

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NEW PHYSICIAN - c.ymcdn.com

Inform Medical Staff/Peer Review Coordinator and Director of Managed Care that new physician has signed contract for credentialing and contracting purposes.

http://c.ymcdn.com/sites/www.aspr.org/resource/resmgr/imported/Form-New%20Physician%20Orientation%20Checklist.doc

Date added: May 5, 2014 - Views: 76

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ILLINOIS CRITICAL ACCESS HOSPITAL NETWORK -...

EXTERNAL PEER REVIEW NETWORK. PHYSICIAN REPORT FORM - RADIOLOGY CONFIDENTIAL. Part I – to be completed by the requesting hospital and ICAHN office and sent to the ...

http://www.icahn.org/files/EPRN_Library/radiologist_eprn_report_form.doc

Date added: September 30, 2013 - Views: 2

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Trauma Center Performance Improvement and Patient...

Trauma PI issues will be documented on the “Trauma Review Form ... Provider Peer Review-issues identified in the review ... Trauma Director/Other Physician Review:

http://www.healthy.arkansas.gov/programsServices/injuryPreventionControl/TraumaticSystems/Documents/trauma/Resources/StateTraumaPerformanceImprovementSafetyPlan.doc

Date added: July 29, 2012 - Views: 90

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RPG Review Critique Template - grants.nih.gov

Apr 29, 2014 · Title: RPG Review Critique Template Subject: RPG Review Critique Template Author: NIH Keywords: RPG Review Critique Template Last modified by: OD/USER

http://grants.nih.gov/grants/peer/critiques/rpg_critique_template.doc

Date added: September 24, 2011 - Views: 43

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Provider Competency Evaluation and Documentation

Documenting Provider Competency for Low-and No-Volume ... Credentialing & Peer Review Legal ... Recommendation and Approval Form for Medical Staff Appointment and ...

http://www.namss.org/LinkClick.aspx?fileticket=__HnYATX7C4%3d&tabid=237&portalid=0&mid=917

Date added: July 17, 2014 - Views: 13

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Chart Review Protocol Template - IRB

Title: Chart Review Protocol Template Author: Ellen Schilling Last modified by: John Serafin Created Date: 5/10/2012 7:56:00 PM Company: Northwestern University ...

http://irb.northwestern.edu/sites/irb/files/templates/chart-review-protocol-1336679827.doc

Date added: April 21, 2016 - Views: 1

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PEER REVIEWER IDENTIFICATION SURVEY - TOA

The form . MUST. be completed by the physician as there are questions that only the ... Peer Reviewer Name: ... Did the Peer Review explain rationale for denying or ...

http://www.toa.org/ecard/2006/09-2006/5th/Forms/PEER%20REVIEWER%20ID%20Survey-printout-form.doc

Date added: October 27, 2011 - Views: 30

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Physician Performance Evaluation

Physician Under Review: Date of Review: / / Section 1 ... Physician Date. Form originally supplied by PhysiciansPractice.com. Title: Physician Performance Evaluation

http://imaging.ubmmedica.com/all/p2files/tools/phyeval.doc

Date added: July 12, 2015 - Views: 3

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Clinical Appeals Process - CignaBehavioral.com

peer-to-peer review, in which. your case will be discussed between your provider and another clinician who has the same licensure. ... Clinical Appeals Process ...

http://www.cignabehavioral.com/web/basicsite/professional/formsAndComplianceDocs/Forms/Clinical_Appeals_Process.doc

Date added: October 9, 2011 - Views: 52

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HOSPITAL CHART REVIEW FORM - National POLST

I want tube feedings only as my physician recommends. ... HOSPITAL CHART REVIEW FORM: page 1. Created on 12/14/2012 . Title: HOSPITAL CHART REVIEW FORM Author: hickmans

http://www.polst.org/wp-content/uploads/2013/02/Instrument-V-WI-Hospital-Chart-Review-Form.doc

Date added: June 17, 2013 - Views: 24

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Trauma Case Review - MTPIN

Trauma Case Review. ... Physician / Surgeon Time: ... Refer to Multidisciplinary Trauma Committee or Medical Staff Peer Review Process)

http://www.mtpin.org/docs/Peer%20Review%201%20Trauma%20Case%20Review%20Form.doc

Date added: March 6, 2012 - Views: 62

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physiciansmedicalreview.com

REFERRAL FORM. www.pmrfa.com Service Requested Rush Service ... Physician Peer Review Pharmacological Review Lien Verification CMS Submission Case Type

http://physiciansmedicalreview.com/pdfs/pmr_referral_form.doc

Date added: August 24, 2013 - Views: 9

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Drug Regimen Review Request Form

... Review, Peer to Peer Outreach provides a telephonic meeting with the treating prescriber(s) by a specialist physician to review therapy ... Review Request Form

http://painmanagement.pmsionline.com/Documents/MedAssess_Care_Management_Services%20Request_Form_8-24-2012_(Locked).docx

Date added: November 21, 2013 - Views: 27

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www.icahn.org

Peer Review Case Rating Form. MR#_____ D/C Date: _____ Referral Date:_ _____ Provider #:_____ _____ Referral Source: ... (CONTINUE PHYSICIAN REVIEW ON NEXT PAGE)

http://www.icahn.org/files/Policy_Bank/Attachment_D__Peer_Review_Case_Rating_Form.docx

Date added: September 9, 2015 - Views: 1

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St

St. Joseph’s / Candler Health System. The Care Network. Medical Staff Policy. Title: Peer Review Process. Section: Medical Staff Services. Policy Number:

http://www.sjchs.org/media/file/Peer%20review%20policy%20Final%2008%2007.doc

Date added: March 25, 2015 - Views: 1

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Chart Review Template - Oregon Health & Science...

Chart Review Protocol Template Instructions. The protocol template is a tool to facilitate protocol development. It is not intended to supersede the role of the ...

http://www.ohsu.edu/xd/health/services/cancer/research-training/shared-resources/upload/Chart-Review-Template.doc

Date added: October 26, 2011 - Views: 204

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Confidential For Peer Review Purposes Only - GCRAC

form:_____ MR Number ... **ALL “YES” RESULTS ARE FALLOUTS AND REQUIRE REVIEW. Physician reviewer ... Confidential For Peer Review Purposes Only ...

http://www.gcrac.org/wp-content/uploads/2009/05/stroke_pi_indicators_12-09.doc

Date added: September 30, 2013 - Views: 21

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Chart Review Template - NYU Langone Medical Center

The protocol must be reviewed and approved by the NYU Cancer Institute Protocol Review and Monitoring Committee (PRMC) and NYU Institutional Review Board ...

http://webdoc.nyumc.org/nyumc/files/ci/assets/PRMC-Non-Interventional-Protocol-Template.doc

Date added: March 14, 2012 - Views: 73

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COMMUNITY HEALTH CARE, INC - Aspirus Medical Staff

Peer Review: The term “peer ... (e.g., physician, ... documentation will include the elements described in 8.2 accompanied by a final copy of an Initial Review form ...

http://www.aspirusmedicalstaff.org/media/MedicalStaffPeerReviewProcess2011.doc

Date added: May 2, 2013 - Views: 50

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Annual Review for Michael Watson Rural Health...

Annual Review for Michael Watson Rural Health Clinic Author: Alice Makela Last modified by: Marsha Marze Created Date: 10/15/2009 4:58:00 PM Company:

http://adph.org/ruralhealth/assets/AnnualEvaluationFacility.doc

Date added: February 19, 2012 - Views: 57

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POLICY: Operative & Invasive Procedures...

The reviews shall be conducted as part of the peer review and quality ... The initial review is completed by a non-physician, ... External Cardiovascular Review Form

https://www.tenethealth.com/docs/default-source/policies/policies---mn/policy---co-5-006_policy_operative_and_invasive.doc?sfvrsn=2

Date added: November 3, 2014 - Views: 5

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Policy and Procedure Approval Form - HCA...

It is inappropriate for Coders to ask multiple questions on one physician query form ... CMS memorandum to the Peer Review ... Policy and Procedure Approval Form ...

http://ec.hcahealthcare.com/CPM/REGSDOC002.doc

Date added: September 25, 2011 - Views: 54

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Model SOP - Quality Assurance/Quality Improvement...

Charts for peer review will be selected at random by the clinic medical clerk/secretary. Five percent (5%) of each provider’s charts (physician, PA, and NP) for ...

https://phc.amedd.army.mil/PHC%20Resource%20Library/PHC_Model_SOP_QA-QI%20_Final.docx

Date added: January 31, 2016 - Views: 1

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www.cme.hsc.usf.edu

OFFICE OF CONTINUING PROFESSIONAL DEVELOPMENT - PEER REVIEW DOCUMENTATION (Tab between fields or print document) Program Title: Program Number: Speaker

http://www.cme.hsc.usf.edu/files/Peer%20Review%20Documentation%20Form%205-13.doc

Date added: September 30, 2013 - Views: 1

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Policy and Procedure Approval Form - HCA...

CMS memorandum to the Peer Review Organizations entitled “Use of Physician Query Form” with Policy Clarification of Temporary Suspension of January 22, ...

http://ec.hcahealthcare.com/CPM/REGSCOD012%20REV%203-6-06.doc

Date added: February 4, 2012 - Views: 41

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PROCTOR REPORT - Lucile Packard Children's...

Confidential Peer Review Document. INSTRUCTIONS TO PROCTOR: ... Please keep this Proctor Report form with you at all times while in the hospital.

https://intranet.lpch.org/mss/pdf/Evaluation%20of%20Chart%20Reviews%20and%20Observations%20for%20LPCH.doc

Date added: February 14, 2012 - Views: 11

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PEER REVIEWER IDENTIFICATION SURVEY - toa.org

The form . MUST. be completed by the physician as there are questions that only the physician can ... Did the Peer Review explain rationale for denying or approving ...

http://www.toa.org/_forms/PEER_REVIEWER_ID_Survey-e-form.doc

Date added: April 29, 2016 - Views: 1

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10: QA /I QUARTERLY PEER REVIEW WORKSHEETS - Ohio

Title: QA/I QUARTERLY PEER REVIEW WORKSHEETS Author: Humenay Last modified by: Dietz Created Date: 7/19/2011 3:30:00 PM Company: ODADAS Other titles

http://mha.ohio.gov/Portals/0/assets/Regulation/LicensureAndCertification/approvedForms/2012%20Peer%20Records%20Review%20Worksheet.doc

Date added: December 5, 2013 - Views: 9