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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# Urgent Care Triage Assessment
| Form ID | FRM-UC-001 | Revision | 1.0 |
|---------|-------------|----------|-----|
---
## Patient Information
| Field | Entry |
|-------|-------|
| Patient Name | |
| MRN | |
| Date of Birth | |
| Age | |
| Sex | ☐ Male ☐ Female |
| Date | |
| Time of Arrival | |
| Time of Triage | |
---
## Chief Complaint
*In patient's own words:*
**Duration of Symptoms:**
---
## Vital Signs
| Parameter | Value | Normal? |
|-----------|-------|---------|
| Temperature | °F / °C | ☐ Yes ☐ No |
| Heart Rate | bpm | ☐ Yes ☐ No |
| Respiratory Rate | /min | ☐ Yes ☐ No |
| Blood Pressure | / mmHg | ☐ Yes ☐ No |
| SpO2 | % on ☐ RA ☐ O2 ___L | ☐ Yes ☐ No |
| Pain Score | /10 | |
| Weight | kg / lbs | |
| Blood Glucose (if indicated) | mg/dL | ☐ N/A |
---
## Allergies
☐ No Known Drug Allergies (NKDA)
☐ No Known Allergies (NKA)
| Allergen | Type | Reaction |
|----------|------|----------|
| | ☐ Drug ☐ Food ☐ Environmental | |
| | ☐ Drug ☐ Food ☐ Environmental | |
| | ☐ Drug ☐ Food ☐ Environmental | |
---
## Current Medications
| Medication | Dose | Frequency |
|------------|------|-----------|
| | | |
| | | |
| | | |
| | | |
---
## Brief Medical History
☐ None significant
| Condition | Yes | Condition | Yes |
|-----------|-----|-----------|-----|
| Diabetes | ☐ | Heart Disease | ☐ |
| Hypertension | ☐ | Lung Disease/Asthma | ☐ |
| Kidney Disease | ☐ | Liver Disease | ☐ |
| Blood Clots/DVT | ☐ | Cancer | ☐ |
| Seizures | ☐ | Immunocompromised | ☐ |
| Pregnancy | ☐ (LMP: _______) | Other: | ☐ |
---
## History of Present Illness
### OPQRST
| Element | Response |
|---------|----------|
| **O**nset: When did this start? | |
| **P**rovocation: What makes it better/worse? | |
| **Q**uality: Describe the symptom | |
| **R**adiation: Does it travel anywhere? | |
| **S**everity: How bad is it (0-10)? | |
| **T**iming: Constant or comes and goes? | |
### Associated Symptoms
| Symptom | Present | Symptom | Present |
|---------|---------|---------|---------|
| Fever/Chills | ☐ | Nausea/Vomiting | ☐ |
| Headache | ☐ | Diarrhea | ☐ |
| Shortness of Breath | ☐ | Urinary Symptoms | ☐ |
| Chest Pain | ☐ | Rash | ☐ |
| Dizziness | ☐ | Weakness | ☐ |
| Cough | ☐ | Vision Changes | ☐ |
| Sore Throat | ☐ | Numbness/Tingling | ☐ |
---
## Quick Look Assessment
### General Appearance
| Observation | Finding |
|-------------|---------|
| Alert and oriented | ☐ Yes ☐ No |
| In acute distress | ☐ Yes ☐ No |
| Skin color | ☐ Normal ☐ Pale ☐ Flushed ☐ Cyanotic |
| Respiratory effort | ☐ Normal ☐ Labored |
| Ambulation | ☐ Independent ☐ Assisted ☐ Wheelchair ☐ Stretcher |
| Obvious injuries | ☐ None ☐ Present: _______ |
---
## Screening Questions
### Safety Screens
| Question | Response |
|----------|----------|
| Fall in past 24 hours? | ☐ Yes ☐ No |
| Head injury? | ☐ Yes ☐ No |
| Loss of consciousness? | ☐ Yes ☐ No |
| Recent surgery? | ☐ Yes (When: _______) ☐ No |
| Recent travel? | ☐ Yes (Where: _______) ☐ No |
| Exposure to COVID-19/illness? | ☐ Yes ☐ No |
### For Women of Childbearing Age
| Question | Response |
|----------|----------|
| Could you be pregnant? | ☐ Yes ☐ No ☐ N/A |
| Last menstrual period | |
| Currently breastfeeding? | ☐ Yes ☐ No ☐ N/A |
---
## Red Flag Assessment
**Check if ANY present (requires immediate provider notification):**
| Red Flag | Present |
|----------|---------|
| Chest pain/pressure | ☐ |
| Difficulty breathing at rest | ☐ |
| SpO2 <92% | ☐ |
| Severe headache (worst of life) | ☐ |
| Sudden vision loss | ☐ |
| Sudden weakness/numbness | ☐ |
| Speech difficulty | ☐ |
| Facial droop | ☐ |
| Uncontrolled bleeding | ☐ |
| Altered mental status | ☐ |
| Syncope | ☐ |
| Anaphylaxis symptoms | ☐ |
| Suicidal/homicidal ideation | ☐ |
**If ANY checked → Immediate provider evaluation and consider ED transfer**
---
## Acuity Level Assigned
**Level 1 - Emergent** (ED Transfer Required)
→ Provider/911 notified: Time _______ Name _______
**Level 2 - Urgent** (Provider within 15 min)
→ Provider notified: Time _______
**Level 3 - Semi-Urgent** (Provider within 30 min)
**Level 4 - Non-Urgent** (Provider within 60 min)
**Level 5 - Redirect** (Outside UC scope)
→ Redirected to: _______
---
## Interventions Initiated
| Intervention | Ordered | Completed |
|--------------|---------|-----------|
| Ice pack | ☐ | ☐ |
| Elevation | ☐ | ☐ |
| Wound care | ☐ | ☐ |
| POC glucose | ☐ | ☐ |
| POC UA | ☐ | ☐ |
| POC strep | ☐ | ☐ |
| POC flu/COVID | ☐ | ☐ |
| ECG | ☐ | ☐ |
| Other: | ☐ | ☐ |
---
## Pain Assessment
| Field | Entry |
|-------|-------|
| Location | |
| Quality | ☐ Sharp ☐ Dull ☐ Aching ☐ Burning ☐ Throbbing |
| Intensity (0-10) | /10 |
| Onset | ☐ Sudden ☐ Gradual |
| Duration | |
| What relieves it? | |
| What worsens it? | |
| Previous episodes? | ☐ Yes ☐ No |
---
## Injury Details (if applicable)
| Field | Entry |
|-------|-------|
| Mechanism of Injury | |
| Time of Injury | |
| Location of Injury | |
| Tetanus status | ☐ Up to date ☐ Needs update ☐ Unknown |
| Work-related? | ☐ Yes ☐ No |
---
## Additional Notes
---
## Re-Triage (if waiting time extended)
| Time | Vital Signs | Condition Changed? | New Acuity | Initials |
|------|-------------|-------------------|------------|----------|
| | | ☐ Yes ☐ No | | |
| | | ☐ Yes ☐ No | | |
| | | ☐ Yes ☐ No | | |
---
## Triage Nurse/MA Signature
| Field | Entry |
|-------|-------|
| Name | |
| Credentials | |
| Signature | |
| Date | |
| Time | |
---
## Provider Acknowledgment
| Field | Entry |
|-------|-------|
| Provider notified at | (time) |
| Provider seen at | (time) |
| Provider Signature | |
---
*Form FRM-UC-001 Rev 1.0 - Urgent Care Triage Assessment*

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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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