Patient Care Facility Accreditation Guide

October 2023


Additional Resources Just for You

The online Resource Pack is your go-to source for sample forms, templates, checklists and articles available for you to review, use and modify to fit your practice’s needs. You can access the Resource Pack from your facility’s MY ABC account.

Resource Pack Includes


Annual Facility Review Checklist  *UPDATED

OIG Exclusion Checklist (AD.5.1)

Patient Acknowledgement Form

Human Resources

Employee Verification (HR.2, 4.1 and 4.2)

Instructions for Establishing Privileging Criteria (HR.6 and 6.1)  *UPDATED

Individual Privileging Record Template (HR.6 and 6.1)

Employee Performance Evaluation Form (HR.7)

Assessment of Employee Continued Competency (HR.7)

Product Safety

Equipment Maintenance Log (PS.3.1 and PS.12)  *UPDATED

Performance Management

Free Sample Patient Satisfaction Survey (PM.2)

How to Write and Analyze Customer Satisfaction Surveys (PM.2.1)

Guide to Patient Satisfaction Trends

Billing and Coding Error Report (PM.6)

Facility Safety

Safety Management Checklist (FS.1.1) *NEW for 2019

Fire Emergency Drill Documentation (FS.3.2.1 and 3.2.2)

Disaster Preparedness Resources (FS.3.3) *NEW for 2019

Claims and Billing

Billing Education Documentation (CB.3)

Patient Chart Audit Form (CB.4 and 4.1)

Patient Care

Patient Care Communication Log


Medicare Patient Phone Surveys

Medicare Complaint Form


Sample Referral Thank You Card *NEW for 2019

Sample Accreditation Press Release