CONFIDENTIAL UC Davis Student Health and Counseling Services

Peer Review Document Registered Dietitian Electronic Health Record (EHR) Chart Review

Provider Being Reviewed: Academic Year: Date of Review: Page 1 of 1

INSTRUCTIONS: Please review each EHR section and select 1, 2 or NA (1=adequate/appropriate, 2=Opportunity for Improvement Identified, NA=Not applicable). As you complete the review, please keep in mind that opportunities for improvement can include communication issues, educational issues, systems or processes that may need improvement, as well as patient care issues. Please provide a comment when identifying a ‘2’; and initial all reviews.

SID Number:
Date of Service:
How was diagnosis selected? Circle one: HR/LV (high risk/low volume),
LR/HV (low risk/high volume), or Randomly Selected Diagnosis:
SUBJECTIVE/OBJECTIVE INFORMATION PRESENT IN EHR:
(use ‘1’ or ‘2’ rating or ‘NA’ for each criteria for each record review) circle one: / Initial or f/u / Initial or f/u / Initial or f/u / Initial or f/u / Initial or f/u
Subjective information was obtained from the patient:
Chief nutrition concern and related symptoms
OTC and/or prescribed medication and/or supplement use
Previous medical history
24-hr food recall and fluid intake or general diet history
Physical Activity
Objective information was obtained from the patient:
Weight, Height, and Weight History
Nutrition-related labs
CLINICAL ASSESSMENT INFORMATION INCLUDED IN EHR:
Nutrition status is determined/diagnosed
Food /supplement/drug interactions evaluated
Allergies & reactions to drugs/materials on initial visit
Patient reports and consultations reviewed
Medical advice via phone or online is entered into the EHR
NUTRITION CARE PLAN CONTAINS:
Recommended nutrition intervention consistent with patient’s readiness, knowledge, abilities and resources
Nutrition and/or behavior change goals established and/or adjusted as needed
Instructions/education provided to patient and materials used documented
Clear plan including follow-up
REVIEW OF FOLLOW-UP AFTER VISIT:
Communication to patient and other clinicians as needed
*OVERALL RANKING of Care (1 or 2) AND Reviewer's Initials : / 1 or 2 Reviewer’s Initials: / 1 or 2 Reviewer’s Initials: / 1 or 2 Reviewer’s Initials: / 1 or 2 Reviewer’s Initials: / 1 or 2 Reviewer’s Initials:
Comments (Please continue your comments on the reverse side if needed):

1/2015 kkf