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Administrative Staff Chart Checklist
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Admin Team Being Audited
*
Choose
Lewis Center Staff
Date of Encounter
*
MM
/
DD
/
YYYY
Initials of Patient
*
Your answer
Most Recent Office Policy Form is Uploaded
*
Yes
No
Current Year Insurance Card is Uploaded
*
Yes
No
N/A
ID is Uploaded
*
Yes
No
Insurance Information is Updated Quarterly
*
Yes
No
Consent for Online/Virtual Mental Health Treatment is Uploaded
*
Yes
No
N/A - patient is not doing virtual visits
Any Correspondence Sent to Patient is Professional Looking and Properly Formatted
*
Yes
No
N/A
No End Date is Entered in the Insurance Information Field
*
Yes
No
Team Leader Completing the Audit:
*
Bonne Demboski
Matthew Lowe, DO
Cilla Mathys
Required
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