Sync template from atomicqms-style deployment
This commit is contained in:
0
Forms/Contrast-Records/.gitkeep
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Forms/Contrast-Records/.gitkeep
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Forms/Dose-Logs/.gitkeep
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Forms/Dose-Logs/.gitkeep
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64
Forms/FRM-001-Document-Change-Request.md
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64
Forms/FRM-001-Document-Change-Request.md
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# Document Change Request Form
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| Form ID | FRM-001 | Revision | 1.0 |
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|---------|---------|----------|-----|
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---
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## Section 1: Request Information
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| Field | Entry |
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|-------|-------|
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| Request Date | |
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| Requested By | |
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| Department | |
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## Section 2: Document Information
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| Field | Entry |
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|-------|-------|
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| Document Number | |
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| Document Title | |
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| Current Revision | |
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## Section 3: Change Description
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### Type of Change
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- [ ] New Document
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- [ ] Revision to Existing Document
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- [ ] Document Obsolescence
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### Description of Change
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*(Describe the proposed change in detail)*
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### Reason for Change
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*(Explain why this change is needed)*
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## Section 4: Impact Assessment
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### Affected Areas
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- [ ] Training Required
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- [ ] Other Documents Affected
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- [ ] Process Changes Required
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- [ ] Validation Impact
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### List Affected Documents
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## Section 5: Approvals
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| Role | Name | Signature | Date |
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|------|------|-----------|------|
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| Requester | | | |
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| Document Owner | | | |
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| Quality Assurance | | | |
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---
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*Form FRM-001 Rev 1.0*
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91
Forms/FRM-003-CAPA-Form.md
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Forms/FRM-003-CAPA-Form.md
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# Corrective and Preventive Action (CAPA) Form
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| Form ID | FRM-003 | Revision | 1.0 |
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|---------|---------|----------|-----|
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---
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## Section 1: CAPA Identification
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| Field | Entry |
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|-------|-------|
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| CAPA Number | |
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| Date Initiated | |
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| Initiated By | |
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| CAPA Owner | |
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| Target Closure Date | |
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## Section 2: Classification
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### Type
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- [ ] Corrective Action
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- [ ] Preventive Action
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### Source
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- [ ] Customer Complaint
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- [ ] Internal Audit
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- [ ] External Audit
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- [ ] Process Deviation
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- [ ] Nonconforming Product
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- [ ] Management Review
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- [ ] Other: ____________
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### Priority
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- [ ] Critical (5 business days)
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- [ ] Major (15 business days)
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- [ ] Minor (30 business days)
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## Section 3: Problem Description
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*(Describe the nonconformity or potential nonconformity)*
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## Section 4: Immediate Containment
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*(Actions taken to contain the immediate impact)*
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## Section 5: Root Cause Investigation
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### Investigation Method Used
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- [ ] 5 Whys
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- [ ] Fishbone Diagram
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- [ ] Fault Tree Analysis
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- [ ] Other: ____________
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### Root Cause Determination
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## Section 6: Corrective/Preventive Actions
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| Action | Responsible | Due Date | Status |
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|--------|-------------|----------|--------|
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| | | | |
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| | | | |
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| | | | |
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## Section 7: Effectiveness Verification
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| Criteria | Method | Result |
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|----------|--------|--------|
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| | | |
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Verification Date: ____________
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Verified By: ____________
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## Section 8: Closure
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| Role | Name | Signature | Date |
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|------|------|-----------|------|
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| CAPA Owner | | | |
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| Quality Approval | | | |
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---
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*Form FRM-003 Rev 1.0*
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Forms/FRM-006-Audit-Checklist.md
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Forms/FRM-006-Audit-Checklist.md
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# Internal Audit Checklist
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| Form ID | FRM-006 | Revision | 1.0 |
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|---------|---------|----------|-----|
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---
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## Audit Information
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| Field | Entry |
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|-------|-------|
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| Audit Number | |
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| Audit Date | |
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| Area/Process Audited | |
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| Lead Auditor | |
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| Auditee(s) | |
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---
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## Checklist Items
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| # | Requirement/Question | Reference | C/NC/NA | Evidence/Notes |
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|---|---------------------|-----------|---------|----------------|
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| 1 | Are current versions of applicable procedures available? | SOP-001 | | |
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| 2 | Are personnel trained on applicable procedures? | SOP-003 | | |
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| 3 | Are training records current and complete? | SOP-003 | | |
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| 4 | Are records properly maintained and retrievable? | SOP-001 | | |
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| 5 | Are nonconformities being documented and addressed? | SOP-002 | | |
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| 6 | Are CAPAs being completed on time? | SOP-002 | | |
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| 7 | Is equipment calibrated and maintained? | | | |
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| 8 | Are process controls being followed? | | | |
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| 9 | Are quality objectives being monitored? | | | |
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| 10 | | | | |
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**Legend:** C = Conforming, NC = Nonconforming, NA = Not Applicable
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---
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## Findings Summary
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| Finding # | Type | Description | Clause Reference |
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|-----------|------|-------------|------------------|
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| | | | |
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| | | | |
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---
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## Auditor Signature
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| Auditor | Signature | Date |
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|---------|-----------|------|
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| | | |
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---
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*Form FRM-006 Rev 1.0*
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0
Forms/Patient-Screening/.gitkeep
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0
Forms/Patient-Screening/.gitkeep
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262
Forms/Procedure-Logs/FRM-RAD-001-CT-Procedure-Log.md
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262
Forms/Procedure-Logs/FRM-RAD-001-CT-Procedure-Log.md
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# CT Procedure Log
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| Form ID | FRM-RAD-001 | Revision | 1.0 |
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|---------|-------------|----------|-----|
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---
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## Patient Information
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| Field | Entry |
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|-------|-------|
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| Patient Name | |
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| MRN | |
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| Date of Birth | |
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| Age | |
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| Sex | ☐ Male ☐ Female |
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| Weight | kg / lbs |
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| Height | cm / in |
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---
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## Exam Information
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| Field | Entry |
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|-------|-------|
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| Date of Exam | |
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| Time Start | |
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| Time End | |
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| Ordering Physician | |
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| Exam Type | |
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| Accession Number | |
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| Scanner ID | |
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---
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## Clinical Information
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| Field | Entry |
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|-------|-------|
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| Indication | |
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| Relevant History | |
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| Prior CT exams? | ☐ Yes (Date: _______) ☐ No |
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---
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## Pre-Procedure Screening
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### General Safety
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| Question | Response |
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|----------|----------|
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| Patient identity verified (2 identifiers)? | ☐ Yes |
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| Order verified? | ☐ Yes |
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| Procedure explained to patient? | ☐ Yes |
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| Pregnancy status (if applicable) | ☐ Not pregnant ☐ Pregnant ☐ Unknown ☐ N/A |
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| Metallic implants in scan area? | ☐ Yes (describe: _______) ☐ No |
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### Contrast Screening (if contrast study)
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| Question | Response |
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|----------|----------|
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| Contrast study? | ☐ Yes ☐ No → Skip to Technical Parameters |
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| Previous contrast reaction? | ☐ Yes (describe: _______) ☐ No |
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| Premedication given? | ☐ Yes ☐ No ☐ N/A |
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| Allergies? | ☐ Yes (list: _______) ☐ NKDA |
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| Kidney disease? | ☐ Yes ☐ No |
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| Diabetes? | ☐ Yes ☐ No |
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| Metformin use? | ☐ Yes ☐ No |
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| eGFR/Creatinine | Value: _______ Date: _______ |
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| Adequate renal function? | ☐ Yes ☐ No (radiologist notified) |
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### Consent
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| Field | Entry |
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|-------|-------|
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| Consent obtained? | ☐ Yes ☐ Waived (emergency) |
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| Consent signed by | |
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| Witnessed by | |
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---
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## IV Access (for contrast studies)
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| Field | Entry |
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|-------|-------|
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| IV Access | ☐ Existing ☐ New |
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| Gauge | ☐ 18G ☐ 20G ☐ 22G ☐ Other: |
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| Location | ☐ Right AC ☐ Left AC ☐ Right Hand ☐ Left Hand ☐ Other: |
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| Patency verified | ☐ Yes |
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| Inserted by | |
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---
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## Technical Parameters
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### Protocol Used
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| Field | Entry |
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|-------|-------|
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| Protocol Name | |
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| Body Region | ☐ Head ☐ Neck ☐ Chest ☐ Abdomen ☐ Pelvis ☐ Spine ☐ Extremity ☐ Other |
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| kVp | |
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| mAs (or reference) | |
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| Slice Thickness | mm |
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| Pitch | |
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| Gantry Rotation Time | sec |
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| Scan Mode | ☐ Axial ☐ Helical |
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| Coverage | |
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### Multi-Phase Studies
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| Phase | Delay (sec) | Acquired? |
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|-------|-------------|-----------|
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| Non-contrast | - | ☐ |
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| Arterial | | ☐ |
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| Portal Venous | | ☐ |
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| Delayed | | ☐ |
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| Other: | | ☐ |
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---
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## Contrast Administration
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| Field | Entry |
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|-------|-------|
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| Contrast Agent | |
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| Manufacturer | |
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| Lot Number | |
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| Expiration Date | |
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| Concentration | mgI/mL |
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| Volume Administered | mL |
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| Injection Rate | mL/sec |
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| Injection Method | ☐ Power Injector ☐ Hand Injection |
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| Saline Flush | ☐ Yes Volume: ___mL ☐ No |
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| Warming Used? | ☐ Yes ☐ No |
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### Contrast Timing
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| Field | Entry |
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|-------|-------|
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| Timing Method | ☐ Fixed Delay ☐ Bolus Tracking ☐ Test Bolus |
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| Trigger Location (if tracking) | |
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| Threshold (HU) | |
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| Delay after trigger | sec |
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---
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## Dose Information
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| Metric | Value |
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|--------|-------|
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| CTDIvol | mGy |
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| DLP | mGy·cm |
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| Scan Length | cm |
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| Number of Series | |
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**Dose within reference level?** ☐ Yes ☐ No (explain: _______)
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---
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## Image Quality Assessment
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| Criterion | Satisfactory? |
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|-----------|---------------|
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| Positioning correct | ☐ Yes ☐ No |
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| Coverage adequate | ☐ Yes ☐ No |
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| No significant motion artifact | ☐ Yes ☐ No |
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| Contrast enhancement adequate (if applicable) | ☐ Yes ☐ No ☐ N/A |
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| Noise level acceptable | ☐ Yes ☐ No |
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**Overall Technical Quality:** ☐ Diagnostic ☐ Limited ☐ Non-diagnostic
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**If limited/non-diagnostic, explain:**
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**Repeat acquisition required?** ☐ Yes ☐ No
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---
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## Patient Monitoring (Contrast Studies)
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### During Injection
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| Time | BP | HR | SpO2 | Symptoms |
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|------|----|----|------|----------|
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| Pre-injection | | | | |
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| Post-injection | | | | |
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### Post-Procedure Observation
|
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| Field | Entry |
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|-------|-------|
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| Observation time | minutes |
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| Any adverse reactions? | ☐ Yes (complete Reaction section) ☐ No |
|
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| IV site condition at removal | ☐ Normal ☐ Swelling ☐ Erythema ☐ Extravasation |
|
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|
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---
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|
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## Adverse Reaction (if occurred)
|
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|
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| Field | Entry |
|
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|-------|-------|
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| Time of onset | |
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| Type of reaction | ☐ Mild ☐ Moderate ☐ Severe |
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| Symptoms | |
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| Treatment given | |
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| Outcome | ☐ Resolved ☐ Transferred for care |
|
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| Radiologist notified | ☐ Yes Time: |
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| Adverse Event Report filed | ☐ Yes Report #: |
|
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|
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---
|
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|
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## Extravasation (if occurred)
|
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|
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| Field | Entry |
|
||||
|-------|-------|
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| Estimated volume extravasated | mL |
|
||||
| Location | |
|
||||
| Symptoms | ☐ Pain ☐ Swelling ☐ Erythema ☐ Blistering |
|
||||
| Treatment | ☐ Elevation ☐ Ice ☐ Warm compress ☐ Other |
|
||||
| Follow-up instructions given | ☐ Yes |
|
||||
| Incident report filed | ☐ Yes |
|
||||
|
||||
---
|
||||
|
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## Post-Procedure
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Patient condition at discharge | ☐ Stable ☐ Other: |
|
||||
| Instructions provided | ☐ Hydration ☐ Metformin hold ☐ Reaction warning signs ☐ Other |
|
||||
| Images sent to PACS | ☐ Yes |
|
||||
| Priority | ☐ Routine ☐ Urgent ☐ STAT |
|
||||
|
||||
---
|
||||
|
||||
## Special Circumstances/Notes
|
||||
|
||||
---
|
||||
|
||||
## Technologist Attestation
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Technologist Name | |
|
||||
| RT(R)(CT) # | |
|
||||
| Signature | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
|
||||
---
|
||||
|
||||
## Radiologist Review (if applicable at time of exam)
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Radiologist Name | |
|
||||
| Preliminary Findings | |
|
||||
| Signature | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-RAD-001 Rev 1.0 - CT Procedure Log*
|
||||
0
Forms/Protocol-Sheets/.gitkeep
Normal file
0
Forms/Protocol-Sheets/.gitkeep
Normal file
0
Forms/QC-Records/.gitkeep
Normal file
0
Forms/QC-Records/.gitkeep
Normal file
72
Forms/Training/FRM-004-Training-Record.md
Normal file
72
Forms/Training/FRM-004-Training-Record.md
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@@ -0,0 +1,72 @@
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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 | | | |
|
||||
|
||||
---
|
||||
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*Form FRM-004 Rev 1.0*
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Reference in New Lab Ticket
Block a user