Facility Site Review Binder

The following documents are designed to help CenCal Health providers prepare for an upcoming site review. If you have questions regarding these materials please contact Health Services QI Coordinator at (805) 562-1628.


Site Review Guidelines
Medical Record Review Guidelines
PARS Tool Attachment C
Cidex Efficacy
Glucometer Quality Control
Hemacue Quality Control 
Hearing & Vision Screening
Temperature Log Fahrenheit
Temperature Log Celsius 
Medical Waste Mailback Sources 
Medical Waste Treatment
Adult Immunization Record 
CDC Vaccine Abbreviations
Vaccine Information Statements
Facility Site Pre-Audit Checklist
Sharps Injury Log 
Emergency Medication Dosage Chart 
Patient Referral Tracking Log
California Tuberculosis (TB) Risk Assessment
Posting for Doctor's Office
Cidex Log
Biological Indicator Spore Testing Procedure

Please note:
A Staying Healthy Assessment (SHA) must be completed as part of the Initial Health Assessment, or new patient exam, within 120 days of member's enrollment in CenCal Health.  A new SHA form must also be completed whenever the patient enters a new age group. It is recommended that the form be reviewed by the PCP at annual check-ups. More information about the requirement and resources for implementation, including forms for each age group, can be found at the DHCS website: www.dhcs.ca.gov/formsandpubs/forms/pages/stayinghealthy.aspx 

Sample Binder: Office P&P & Staff Training