CPC Pre-Audit Facility Assessment

Section 01

Facility Identity

Date

Facility Name

Facility Address

Trauma Level

▼

Is the facility affiliated with a System Body?

Yes No

Name of Health System

Name

Title

Best Contact Number

Email Address

Section 02

Accrediting Organization

Date of Last Audit

Were there findings specifically for SPD?

Yes No

Please list the top 4 findings:

Direct Reporting Line

Section 03

Full Time (Including FMLA)

Full Time (Active)

Part Time

Per Diem

Travelers / Agency

Hours of Operation

Operating Rooms

Clinics Supported

Section 04

Indicate which of the following items are processed within the SPD:

Section 05

Is an electronic tracking system utilized?

Yes No

Operational Pain Points

Please detail the major challenges the department is currently facing.

Additional Information