Chart Audit Form (Page 2 of 3) in pdf

Chart Audit Form Page 2

Exhibit 4-J

B. Nutrition and Breastfeeding

Education

1. Initial Education

a. Initial education is documented.

b. INCP documentation is apparent.

2. Substance Abuse Education is documented.

3. Documentation of Breastfeeding promotion

present for pregnancy certification (or reason

breastfeeding was not promoted).

4. Additional Education

a. “Other” additional education contact is

documented.

b. Infant contacts at quarterly rate are

documented.

c. INCP follow-up documentation apparent.

5. Nutrition Ed.

a. Nutrition Education is related to nutritional

need.

b. Nutrition Education reflects integration of

information collected during assessments.*

6. For participants with many education needs,

education reflects the highest priority needs.*

7. Documentation of Nutrition Education

a. Documentation of each nutrition education

contact is complete, capturing necessary

details.*

b. Documentation provides for continuity

of care.*

8. Referrals for health, social and food resources

are documented and appropriate.

*Quality Assurance items. Other items (those without *) are part of the WIC Federal Regulations.

9/7/11

4.J-2

Chart Audit Form Page 2