EvidenceNOW: Data Submission Form
Resource: Chart Review: Submission for Baseline, 12, & 18 Months (PDF, 148 KB, 2 pages)
This data submission form was used by an EvidenceNOW Cooperative to standardize manual chart audits. Fields include: measure, time period, reason for chart review, reviewer, and selection method.
Institution of origin: Northwestern University
Permissions: Used with the permission of Healthy Hearts in the Heartland.
Acknowledgements: Healthy Hearts in the Heartland, Agency for Healthcare Research and Quality EvidenceNOW Initiative