Administrative Forms

Numeric Order

• A001 Equipment Maintenance Log
• A002 Laser Safety Checklist
• A003 Fax-Cover Sheet PMC
• A004 PMC Cleaning Checklist
• A005 Controlled Substance Administration Record
• A006 Tuttnauer 3870EA Sterilization Maintenance Log
• A007 Sterilization Load Log
• A008 Cleaning Log
• A009 Refrigerator Temperature Log
• A010 Needle and Sponge Count Sheet
• A011 New Product Evaluation Form
• A012 Multistix 10SG Quality Control Log
• A013 Drill Performance Summary
• A014 AED Daily Check Log
• A015 Surgical Safety CheckList
• A016 Employee Reimbursement Form
• A017 Controlled Substances Inventory Record
• A018 Immediate Use Sterilization Log
• A019 Fire Evaluation Tool
• A020 Fire Risk Assessment Form
• A021 Patient Transfer Form
• A022 Clinitest hCG Pregnancy Test Control Log
• A023 Variance Incident Report Form
• A024 Request to Observe Care
• A025 Routine Anesthesia Peer Review
• A026 Routine Surgeon Peer Review
• A027 Annual Peer Review Worksheet
• A028 Key Assignment Log
• A029 Business Associate Agreement
• A030 Verify Test Washer Weekly Log
• A031 Rapid Attest BI 1292 Log
• A032 Medical Record Audit Tool
• A033 Miele G7899 Washer Disinfector Maintenance Log
• A034 Credentialing Recredentialing Checklist
• A035 Evencare G3 Blood Glucose Quality Control Log
• A036 Monthly Medication Expiration Date Check Log
• A037 Authorization to Release PHI
• A038 Routine Anesthesia Peer Review Quarterly Summary
• A039 Routine Surgeon Peer Review Quarterly Summary
• A040 Sterile Processing Storage Monthly Audit Log
• A041 Environmental Temperature Log
• A042 Eye Wash Weekly Log
• A043 Emergency Exit Light Test Monthly Log
• A044 Medical Record Tracer Log
• A045 CO Detector Weekly Log
• A046 Visitor Sign In Sheet
• A047 Oxygen Tank Inventory Log
• A048 Refund Request Form
• A052 Credit Card Authorization Form

Personnel Forms

• P002 Time Schedule Template