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Chiropractic Compliance Forms

OCCM - Included Forms, Tools and Audit Set

Ready to customize with your practice info and print!

Detail by Section:

LAUNCH - FORMS & LOGS

1. OCCM Compliance Program Launch

Initial actions following purchase and download

2. Appointment of CM / Privacy Officer 

Form documenting the Appointment of the Clinic’s Privacy Officer/Compliance Manager.

3. Adoption of Compliance Manual

Form formally adopting the new manuals for use in the Clinic.

PLUS 6 MORE Forms!

 

COMPLIANCE MANUAL

1. Inquiry Log

Use this log to document all patient inquiries into proper billing processes or payments.  As needed.

Required if there’s an actual patient inquiry.

2. PHI Privacy Breach Report

Use this to document the investigation if a breach of PHI occurs.  As needed.

3. Breach Corrective Action Plan

Use this to document the Corrective Action Plan if a breach occurs.  As needed.

4. Business Associate Agreement

A generic Business Associate Agreement to use with your vendors. As needed.

5. Acknowledgement Receipt Privacy Policies

New version of the old HIPAA Form that patients sign at the beginning of care. Required.

PLUS 33 MORE Forms!

 

OPERATIONS MANAGEMENT & ADMINISTRATION MANUAL

1. Computer Usage Agreement

Employee’s agreement to abide by specific rules when using office computer system.

Required: All current staff members must read and sign (and have on file). Required for all future staff members.

2. Employee Contact Info

Employee’s personal information to be kept on file and updated as necessary.  Required.

PLUS 3 MORE Forms!

 

HUMAN RESOURCES MANUAL

1. Sample Interview Questions

Examples of interview questions that do not violate EEOC regulations.

2. Interview Question Answers Grid

Scoring grid for the answers made by an interviewee. Maintain all for 1 year.

3. Job Candidate Evaluation Grid

Scoring grid to show justification for candidate’s hiring.

PLUS 12 MORE Forms!

 

SAFETY MANUAL

1. Risk Assessment Inspection

In-depth facility inspection form for the Safety Manager to utilize on a regular basis.

Required by OSHA.

2. OSHA Guidelines Regulations

Brief introduction to OSHA Guidelines for use during training of staff.

3. Safety Review Log

Introduction page for the Safety Review Log outlining materials to be maintained in the Safety Review Log.

Required by OSHA.

PLUS 5 MORE Forms!

 

AUDIT & ASSESSMENT TOOLS

**All of the Audit Tools are necessary to document various compliancy aspects.

1. Introduction to the Audit and Assessment Tools

2. Operations Review Checklist

Prior Policies and Procedures Checklist and Compliance Policy Review Checklist.

3. Initial Compliance Assessment

HIPAA Security Assessment of the facility.

PLUS 6 MORE Forms!

 

*Click to see details on the Compliance Manuals content.

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