KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬

MINISTRY OF HEALTH ‫وزارة الصحة‬

OQLA AL-SOQOUR HOSPITAL ‫مستشفى عقلة الصقور العام‬
Scope of risk (Medical Staff) Checklist
WARD/UNIT: _________________________ DATE: ____________________

LEGEND: PT = Preparation Tool INT = Interview OBS = Observation MR = Medical Record O/I =
Observation/Interview DR=Document Review NM =Not met (Score = 0 when < 50 % compliance) PM = Partially met
(Score=1 ≥ 50 to < 80 % compliance) FM = Fully met( Score= 2 when ≥ 80 % compliance) NA = Not applicable(Cancelled
Score )
RESULT
Points of measurement PT COMMENTS

NM PM FM NA
0 1 2
1- All medical staff are subjected to departmental by-laws DR
2- Each physician is issued a name stamp for authentication of signature and chart OBS
entries.
3- Medical staff members confine their practice to their approved clinical privileges and DR
competencies.
4- All staff are certified in CPR. DR
5- There is a qualified physician on duty, on the premises, at all times to provide DR
necessary services to inpatients.
6- The attending physician sees all patients admitted to his service within 24 hours MR
(routine) or 4 hours (urgent) or within 30 minutes (emergency) and assure management
of the patient according to the policy.
7- Specific patient consent is signed by both the patient/legal guardian and the physician MR
requesting the consent, also by 2 witnesses.
8- A consultation request clearly defines the services requested from the consultant. MR
9- Evacuation plan map is posted indicating the evacuation route. OBS

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 KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
MINISTRY OF HEALTH ‫وزارة الصحة‬
OQLA AL-SOQOUR HOSPITAL ‫مستشفى عقلة الصقور العام‬
Scope of risk (Medical Staff) Checklist

NAME&SIGNATURE OF ASSESSOR:__________________________ NAME&SIGNATURE OF HEAD DEPART:______________________________

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