Sync template from atomicqms-style deployment

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# Document Change Request Form
| Form ID | FRM-001 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: Request Information
| Field | Entry |
|-------|-------|
| Request Date | |
| Requested By | |
| Department | |
## Section 2: Document Information
| Field | Entry |
|-------|-------|
| Document Number | |
| Document Title | |
| Current Revision | |
## Section 3: Change Description
### Type of Change
- [ ] New Document
- [ ] Revision to Existing Document
- [ ] Document Obsolescence
### Description of Change
*(Describe the proposed change in detail)*
### Reason for Change
*(Explain why this change is needed)*
## Section 4: Impact Assessment
### Affected Areas
- [ ] Training Required
- [ ] Other Documents Affected
- [ ] Process Changes Required
- [ ] Validation Impact
### List Affected Documents
## Section 5: Approvals
| Role | Name | Signature | Date |
|------|------|-----------|------|
| Requester | | | |
| Document Owner | | | |
| Quality Assurance | | | |
---
*Form FRM-001 Rev 1.0*

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# Corrective and Preventive Action (CAPA) Form
| Form ID | FRM-003 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: CAPA Identification
| Field | Entry |
|-------|-------|
| CAPA Number | |
| Date Initiated | |
| Initiated By | |
| CAPA Owner | |
| Target Closure Date | |
## Section 2: Classification
### Type
- [ ] Corrective Action
- [ ] Preventive Action
### Source
- [ ] Customer Complaint
- [ ] Internal Audit
- [ ] External Audit
- [ ] Process Deviation
- [ ] Nonconforming Product
- [ ] Management Review
- [ ] Other: ____________
### Priority
- [ ] Critical (5 business days)
- [ ] Major (15 business days)
- [ ] Minor (30 business days)
## Section 3: Problem Description
*(Describe the nonconformity or potential nonconformity)*
## Section 4: Immediate Containment
*(Actions taken to contain the immediate impact)*
## Section 5: Root Cause Investigation
### Investigation Method Used
- [ ] 5 Whys
- [ ] Fishbone Diagram
- [ ] Fault Tree Analysis
- [ ] Other: ____________
### Root Cause Determination
## Section 6: Corrective/Preventive Actions
| Action | Responsible | Due Date | Status |
|--------|-------------|----------|--------|
| | | | |
| | | | |
| | | | |
## Section 7: Effectiveness Verification
| Criteria | Method | Result |
|----------|--------|--------|
| | | |
Verification Date: ____________
Verified By: ____________
## Section 8: Closure
| Role | Name | Signature | Date |
|------|------|-----------|------|
| CAPA Owner | | | |
| Quality Approval | | | |
---
*Form FRM-003 Rev 1.0*

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# Internal Audit Checklist
| Form ID | FRM-006 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Audit Information
| Field | Entry |
|-------|-------|
| Audit Number | |
| Audit Date | |
| Area/Process Audited | |
| Lead Auditor | |
| Auditee(s) | |
---
## Checklist Items
| # | Requirement/Question | Reference | C/NC/NA | Evidence/Notes |
|---|---------------------|-----------|---------|----------------|
| 1 | Are current versions of applicable procedures available? | SOP-001 | | |
| 2 | Are personnel trained on applicable procedures? | SOP-003 | | |
| 3 | Are training records current and complete? | SOP-003 | | |
| 4 | Are records properly maintained and retrievable? | SOP-001 | | |
| 5 | Are nonconformities being documented and addressed? | SOP-002 | | |
| 6 | Are CAPAs being completed on time? | SOP-002 | | |
| 7 | Is equipment calibrated and maintained? | | | |
| 8 | Are process controls being followed? | | | |
| 9 | Are quality objectives being monitored? | | | |
| 10 | | | | |
**Legend:** C = Conforming, NC = Nonconforming, NA = Not Applicable
---
## Findings Summary
| Finding # | Type | Description | Clause Reference |
|-----------|------|-------------|------------------|
| | | | |
| | | | |
---
## Auditor Signature
| Auditor | Signature | Date |
|---------|-----------|------|
| | | |
---
*Form FRM-006 Rev 1.0*

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# New Patient Registration Form
| Form ID | FRM-OPT-001 | Revision | 1.0 |
|---------|-------------|----------|-----|
---
## Patient Information
| Field | Entry |
|-------|-------|
| Last Name | |
| First Name | |
| Middle Name/Initial | |
| Preferred Name | |
| Date of Birth | |
| Age | |
| Sex | ☐ Male ☐ Female ☐ Other |
| Social Security # (last 4) | XXX-XX-_____ |
### Contact Information
| Field | Entry |
|-------|-------|
| Street Address | |
| Apartment/Unit | |
| City | |
| State | |
| Zip Code | |
| Home Phone | |
| Cell Phone | |
| Work Phone | |
| Preferred Contact Method | ☐ Home ☐ Cell ☐ Work ☐ Email |
| Email Address | |
| OK to Leave Message? | ☐ Yes ☐ No |
### Additional Information
| Field | Entry |
|-------|-------|
| Marital Status | ☐ Single ☐ Married ☐ Divorced ☐ Widowed ☐ Partnered |
| Race/Ethnicity (optional) | |
| Preferred Language | |
| Interpreter Needed? | ☐ Yes (Language: _______) ☐ No |
| Employer | |
| Occupation | |
---
## Emergency Contact
| Field | Entry |
|-------|-------|
| Name | |
| Relationship | |
| Home Phone | |
| Cell Phone | |
| Work Phone | |
---
## Primary Care Information
| Field | Entry |
|-------|-------|
| Primary Care Physician | |
| Practice Name | |
| Phone Number | |
| Fax Number | |
| Address | |
| Date of Last Visit | |
---
## Referring Provider (if applicable)
| Field | Entry |
|-------|-------|
| Referring Physician | |
| Practice Name | |
| Phone Number | |
| Fax Number | |
| Reason for Referral | |
---
## Insurance Information
### Primary Insurance
| Field | Entry |
|-------|-------|
| Insurance Company | |
| Policy/ID Number | |
| Group Number | |
| Policy Holder Name | |
| Policy Holder DOB | |
| Relationship to Patient | ☐ Self ☐ Spouse ☐ Child ☐ Other: _______ |
| Insurance Phone | |
### Secondary Insurance (if applicable)
| Field | Entry |
|-------|-------|
| Insurance Company | |
| Policy/ID Number | |
| Group Number | |
| Policy Holder Name | |
| Policy Holder DOB | |
| Relationship to Patient | ☐ Self ☐ Spouse ☐ Child ☐ Other: _______ |
| Insurance Phone | |
---
## Responsible Party (if different from patient)
| Field | Entry |
|-------|-------|
| Name | |
| Relationship to Patient | |
| Date of Birth | |
| Address (if different) | |
| Phone Number | |
| Email | |
---
## Pharmacy Information
| Field | Entry |
|-------|-------|
| Preferred Pharmacy Name | |
| Address | |
| Phone Number | |
| Cross Street/Location | |
| Preferred Mail Order Pharmacy | |
---
## Medical History Summary
### Current Medications
*List all current medications including over-the-counter and supplements*
| Medication Name | Dose | Frequency |
|-----------------|------|-----------|
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
### Allergies
☐ No Known Allergies (NKA)
| Allergen | Type | Reaction |
|----------|------|----------|
| | ☐ Drug ☐ Food ☐ Other | |
| | ☐ Drug ☐ Food ☐ Other | |
| | ☐ Drug ☐ Food ☐ Other | |
### Medical Conditions
*Check all that apply*
| Condition | ☐ | Condition | ☐ |
|-----------|---|-----------|---|
| Arthritis | | Liver Disease | |
| Asthma | | Lung Disease/COPD | |
| Cancer | | Mental Health Condition | |
| Diabetes | | Seizures/Epilepsy | |
| Heart Disease | | Stroke/TIA | |
| High Blood Pressure | | Thyroid Disease | |
| High Cholesterol | | Other: _____________ | |
| Kidney Disease | | Other: _____________ | |
### Surgical History
| Surgery/Procedure | Year |
|-------------------|------|
| | |
| | |
| | |
---
## Social History
| Field | Entry |
|-------|-------|
| Tobacco Use | ☐ Never ☐ Current ☐ Former (Quit year: _____) |
| If yes, type/amount | |
| Alcohol Use | ☐ None ☐ Social ☐ Daily |
| If yes, type/amount | |
| Exercise | ☐ None ☐ Light ☐ Moderate ☐ Vigorous |
| Frequency | times per week |
---
## How Did You Hear About Us?
☐ Physician Referral: _________________
☐ Insurance Directory
☐ Internet Search
☐ Social Media
☐ Friend/Family Member
☐ Other: _________________
---
## Acknowledgments
### Financial Policy
☐ I have read and understand the financial policy. I authorize payment directly to this practice of any insurance benefits otherwise payable to me. I understand that I am responsible for any amount not covered by insurance.
### Privacy Practices
☐ I have received a copy of the Notice of Privacy Practices and understand how my health information may be used and disclosed.
### Release of Information
☐ I authorize the release of medical information necessary to process insurance claims and for continuity of care with referring and consulting physicians.
### Communication Authorization
☐ I authorize communication via: ☐ Phone ☐ Email ☐ Text Message for appointment reminders and health information.
### Assignment of Benefits
☐ I authorize payment of medical benefits to this practice for services rendered.
---
## Patient Portal
☐ I would like to enroll in the patient portal
| Field | Entry |
|-------|-------|
| Preferred Email for Portal | |
---
## Signature
| Field | Entry |
|-------|-------|
| Patient/Guardian Signature | |
| Printed Name | |
| Relationship (if not patient) | |
| Date | |
---
## For Office Use Only
| Field | Entry |
|-------|-------|
| Date Received | |
| Entered By | |
| Chart Number | |
| Insurance Verified | ☐ Yes |
| Copay Collected | $ |
| Notes | |
---
*Form FRM-OPT-001 Rev 1.0 - New Patient Registration Form*

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# Training Record Form
| Form ID | FRM-004 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: Employee Information
| Field | Entry |
|-------|-------|
| Employee Name | |
| Employee ID | |
| Department | |
| Job Title | |
## Section 2: Training Information
| Field | Entry |
|-------|-------|
| Training Title | |
| Training Date | |
| Training Duration | |
| Trainer Name | |
| Trainer Qualification | |
### Training Type
- [ ] Initial Training
- [ ] Retraining
- [ ] Refresher
- [ ] Procedure Update
### Delivery Method
- [ ] Classroom
- [ ] On-the-Job
- [ ] Self-Study
- [ ] Computer-Based
- [ ] Other: ____________
## Section 3: Training Content
*(List topics covered or attach training materials)*
## Section 4: Assessment
### Assessment Method
- [ ] Written Test
- [ ] Practical Demonstration
- [ ] Verbal Assessment
- [ ] Observation
### Assessment Results
| Metric | Result |
|--------|--------|
| Score (if applicable) | |
| Pass/Fail | |
## Section 5: Signatures
| Role | Name | Signature | Date |
|------|------|-----------|------|
| Trainee | | | |
| Trainer | | | |
| Supervisor | | | |
---
*Form FRM-004 Rev 1.0*

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