Atlas Commons™ is a minimal, openly licensed toolkit from Clinic Commons Foundation™. It provides starter templates any outpatient clinic can copy, adapt, and improve.
Title: Universal Safety Checklist Version: pre-01 ☑ Verify patient identity with two identifiers ☑ Confirm procedure / service and informed consent ☑ Review known allergies or critical alerts ☑ Ensure required equipment and emergency supplies available ☑ Conduct team “pause / timeout” before starting ☑ Document completion in patient record
Consent & Disclosure Log · v pre-01 Date: __________ Staff Initials: _____ | Patient | Service | Consent Signed (Y/N) | Language Assistance (Y/N) | Staff Signature | |---------|---------|----------------------|---------------------------|-----------------| | | | | | | | | | | | |
This is a baseline credentialing framework. Clinics should adapt based on state requirements, specialty, and organizational structure. 1. Practitioner submits credentials (license, resume, references) 2. Designated clinic admin verifies documentation 3. Review group or board conducts vote (suggested: ≥3 individuals) 4. Approved staff receive scope-limited privileges, valid for 12 months 5. Review occurs annually or sooner if concerns arise Note: This is a sample governance loop. It is not regulatory advice.
Visit Note · Template v pre-01 Chief Concern: ______________________________ Assessment: __________________________________ Plan / Next Steps: ___________________________ Follow-up: _____ days Provider: _____________
Content © Clinic Commons Foundation™. Licensed under CC BY-SA 4.0. You may copy, adapt, and redistribute with attribution; derivatives must remain under the same license.