IDHI Stroke Program QI/Peer Review Participant Form

Purpose: to establish a method for peer reviews of IDHI Stroke Program consults. This is a privileged and confidential document. The contents shall not be disclosed to any person, agency or entity not directly associated with hospital peer review or IDHI Stroke Program peer review quality improvement process.

IDHI Stroke Program QI Peer/Review Members:

Medical Director- Dr. Sanjeeva Onteddu | UAMS IDHI Clinical Program Director - C. Renee Joiner | UAMS IDHI Stroke Program Director - Lorri Berry | QA Coordinator-Calvin Duncan
Occurrence Site:
Neurologist who conducted the consult:
First Last
Call Center operator who facilitated the call:
First Last
Nurse Facilitator at the site:
First Last
ED Physician at the site:
First Last
Accepting physician at receiving site:
First Last
Lead nurse at receiving site:
First Last
EMS Agency representative (when applicable):
IDHI Stroke Program Outreach Nurse assigned to the region to observe:
First Last
IDHI Stroke Program Video Support :
First Last

IDHI Stroke Program QI/Peer Review Participant Form

IDHI Stroke Program QI/Peer Review Participant Form

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