Worksheet for Assessing Current Preventive Services


Preventive Services Provided

What preventive care do we currently provide our patients?

_____________________________________________________________________

_____________________________________________________________________

Do we provide preventive services for which each patient is eligible?

_____________________________________________________________________

_____________________________________________________________________

What services are we documenting?

_____________________________________________________________________

_____________________________________________________________________

 

Existing Systems for Providing Preventive Services

What policies and procedures do we have in place for providing preventive services?

_____________________________________________________________________

_____________________________________________________________________

What forms and systems are we using?

_____________________________________________________________________

_____________________________________________________________________

How does our current physical environment support or inhibit our delivery of preventive services?

_____________________________________________________________________

_____________________________________________________________________

What preventive services delivery systems have worked? Why?

_____________________________________________________________________

_____________________________________________________________________

What preventive services delivery systems have not worked? Why?

_____________________________________________________________________

_____________________________________________________________________

What can we do differently?

_____________________________________________________________________

_____________________________________________________________________

Will the PPIP system duplicate the work we are already doing?

_____________________________________________________________________

_____________________________________________________________________

 

Staff Roles

What functions do staff currently serve in the provision of preventive care?

_____________________________________________________________________

_____________________________________________________________________

Who is documenting the delivery of preventive services?

_____________________________________________________________________

_____________________________________________________________________

 

Patient Flow

How does our current patient flow support or inhibit our delivery of preventive services?

_____________________________________________________________________

_____________________________________________________________________

 


Return to Document