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Overview
Complete
Facility Closure Checklist - Medical Facility
11 Dec 2019 / Matt Andrews
Inspection score
67.57%
Failed items
0
Created actions
1
Facility Name
Health Medical site A
Conducted on

11th Dec, 2019

8:00 AM +08

Prepared by
Matt Andrews
Location
2541 White Rd, Irvine, CA 92614, USA
Actions
1
Closure Checklist
1
67.57%
Notifications - 60 to 90 days before closing
1
58.82%
Staff
Organize a staff meeting to notify employees of practice closure
Not Yet Done
Actions
Done
Hello Shine! Please schedule a staff meeting for tomorrow. We need to inform everyone of our site's closure next year.
Prepare to hire temporary staff if current employees leave prior to closing date
Done
Notes
Temporary staff hired and onboarded.
Patients
Prepare and send notification to patients listing the closing date and reason for closing
Not Yet Done
Notes
Patients to be informed right after the employees are made aware during the meeting.
Include an authorization form to transfer medical records to your patients’ new providers
Done
Place a dated copy of the notification in each patient’s medical record
Done
Public
Publish local newspaper ads with details about the closing
Not Yet Done
Notes
I will prepare the ad after the staff meeting.
Post signage in your office to notify visitors of your last day of business
Not Yet Done
Professional Associations
Notify the state medical board, licensing board, credentialing organizations, professional memberships, etc
Done
Drug Enforcement Agency (DEA)
Inform the DEA of your wishes to either continue or surrender your DEA registration
Done
Health Insurance Companies
Inform all contracted payers of your intent to close your practice
Done
Provide payers with a forwarding address to send payments that resolve after the office closes
Done
Hospitals
Notify the hospitals where you have privileges of your intention to close your practice
Done
Ancillary Services
Contact ancillary services such as labs, MRI facilities, etc. that you refer patients to
Done
Suppliers/Service Contracts
Inform medical suppliers, office suppliers, collection agencies, laundry services, housekeeping services, hazardous waste disposal services, magazine subscriptions, etc.
Not Yet Done
Request final statements from these vendors to close your accounts with them.
Not Yet Done
Other Physicians
Let the colleagues that you work with, or refer to, know of your decision to close
Done
Utilities
Notify all utility service providers of the day you wish to discontinue service
Not Yet Done
Tasks - 30 to 60 days before closing
75%
Patient Scheduling
No new patients should be accepted once the closing date is announced
Not Yet Done
Start restricting nonemergent appointments as much as possible
Done
Patients who need continual follow-up and care should be referred to another provider
Not Yet Done
Notes
The directive for referral to other providers will be made during the staff meeting.
Accounts Receivable
Process your accounts receivable, as much as possible, to collect money owed to you
Done
Consider employing a collection agency or staff member to reconcile accounts after the practice has closed
Done
Insurance Policies
Review your and your employees’ insurance policies and update or cancel where appropriate: i.e., liability, health, life, disability, workers compensation, etc
Done
Obtain tail coverage extended liability insurance if necessary, which provides coverage against claims reported after the liability policy expires
Done
Medical Records
Arrange for safe storage for both paper and electronic medical records
Done
Notify your state medical board of the storage location
Not Yet Done
Notes
I will notify them after the staff meeting.
Determine the correct amount of time your medical records should be stored, as defined by your state law
Done
Notes
I am sure I know this but will clarify tomorrow.
Make sure the storage facility has experience handling confidential patient information and HIPAA agreements
Done
Establish a mailing address or PO Box for medical record requests after closing
Done
Clinic Documents & Equipment
Arrange for storage of personnel records according to your state law
Done
Organize the disposal or proper storage of clinic documents such as financial records, patient education materials, brochures, etc
Done
Plan to sell or lease office and medical equipment, if appropriate
Done
Medications
Follow the federal guidelines for disposing of prescription drugs and medications
Done
Contact drug representatives to determine what to do with unused samples, if applicable
Done
Notes
Already contacted and we are aware of what to do.
Destroy all prescription pads
Done
Phone Service
Consider using an answering service or prepare messaging for office phone calls after the closing date
Not Yet Done
Mail Service
Contact the postal service to coordinate mail forwarding details
Not Yet Done
Completion
Comments/Recommendations
The staff meeting tomorrow is when we make the big announcement about the closing of our medical facility. There are a few remaining facility closing tasks and notifications to be done but those I will work on right after the staff meeting.
Name and Signature
Matt Andrews
11th Dec, 2019 10:01 AM +08