Hospital Patient Privacy Compliance Audit Checklist Form
Complete this checklist to document the results of your hospital patient privacy compliance audit. Ensure all relevant sections are filled for accurate audit tracking.
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Name
*
First Name
Last Name
Department/Unit Audited
*
Audit Scope or Area Reviewed
*
Privacy Compliance Checklist
*
Patient information is only accessible to authorized personnel
Physical records are securely stored and access controlled
Electronic records are protected by secure passwords and access logs
Workstations are locked when unattended
Patient information is not discussed in public areas
Staff have received privacy and confidentiality training
Other (please specify)
Incident/Issue Description (if any)
Corrective Actions Required
Priority Level
*
Low
Medium
High
Follow-Up Due Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Audit Notes or Summary
Submit Audit Checklist
Should be Empty: