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Medical Record Audit Form Template

Streamline Your Medical Record Evaluation Process

Incomplete or inaccurate medical records can lead to significant compliance issues and impact patient care. This Medical Record Audit Form Template helps healthcare professionals ensure the quality and accuracy of your records, aligning with industry standards. You'll benefit from easy tracking of audit findings, streamlined reporting processes, and effective compliance with regulations, all while saving time and reducing errors. Explore this live template to gain confidence in your auditing practices.

Audit date
Auditor full name
Facility or department
Medical record number or patient identifier
Encounter type
Inpatient
Outpatient
Emergency
Observation
Telehealth
Other
Please Specify:
Patient name is consistent with the medical record number across the record
Yes
No
Unable to determine
Date of birth is documented
Yes
No
Unable to determine
Two patient identifiers are present where required (e.g., name and DOB)
Yes
No
Not applicable
Unable to determine
Consent to treat is documented for this encounter
Yes
No
Not applicable
Unable to determine
Chief complaint is documented
Yes
No
Not applicable
Unable to determine
History of present illness (HPI) documentation completeness
Complete
Partial
Not documented
Not applicable
Unable to determine
Allergies (or NKDA/NKA) are recorded
Yes
No
Not applicable
Unable to determine
Medication reconciliation is completed for this encounter
Yes
No
Not applicable
Unable to determine
Physical examination is documented when indicated
Yes
No
Not applicable
Unable to determine
Orders are authenticated by the provider with date/time
Yes
No
Not applicable
Unable to determine
Test results are reviewed and acknowledgment is documented
Yes
No
Not applicable
Unable to determine
Procedure note includes indication, consent, key findings, complications, and disposition
Complete
Partial
Not documented
Not applicable
Unable to determine
Diagnoses are documented with appropriate specificity and status
Complete
Partial
Not documented
Unable to determine
Plan includes treatment, monitoring, and follow-up instructions
Yes
No
Not applicable
Unable to determine
E/M level is supported by the documentation
Yes
No
Not applicable
Unable to determine
ICD-10 diagnosis codes are consistent with the documentation
Yes
No
Unable to determine
CPT/HCPCS procedure codes are supported by the documentation
Yes
No
Not applicable
Unable to determine
Time-based billing (if used) is justified with total time and activities
Yes
No
Not applicable
Unable to determine
Provider signature is present, legible, and dated
Yes
No
Not applicable
Unable to determine
Entries are dated and time-stamped
Yes
No
Unable to determine
Documentation timeliness relative to policy
Within policy
1-3 days late
4-7 days late
More than 7 days late
Unable to determine
Minimum necessary standard is observed in the documentation
Met
Partially met
Not met
Not applicable
Unable to determine
PHI disclosures are documented appropriately when applicable
Yes
No
Not applicable
Unable to determine
Overall documentation quality for this encounter
Poor
Below average
Average
Good
Exceptional
Likelihood this record would pass internal audit review
0 Not at all likely
1
2
3
4
5 Extremely likely
Key issues identified
Please Specify:
Responsible party for corrective action
Target completion date for corrective action
Additional comments or notes
Corrective action required
Yes
No
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Paper art illustration showcasing a medical record audit form template for FormCreatorAI article

When to use this form

Use this audit form when you need a consistent way to review patient charts for completeness, accuracy, and compliance. It helps clinic managers, coders, and quality teams spot gaps before payer reviews, accreditation visits, or provider onboarding. Run it after an EHR migration, during focused reviews of high-risk services, or as a monthly sample to track trends. Confirm that required authorizations accompany requests using the Medical record release form. For post-stay reviews, verify discharge documents and instructions against the Hospital patient release form. You can also include program-specific elements, such as medication monitoring or lab orders, to match your workflows. The result is cleaner documentation, fewer denials, and faster follow-up.

Must Ask Medical Record Audit Questions

  1. What date range, encounter types, and departments are in scope?

    Defining scope keeps your sample representative and your findings comparable over time. It prevents reviewers from pulling in out-of-scope visits that skew results.

  2. Are patient identifiers, allergies, consents, and clinician signatures present and current?

    Missing basics cause claim edits, safety risks, and privacy issues. Verifying currency reduces rework and speeds release of information.

  3. Do diagnoses, orders, and results align and support medical necessity?

    When orders and results trace back to the stated diagnoses, coders can defend the claim and quality reviewers can validate care. If orders are missing, reference your process and attach the Medical requisition form to close the loop.

  4. Are discharge summaries, follow-up plans, and patient instructions complete and timely?

    Strong discharge documentation supports continuity and reduces readmissions. Timeliness shows compliance with policy and payer rules.

  5. For controlled substances or high-risk care, is required monitoring documented?

    Documented monitoring shows adherence to standards and protects patients. Capture evidence such as lab results using the Urine drug screen form when your policy requires it.

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