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Allergy Notification Checklist
Allergy Notification Checklist
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Created by Qualaris Staff
Critical Access Hospital
Dietician
Table of Contents
Audit Form
Audit Form
Allergy Notification Checklist
Required
Observed Date
Allergy Notification Checklist Checklist
Mark all as...
Received notification of allergy from nursing via individual diet order sheet
Yes
No
If no, did nursing call down to kitchen to report allergy?
Yes
No
N/A
If allergy not listed on original sheets, did nursing update the individual or group diet order sheet?
Yes
No
N/A
Did dietary provide the appropriate diet regarding allergies to the patient?
Yes
No
N/A
