Skip to main content
University of Arkansas for Medical Sciences
Stroke Program
UAMSHealth
Jobs
Giving
Quick Links
Media
Signs of Stroke
Resources
Publications
Events
Community Outreach
Staff
Donate Now
Menu
Media
Signs of Stroke
Resources
Publications
Events
Community Outreach
Staff
Donate Now
Home
Stroke Program
IDHI Stroke Program QI/Peer Review Case Summary
IDHI Stroke Program QI/Peer Review Case Summary
IDHI Stroke Program QI/Peer...
IDHI Stroke Program QI/Peer Review Case Summary
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:
Case Review Date:
- must be mm/dd/yyyy format
MM slash DD slash YYYY
Stroke Band Number:
Determination:
Symptom Related
Disease Related
Provider Related
Other
Other:
Was the event preventable?
Yes
No
Undetermined
Explain:
Were Opportunities for Improvement (OFI’s) identified? (List)
Quality Improvement Actions:
None required
Trend
Guideline or Protocol implemented
Counseling
FYI Letter
Letter with follow up required
Education:
Please specify education:
Corrective Action Plan (if needed):
Re-evaluation Date:
- must be mm/dd/yyyy format
MM slash DD slash YYYY
Loop Closure Date:
- must be mm/dd/yyyy format
MM slash DD slash YYYY
Connect with us:
Facebook
Calendar