Std Medical Record Audit Tool Template Page 3
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3STD Medical Record Audit Tool
AUDIT DATE: ______________________
County: ______________________________
MONITOR: ________________________
Chart Number
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Evidence of Service Integration
Family Planning
Women’s Health/Men’s Health Clinic
Immunizations
DIS
Social Service
Community Support Group
Medical Home
Other
Billing and Coding
ERRN time is documented in minutes and units
Billing Sheet reflects correct coding with ICD-
9/ICD-10 and CPT codes
MONITOR’S COMMENTS: Please list chart number before each comment.
Page 3 of 3
N.C. Division of Public Health
Epidemiology Section
Communicable Disease Branch
DHHS EPI STD Medical Record Audit Tool-Draft
March 2013
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