Physical Setting and Safety Standards

1. Office is accessible to the disabled-parking, entrance, restrooms, hallways, elevators

2. Office appearance is clean and organized

3. Waiting area has adequate seating

4. Exam room/consulting office design ensures privacy

5. Exam rooms have adequate lighting, sink w/running water or 60% alcohol-based hand solution, if applicable.

6. There are provisions for appropriate disposal of bio-hazardous materials/waste

7. Exit signs visible

8. Fire/disaster evacuation routes posted

9. Visible, charged fire extinguisher

10. Staff trained to manage emergencies. i.e. environmental/medical

11. The clinic has a preventive maintenance program to ensure that all essential mechanical, electrical and patient-care equipment is maintained and in safe operating condition.

12. Controlled drugs are properly handled-locked cabinet, log maintained

13. Sample drugs, rx pads, needles/syringes only available in restricted area

14. Policy and Procedure for expired and discarding medications

15. Patient/member Rights and Responsibilities posted in plain sight

Provision of Services

16. The clinic’s policies include a description of the services the clinic furnishes directly, (scope of service) and those furnished through agreement or arrangement.

17. The clinic’s policies include guidelines for the medical management of health problems which include treatment protocols.

Program Evaluation

18. The clinic carries out, or arranges for, an annual evaluation of its total program.

19. The clinic conducts an evaluation to determine whether the utilization of services were appropriate.

Complaint Monitoring

20. Evidence of files maintained and investigated with results and resolution.

Lab On Site (Yes)

21. Current CLIA certificate is displayed   

22. Written policies and procedures

23. Equipment maintenance log available

Lab On Site (No)

24. Certificate of CLIA waiver available

25. Written policies and procedures

Pharmacy On Site (Yes)

26. Registered pharmacist oversees the pharmacy

27. If no registered pharmacist, written policies/procedure or process for oversight