Major Depression Audit Form 2009 FINAL

Blue Cross and Blue Shield of Minnesota R e cog nizing Excellence 2009 Major Depressive Disorder Treatment Response Monitoring Audit Form Pay-for-performance program Last Updated: 08/2009 Blue Cross and Blue Shield of Minnesota is a licensee of the Blue Cross and Blue Shield Association Numerator Tally SMRecognizing Excellence (RE) Medical Record Audit Form MAJOR DEPRESSIVE DISORDER TREATMENT RESPONSE MONITORING Numerator criteria met? 1Yes 1No Date of Review: ___/___/____ Reviewer: __________________________ Clinic Sample ID#: ______________ Clinic System:_______________________ Specialty: Behavioral Health Clinic Site: __________________________ BCBS Member ? 1Yes 1No Clinician ID (optional):________________ Instructions: Audit only those records that meet the verified inclusion criteria referenced in the 2009 Criteria Summary Table: patient age 18 or older, diagnosis of Major Depressive Disorder with no diagnosis or treatment of depression at the clinic system in the previous 6 months. Answer each question with either yes or no. Missing information is considered NO. Retain this audit tool with your Recognizing Excellence records for reference and validation. Verify audit inclusion criteria: A ...