Midwest Fellowship Chart Review Tool

Please list Patient number and Date below.


  1. Fellow performed and accurately recorded patient history and information.
    Yes
    No


  1. Fellow presented case to preceptor using all information and data gathered.

    Yes
    No


  1. Fellow includes assessment of problems and proposal of plan of care.

    Yes
    No


  1. Fellow accurately states the purpose for Palliative Intervention.

    Yes
    No


  1. Fellow addresses the aspects of care plan that will utilize other members of the IDT team.
    Yes
    No


  1. Fellow completes all documentation/ dictation in concise manner with the signature of the attending physician precepting the rotation.

    Yes
    No


  1. The Fellow consistently assigns proper CPT and ICD coding reflective of his/her medical documentation.

    Yes
    No





Abbe Leffel
IL