Section 640

Section 640.APPENDIX A Standardized Perinatal Site Visit Protocol

Components of site visit tool – information to be completed by applicant facility prior to site visit and reviewed and approved at time of site visit.

(By site visit team)

Initial/Date

I.	PROGRAM DOCUMENTATION:
	/	Updated maternity service plan with current staffing pattern appropriate for
		level of care.
	/	Documentation of orientation program for nursing staff.
	/	Documentation of ongoing continuing education program.
	/	Documentation of Continuous Quality Improvement (CQI) Activities.
	/	Updated, comprehensive procedure manual.
	/	Appropriate resources checklist.
II.	STAFF PERFORMANCE:
	/	Chart review (site visit team).
	/	Discussion of patient care with staff selected at random by the site visit team.
III.	COMMENTS:




Director of Site Visit Team:
Title:

(Source: Amended at 24 Ill. Reg. 12574, effective August 4, 2000)