Monday, February 19, 2024 is Presidents’ Day, our offices will be closed. Have a safe holiday.

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Facility Site Review Binder

The following documents are designed to help CenCal Health providers prepare for an upcoming site review. If you have questions regarding these materials please contact Health Services QI Coordinator at (805) 562-1628.



Advance Healthcare Directive Information
Annual Staff Training
Biological Indicator Spore Testing Procedure
Emergency Medication Dosage Chart
Facility Site Pre-Audit Checklist
Interim Facility Site Review (Fax Back)
Interpreter Quality Standards Guidance
Laboratory Services
Employee Language Skills Self-Assessment Tool
Medical Record Review Guidelines
Medical Waste Mailback Sources 
PARS Tool Attachment C
Pharmaceutical Services
Posting for Doctor’s Office
Radiology Services
Recommendations for Preventive Pediatric Health Care
Recommended Adult Immunization Schedule
Sharps Injury Log 
Site Review Guidelines
Temperature Log Fahrenheit
Tuberculosis (TB) Risk Assessment – Adults
Tuberculosis (TB) Risk Assessment – Children

Please note:
A Staying Healthy Assessment (SHA) must be completed as part of the Initial Health Assessment, or new patient exam, within 120 days of member’s enrollment in CenCal Health.  A new SHA form must also be completed whenever the patient enters a new age group. It is recommended that the form be reviewed by the PCP at annual check-ups. More information about the requirement and resources for implementation, including forms for each age group, can be found at the DHCS website: