Revised: 01/03/2014 Page 1 of 1 I achc.org
[224] DMEPOS Client/Patient File Checklist
CLIENT/PATIENT FILE CHECKLIST
Accreditation Commission for Health Care (ACHC) Standard DRX 5-1A states that an organization must have a written
policy and procedure established and implemented relating to the required content of the client/patient record.
This checklist can be used as a tool to audit and ensure the required documents are present in your client/patient record.
Using this checklist does not guarantee compliance with ACHC standards nor approval of accreditation.
Client/Patient Records should contain the following but is not limited to:
Identification data
Names of family/legal guardian/emergency contact
Name of primary caregiver(s)
Source of referral
Name of physician responsible for care
Diagnosis
Physician’s orders
Signed release of information and other documents for Protected Health Information
Admission and informed consent documents
Assessment of the home; if applicable
Initial assessments
Ongoing assessments; if applicable
Signed notice of receipt of Client/Patient Rights and Responsibilities
Notice of receipt of the Medicare DMEPOS Supplier Standards, if applicable
Additional requirements for Infusion Pharmacy Provider and Clinical Respiratory Providers:
Physician order that include medications, dietary, treatment and activity orders (as appropriate to the level of
care/service that the client/patient is receiving)
Advance Directives; if applicable
Admission and discharge date from a hospital or other institution; if applicable
Evidence of coordination of care/service provided by the organization with others who may be providing
care/service; if applicable
Signed and dated clinical and progress notes
Copies of summary reports sent to physicians; if applicable
Client/patient/family response to care service provided
A discharge summary; if applicable
