Medical Record and Facility Site Reviews
COVID-19 UPDATE: Facility Site Reviews will be suspended throughout the public health emergency and will resume six months after the pandemic is over. Please check back frequently for updates.
Facility Site Reviews (FSR) and Medical Record Reviews (MRR) are the application of standards by the California Department of Health Care Services (DHCS). All PCP sites must undergo an initial site review upon contracting with HPSM and subsequent reviews thereafter.
The reviews consist of a facility site review and a medical record reviews which are conducted to determine if:
- Primary health care services provided are appropriate and complete
- Provider is compliant with current safety standards
- Provider is compliant with local, state, and federal laws and regulations
- Provider has processes in place to ensure preventive, continuity and coordination of care are fully addressed
DHCS FSR and MRR Training Resources
This training is mandated by the Department of Health Care Services (DHCS) as directed through All Plan Letter (APL) 20-006.
- 2022 DHCS FSR and MRR Provider Training Video 35:20
- Facility Site Review Training PDF (2021 version)
Facility Site Review Tool and Standards
A Facility Site Review is a physical assessment of procedures/practices, policies, accessibility, equipment, infection prevention protocol, medical and non-medical emergency preparedness, and some operational protocol.
Facility Site Review Resources
Access and Safety
- Office Procedure for Earthquake and Fire
- Emergency Equipment Requirements
- Emergency Medical Management
- Oxygen Tank Monthly Check
- Equipment Maintenance
Personnel
- Medical Assistant On the Job Training Certification
- Nurse Practitioner Standardized Procedure Requirements
- Bloodborne Pathogens Training and Post Test
- Bloodborne Pathogen Answer Key
- Suspect Abuse Reporting Guide
- Personnel Training Checklist
- Statement of Confidentiality
- Prior Authorization Form
- Grievance Form
- Employee Language Prescreening Tool
- Interpreter Request and Instructions
Office Management
- Patient Isolation Procedures
- Telephone Advice Guidelines
- Employee Language Prescreening Tool
- Interpreter Request and Instructions
- Grievance Form
- Potential Quality Issue (PQI) Numbers and Instructions
- Potential Quality Issue (PQI) Referral Form
Clinical Services
- Medical Storage and Distribution
- Controlled Substance Log
- Refrigerator-Freezer Log
- Medication Expiration Log
- Clinical Laboratory Improvement Amendments (CLIA) Application Process
- Lab Supplies Expiration Log
Preventive Services
Infection Control
Medical Record Review Tool and Standards
Medical Record Review Resources
Format Criteria
Documentation Criteria
Pediatric Preventive Criteria
- Blood Lead Testing
- California Management Guidelines on Childhood Lead Poisoningfor Health Care Providers
- Standard of Care Guidelines on Childhood Lead Poisoning for California Health Care Providers
- Parent/Guardian Lead Education Materials
- Staying Healthy Assessment (SHA)
- Staying Health Assessment (SHA) FAQs
- Staying Healthy Assessment (SHA) Questionnaires
- What Can You Do to Protect Your Child From Lead?
- Skin Cancer Counseling
- CDC Pediatric Immunization Schedule
- Tuberculosis Risk Assessment
- Bright Futures Periodicity Schedule