Bombay Hospital ,Indore
MEDICAL RECORD AUDIT
AUDIT REPORT FOR: JAN 2022
Submitted to: Date:
Submitted by: Date:
TITLE OF THE AUDIT: Medical Record Audit
BACKGROUND INFORMATION:
Were there any Risk Management issues involved? YES / NO
If yes, please elaborate:
Participants in Audit Design:
Name Designation Department Signature
Evidence-based criteria/standards:
As per NABH standards / WHO standards
Objectives Of The Audit:
Methodology: Random sampling of __________
Findings:
Analysis: (Root Cause Analysis, Parero, Fish-bone, etc.)
Corrective Action: (Taken based on the findings and analysis)
Preventive Action: (To ensure non-recurrence)
References:
1. NABH guidelines 5th Edition HCO Standards.
2. Any others: ________________________________