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Attachment #4, 9.01 7 of 9 Clinic Chart Review
The ____________ clinic has a current caseload of _________, and is classified as (small, medium, or large). Per policy, a random sample of _______ records was reviewed in the Crossroads system. Note: Make copies of this page as needed to review the required number of charts based on established clinic size.
Family ID Number WIC Condition (P-N-B-I-C)
Custody papers scanned into Crossroads, if applicable
Proper documentation of VOC transfers into the state
Photo release forms signed/scanned into Crossroads, if applicable
Parent/Guardian or Caretaker signature captured for certification/subsequent certification
When WIC staff sign (name may be printed) for food instrument issuance, proper radio button selected and reason for signing noted
If CTads were used for certification, a hard copy Participant Agreement signed and scanned into Crossroads
All applicable screens fully completed for all participants, whether required for certification or not, at each certification or sub-certification
Review of Scanned Custody Papers for Foster Children