DOCUMENTS REQUEST LIST

Revised 1/12

CLINICAL

Advance Review / On-Site Review
  1. List of HIV care providers and designation/role
/
  1. All Clinical Protocols and standard operating policies and procedures (including reproductive health and family planning).

  1. Opening and closing hours policy
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  1. Patient Registers, patient medical charts and other monitoring forms.

  1. Infection control policies and procedures
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  1. Patient Consent Policies and Forms.

  1. HIV counseling and testing policies
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  1. Pharmacy ledgers.

  1. Pharmacy Policies and standard operating Procedures
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  1. Patient referral policies, tracking forms, and referral directory.

  1. Patient Satisfaction Surveys tools and most recent Survey Results
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  1. Continuing medical (professional) Education Attendance Records and or Proceedings.

  1. Emergency care policies and procedures
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  1. List of trainings the clinical staff has participated in the last twelve months.

  1. National HIV Care and Treatment Guidelines (Adult, Pediatrics, PMTCT, HCT, and etc.)
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  1. Laboratory policies and standard operating procedures for absolute minimum tests (HIV antibody test and hemoglobin), basic tests (white blood cell count, serum creatinine, a serum glucose, and pregnancy tests), and (CD4).

  1. Policy documents on post exposureprophylaxis
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  1. Laboratory QA and QC reports.

  1. Quality improvement and assurance plan, protocols and committee minutes
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  1. Clinical charts (adult, PMTCT and pediatric HIV care and treatment)

  1. Continuous Quality Improvement reports (STOCS/PDSA)
/ Clinical training reports (if available)
  1. Standard clinical forms (Blank) if available in electronic format

ADMINISTRATIVE

Advance Review / On-Site Review
  1. Organization’s Mission statement
/
  1. Minutes of Board and Board Committee Meetings

  1. Current Organization Organogram
/
  1. Minutes of staff and management team meetings

  1. Governance Structure/Organogram
/
  1. Other relevant committee meeting minutes

  1. Current HIV Program Organogram
/
  1. Contracts for all HIV service subcontractors

  1. Strategic plan
/
  1. Memorandum of Understanding/Agreement for Partners and Referral sites

  1. Organization Operating policies and
procedures /
  1. Clinic licenses

  1. Board By-Laws
/
  1. Personnel files (employee evaluations, benefits, etc.)

  1. Personnel policies and procedures
/
  1. Description of data collection & information system

  1. Key Position descriptions/Administration
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  1. Staff training manuals and list of trainings staff has participated in during the last 12 months.

  1. Organization QI system documents, if outside of clinical

  1. Personnel files (1 for each category of staff paid by PEPFAR (i.e. doctor, nurse, counselor, etc.)

  1. Insurance (Board, clinic, etc.)

  1. Program monitoring policies and procedures

  1. Program monitoring reports

FINANCIAL

Advance Review / On-Site Review
  1. Current budget for HIV Program.
/
  1. Financial Management Policies and Procedures including applicable organizational, MOH, partner, USG, or Diocesan sources.

  1. Position descriptions of financial management staff including accounting staff.
/
  1. Most recent Management Letter and/or audit report. Prior period report also desired if possible.

  1. Organization chart showing staff responsible for financial management functions
/
  1. Documentation of reconciliation of checking account (s)

  1. Committee structure detailing budget approval process, review process of financial statements, and how audit findings are addressed.
/
  1. Minutes of Management, Governance or other Committee responsible for financial management functions including budget and audit.

  1. Accounting policies and procedures
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  1. Visual review of accounting system including electronic (Excel or Accounting) software.

  1. Billing and Collection policies, if applicable.
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  1. Documentation of internal controls and internal quality assurance provisions.

  1. Procurement policies and procedures
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  1. Payroll records

  1. Chart of accounts
/
  1. Petty cash records

  1. Travel expense records

  1. Expenditure reports (monthly or quarterly)

  1. Inventory control systems