BMI Audit Form 2010 - FINAL

Blue Cross and Blue Shield of Minnesota R e cognizing Excellence 2010 Body Mass Index (BMI) Healthy Eating and Physical Activity Audit Form Pay-for-performance program Last Update: 8/2010 Blue Cross and Blue Shield of Minnesota is a licensee of the Blue Cross and Blue Shield Association Numerator Tally RE criteria met? 1Yes 1No BMI Documentation Tally: 2010 Recognizing Excellence (RE) Medical Record Audit Form BMI documented? 1Yes 1No Body Mass Index (BMI): Healthy Eating and Physical Activity Date of Review: ____/____/___ Reviewer: _______________________ Specialty: ____________________________________________________ Clinic site: ______________________ Clinician ID: ______________ Clinic System:____________________ BCBS Member ? 1Yes 1No Clinic Sample ID#: _________ Instructions: Review only the charts that meet the verified inclusion criteria referenced in the criteria summary table (preventive clinic/annual visit within the last 12 months and at least 2 years old). Answer all questions for each patient who meets the inclusion criteria. Retain this audit tool with your Recognizing Excellence records for reference and validation. Method of data collection. I. Has the patient population with elevated BMI values already been identified via a separate process (ie EMR ...