ED-OFORM 002 - 2018-20+ LAMA Clinical Audit

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Date *

YYYY

UHID *

Reason : Personal

Delay in Registration ( GR)

Delay in Triage ( Nursing )

Delay in Initial Assessment (ED Physician)

Delay in arrival of referral Doctor (Specialist )

Delay in the arrival of referral Doctor (Consultant)

Delay due to Other Work Priority of the Doctor.

Delay in Nursing care due to Patient Load/Disaster

Asset(Money)

Unable to make advance payment

Unaffordable cost cited for further treatment

Request denied for later payment

Unavailability of Insurance coverage/RSBY

Resource (Facility)

Lack of bystander when admitted

Non availability of preferred doctor

Non availability of beds (Classic)

Non availability of preferred Room (Deluxe,Diamond,Gold)

Unwillingness to complete high risk consent

On treatment from another hospital

Distance to far from home to BCMCH

Stays near BCMCH hence want only OPD treatment

Prefers another hospital for further treatment

Patient is not native to Thiruvalla

Unwillingness to register for MLC

Other reasons

No Specific reason provided

Personal Problems at home

Children at home without Help

By stander has other Priorities ( Job, Function)

Patient himself staying a bystander

Does not like hospital stay

Fear of admission

Alcoholic

Comments *

Entered By : Name & EMP ID *

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