IDHI Stroke Program QI/Peer Case Review

This is a privileged and confidential document. The contents shall not be disclosed to any person, agency or entity not directly associated with the hospital peer review or the quality improvement process.

Reporting Facility or Agency:
Date of Occurrence: - must be mm/dd/yyyy format
MM slash DD slash YYYY
Patient Name:
First Last
Patient Outcome:
Stroke Band #:
Source of findings: (staff, individual observation, chart, EMS documentation, patient complaint, other):
Additional Documentation for Upload:
Max. file size: 74 MB.
Findings at the reporting facility or agency:
Discussion and Recommendations by QI/Peer Review group:
(See Summary page for areas of potential Opportunities for Improvement and follow up plan)

IDHI Stroke Program QI/Peer Case Review

IDHI Stroke Program QI/Peer Case Review

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