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Precription Audit Format

This document contains a prescription audit form from the District Civil Hospital in Ambala City for the month of February 2023. The form contains 27 criteria for auditing prescriptions, including whether the patient's registration number, name, age, address and date of consultation are included. It also checks if the diagnosis, medicines, dosage schedule, treatment duration and follow up date are clearly written in accordance with standard treatment guidelines and essential medicines lists. The doctor conducting the audit records their findings and signature at the end.

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Rahul Jalaunia
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400 views2 pages

Precription Audit Format

This document contains a prescription audit form from the District Civil Hospital in Ambala City for the month of February 2023. The form contains 27 criteria for auditing prescriptions, including whether the patient's registration number, name, age, address and date of consultation are included. It also checks if the diagnosis, medicines, dosage schedule, treatment duration and follow up date are clearly written in accordance with standard treatment guidelines and essential medicines lists. The doctor conducting the audit records their findings and signature at the end.

Uploaded by

Rahul Jalaunia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Prescription Audit CH Ambala City February 2023

District Civil Hospital Ambala City


Prescription Audit Form

Name of Doctor conducting audit……………………………………………………………………

Prescription Number…………………………………………………………………………………

Date: …………………………………………………………………………………………………

S.No. Criteria Remarks


1. OPD Registration Number mentioned? Yes/No
2. Complete Name of the patient is written? Yes/No
3. Age in years (≥ 5 in years) in case of < 5 years (in months) Yes/No
4. Weight in Kg (only patients of pediatric age group) Yes/No
5. Complete address of the patient is mentioned Yes/No
6. Date of consultation - day / month / year Yes/No
7. Gender of the patient. Yes/No
8. Handwriting is Legible in Capital letter Yes/No
9. Brief history Written Yes/No
10. Allergy status mentioned Yes/No

11. Salient features of Clinical Examination recorded Yes/No

12. Presumptive / definitive diagnosis written Yes/No

13. Medicines are prescribed by generic names Yes/No

14. Medicines prescribed are in line with STG. Yes/No

15. Medicine Schedule / doses clearly written Yes/No

16. Duration of treatment written Yes/No

17. Date of next visit (review) written Yes/No

18. In case of referral, the relevant clinical details and reason for referral given. Yes/No

19. Follow-up advise and precautions (do’s and don’ts) are recorded Yes/No

20. Prescription duly signed (legibly) Yes/No

21. Medicines Prescribed are as per EML/ Formulary Yes/No

22. Medicines advised are available in the dispensary Yes/No

23. Vitamins, Tonics or Enzymes prescribed? Yes/No


Prescription Audit CH Ambala City February 2023
24. Antibiotics prescribed? Yes/No

25. Antibiotics are prescribed as per facility’s Antibiotic Policy Yes/No

26. Investigations advised? Yes/No

27. Injections prescribed? Yes/No

28. Number of Medicines prescribed.

Signature of Doctor

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