Manual Chart Review Sheet
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3Manual Chart Review Sheet
Report Date: July 1, 2015 – June 30, 2016
Demographic Data:
Audit Date/Auditor Initials _____________________ Chart Number ___________________
Date of Birth _______________ (mm/dd/yyyy) Age ______ Sex ___________ (M/F)
Note: There are new measures and changes to existing measure logic
in FY 2016. Please see Clinical Reporting System v 16.1
Manual for additional measure details.
Audit Result
Diabetes
Diabetes Diagnosed: Has this patient been diagnosed with Diabetes at any
Yes
No
time before the end of the report period?
(Note: The denominator for the Diabetes Diagnosed measure is the User
population. However, the result for this measure is not the same as the “Active
Diabetic Population” which is the denominator for most other diabetes measures.
See below for the definition of the Active Diabetic Population).
User Population Patients:
Documented A1c: Does the patient have a documented A1c during the report
Yes
No
period, regardless of result?
Good Glycemic Control: Does the patient have an A1c value less than (<) 8.0
Yes
No
during the report period?
Controlled BP: Does the patient have controlled blood pressure (less than (<)
Yes
No
140/90) during the report period? (note: only 1 BP reading is required in the
report period)
Nephropathy Assessed: Does the patient have an estimated GFR with result
Yes
No
AND a UACR (not dipstick) during the report period OR evidence of diagnosis
and/or treatment of ESRD at any time before the end of the report period?
Active Diabetic Patients: (all Active Clinical patients diagnosed with diabetes
prior to the report period, and at least two visits during the report period, and two
DM-related visits ever).
Statin Therapy*: Is the patient an active diabetic patient age 40-75, or age 21
and older with documented CVD or an LDL greater than or equal to (>=) 190?
And if so, is the patient a statin therapy user or did they receive an order
(prescription) to receive statin therapy at any point during the Report Period?
*Please note that this measure has a different, more specific denominator than
the other diabetes care measures. (New measure in FY 2016)
Yes
No
Active Diabetic Patients age 40-75 or age 21 and older with documented
CVD or LDL greater than or equal to 190:
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