iRubric: Informed Consent Compliant DRAFT -2- rubric

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Informed Consent Compliant DRAFT -2- Clinical File Review DRAFT 7/29/09 For use in quality review of chiropractic clinical records. Rubric Code: D3XA95 By JP_NYCC Ready to use Public Rubric Subject: Medical Type: (Other) Grade Levels: Graduate

DC File Review Informed Consent Compliant
	Very poor Red 0 pts	Unacceptable Red 1 pts	Acceptable Yellow 2 pts	Good Green 3 pts	Exceptional Blue 4 pts
1. Procedures Specified	Very poor Manipulation or any moderate - high risk procedure performed without IC.	Unacceptable This rating not available for this item.	Acceptable IC obtained for performed manipulation and any moderate – high risk procedures, but not for any low risk procedure.	Good IC obtained for all performed procedures.	Exceptional This rating not available for this item.
2. Diagnosis Specified	Very poor Diagnosis unspecified for any procedure.	Unacceptable This rating not available for this item.	Acceptable This rating not available for this item.	Good Relevant diagnosis(es) specified.	Exceptional This rating not available for this item.
3. Signatures / Dates	Very poor IC form unsigned by patient.	Unacceptable This rating not available for this item..	Acceptable Doctor signature and/or any date missing.	Good IC form signed and dated by patient and doctor.	Exceptional This rating not available for this item.