Referral Form Page 6

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UNIVERSITY DENTAL CENTER
RYAN WHITE PROGRAM
DENTAL RECORD REVIEW ACTION PLAN
According to the UMDNJ – New Jersey Dental School Standards of Care
DENTAL RECORDS
All dental school records will be maintained in a manner that
is current, detailed, organized, and permit effective and
confidential patient care and quality review.
Indicator: At least 90 percent of items reviewed on the chart audit were correct.
Performance Improvement Actions
Performance Review Measure #1:
Number of Client Dental Records Reviewed:
Percentage Correct for Period 1/1/-- thru 12/31/--:
Key Action Steps/Activities
Person(s) Responsible
1.
2.
Performance Review Measure #2:
Number of Client Dental Records Reviewed:
Percentage Correct for Period 1/1/-- thru 12/31/--:
Key Action Steps/Activities
Person(s) Responsible
1.
2.
Performance Review Measure #3:
Number of Client Dental Records Reviewed:
Percentage Correct for Period 1/1/-- thru 12/31/--:
Key Action Steps/Activities
Person(s) Responsible
1.
2.
Performance Review Measure #4:
Number of Client Dental Records Reviewed:
Percentage Correct for Period 1/1/-- thru 12/31/--:
Key Action Steps/Activities
Person(s) Responsible
1.
2.
3.
_________________________________
______________________________
Signature
Date
_________________________________
Print Name
6 - University of Medicine and Dentistry of New Jersey, NJ Dental School 973.972.0190
Tool Posted in the Ryan White TARGET Center TA Library,

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