STUDENT HEALTH CENTER PEER REVIEW Instructions: Check each box as: Y/N (Yes/No) N/A (not applicable) Write all comments on back	DATE
	NAME
1. Allergies and drug sensitivities are clearly and consistently recorded on chart front.
2. Chronic medications and chronic problems with dates are recorded on problem list.
3. Immunizations are documented on face sheet or on Immunization Record.
4. Medication allergies and current medications used are documented on progress notes/flow sheets.
5. Record is legible to staff.
6. Blood pressure is recorded within one year of this visit.
7. The history is adequate based on the chief complaint and other chart entries.
8. The physical exam is appropriate.
9. The diagnoses are appropriate.
10. The diagnostic tests are appropriate based on the H & P.
11. Treatment is consistent with the working Dx.
12. Treatment is cost effective.
13. Appropriate follow-up plan is documented.
14. Telephone advice and/or patient education is documented.
15. Lab and radiology reports are recorded.
16. Consultations and referrals are appropriate and timely.
17. Additional comments. (If checked, write on back)
Signature of Reviewee		Date:	Medical Supervisor	Date:

Name of Reviewee: Name of Reviewer: Date:

Peer Review (4/6/04)