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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# CT Procedure Log
| Form ID | FRM-RAD-001 | Revision | 1.0 |
|---------|-------------|----------|-----|
---
## Patient Information
| Field | Entry |
|-------|-------|
| Patient Name | |
| MRN | |
| Date of Birth | |
| Age | |
| Sex | ☐ Male ☐ Female |
| Weight | kg / lbs |
| Height | cm / in |
---
## Exam Information
| Field | Entry |
|-------|-------|
| Date of Exam | |
| Time Start | |
| Time End | |
| Ordering Physician | |
| Exam Type | |
| Accession Number | |
| Scanner ID | |
---
## Clinical Information
| Field | Entry |
|-------|-------|
| Indication | |
| Relevant History | |
| Prior CT exams? | ☐ Yes (Date: _______) ☐ No |
---
## Pre-Procedure Screening
### General Safety
| Question | Response |
|----------|----------|
| Patient identity verified (2 identifiers)? | ☐ Yes |
| Order verified? | ☐ Yes |
| Procedure explained to patient? | ☐ Yes |
| Pregnancy status (if applicable) | ☐ Not pregnant ☐ Pregnant ☐ Unknown ☐ N/A |
| Metallic implants in scan area? | ☐ Yes (describe: _______) ☐ No |
### Contrast Screening (if contrast study)
| Question | Response |
|----------|----------|
| Contrast study? | ☐ Yes ☐ No → Skip to Technical Parameters |
| Previous contrast reaction? | ☐ Yes (describe: _______) ☐ No |
| Premedication given? | ☐ Yes ☐ No ☐ N/A |
| Allergies? | ☐ Yes (list: _______) ☐ NKDA |
| Kidney disease? | ☐ Yes ☐ No |
| Diabetes? | ☐ Yes ☐ No |
| Metformin use? | ☐ Yes ☐ No |
| eGFR/Creatinine | Value: _______ Date: _______ |
| Adequate renal function? | ☐ Yes ☐ No (radiologist notified) |
### Consent
| Field | Entry |
|-------|-------|
| Consent obtained? | ☐ Yes ☐ Waived (emergency) |
| Consent signed by | |
| Witnessed by | |
---
## IV Access (for contrast studies)
| Field | Entry |
|-------|-------|
| IV Access | ☐ Existing ☐ New |
| Gauge | ☐ 18G ☐ 20G ☐ 22G ☐ Other: |
| Location | ☐ Right AC ☐ Left AC ☐ Right Hand ☐ Left Hand ☐ Other: |
| Patency verified | ☐ Yes |
| Inserted by | |
---
## Technical Parameters
### Protocol Used
| Field | Entry |
|-------|-------|
| Protocol Name | |
| Body Region | ☐ Head ☐ Neck ☐ Chest ☐ Abdomen ☐ Pelvis ☐ Spine ☐ Extremity ☐ Other |
| kVp | |
| mAs (or reference) | |
| Slice Thickness | mm |
| Pitch | |
| Gantry Rotation Time | sec |
| Scan Mode | ☐ Axial ☐ Helical |
| Coverage | |
### Multi-Phase Studies
| Phase | Delay (sec) | Acquired? |
|-------|-------------|-----------|
| Non-contrast | - | ☐ |
| Arterial | | ☐ |
| Portal Venous | | ☐ |
| Delayed | | ☐ |
| Other: | | ☐ |
---
## Contrast Administration
| Field | Entry |
|-------|-------|
| Contrast Agent | |
| Manufacturer | |
| Lot Number | |
| Expiration Date | |
| Concentration | mgI/mL |
| Volume Administered | mL |
| Injection Rate | mL/sec |
| Injection Method | ☐ Power Injector ☐ Hand Injection |
| Saline Flush | ☐ Yes Volume: ___mL ☐ No |
| Warming Used? | ☐ Yes ☐ No |
### Contrast Timing
| Field | Entry |
|-------|-------|
| Timing Method | ☐ Fixed Delay ☐ Bolus Tracking ☐ Test Bolus |
| Trigger Location (if tracking) | |
| Threshold (HU) | |
| Delay after trigger | sec |
---
## Dose Information
| Metric | Value |
|--------|-------|
| CTDIvol | mGy |
| DLP | mGy·cm |
| Scan Length | cm |
| Number of Series | |
**Dose within reference level?** ☐ Yes ☐ No (explain: _______)
---
## Image Quality Assessment
| Criterion | Satisfactory? |
|-----------|---------------|
| Positioning correct | ☐ Yes ☐ No |
| Coverage adequate | ☐ Yes ☐ No |
| No significant motion artifact | ☐ Yes ☐ No |
| Contrast enhancement adequate (if applicable) | ☐ Yes ☐ No ☐ N/A |
| Noise level acceptable | ☐ Yes ☐ No |
**Overall Technical Quality:** ☐ Diagnostic ☐ Limited ☐ Non-diagnostic
**If limited/non-diagnostic, explain:**
**Repeat acquisition required?** ☐ Yes ☐ No
---
## Patient Monitoring (Contrast Studies)
### During Injection
| Time | BP | HR | SpO2 | Symptoms |
|------|----|----|------|----------|
| Pre-injection | | | | |
| Post-injection | | | | |
### Post-Procedure Observation
| Field | Entry |
|-------|-------|
| Observation time | minutes |
| Any adverse reactions? | ☐ Yes (complete Reaction section) ☐ No |
| IV site condition at removal | ☐ Normal ☐ Swelling ☐ Erythema ☐ Extravasation |
---
## Adverse Reaction (if occurred)
| Field | Entry |
|-------|-------|
| Time of onset | |
| Type of reaction | ☐ Mild ☐ Moderate ☐ Severe |
| Symptoms | |
| Treatment given | |
| Outcome | ☐ Resolved ☐ Transferred for care |
| Radiologist notified | ☐ Yes Time: |
| Adverse Event Report filed | ☐ Yes Report #: |
---
## Extravasation (if occurred)
| Field | Entry |
|-------|-------|
| 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 |
---
## 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*

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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*