OFFICE EVALUATION TOOL
Directions:
Step 1) Choose two to four day sheets (sign-in or appointment logs) from the previous 60 days.
Step 2) Pull the patient medical records from the first 10 patients seen each day. (These are patients seen in your office, not in a hospital or other setting.)
Step 3) Check each medical record for an Arbitration Agreement. If an Agreement is present, continue across the Arbitration Self-Evaluation Tool, checking for the presence/correct completion of each item on the Agreement. Confirm the presence of the required item with a checkmark in the appropriate box on the Self-Evaluation Tool.
Step 4) Continue following instructions in step two and step three above until 25 medical records have been reviewed, not until 25 Arbitration Agreements have been found.
Step 5) Calculate the percentage of agreements completed correctly:
Step 6) Count the number of medical records that have all boxes checked.
Step 7) Divide that number by 25 to get percentage of Arbitration Agreements completed correctly.
Example: 20 (medical records with all boxes checked) divided by 25 (total records reviewed) = 80 percent of Arbitration Agreements reviewed are completed correctly.
