ASF Standards · Primary Health Clinic · Standard 2
Standard 2 — Preventive Care & Screening
Criteria in this standard
2.1 — Preventive Care Is Systematically Tracked, Not Relied on From Memory
2.2 — Preventive Care Delivery Doesn't Depend on the Patient Remembering to Ask
2.3 — Screening Completion Rates Are Actively Measured and Acted On
2.4 — Shared Decision-Making Happens for Screening With Genuine Tradeoffs
2.5 — Immunization Status Is Actively Tracked and Gaps Are Closed
2.2 — Preventive Care Delivery Doesn't Depend on the Patient Remembering to Ask
2.3 — Screening Completion Rates Are Actively Measured and Acted On
2.4 — Shared Decision-Making Happens for Screening With Genuine Tradeoffs
2.5 — Immunization Status Is Actively Tracked and Gaps Are Closed
2.1
Preventive Care Is Systematically Tracked, Not Relied on From Memory
Non-Negotiable
The practice uses a systematic tracking process to identify which evidence-graded preventive services each patient is due for, based on age, sex, and risk factors — not relying on a clinician remembering to consider this during a visit already focused on the patient's presenting concern.
In plain terms: The practice has a system — a registry, a recall list, a record flag — that shows which preventive services each patient is due for, based on their age, sex, and risk. Nobody relies on memory.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | N/A | Full | Adapted | Full |
Why this matters
A 55-year-old is due for colorectal cancer screening. A 65-year-old woman is due for a bone density scan. A smoker over 50 may be due for lung cancer screening. A child is due for a vaccine. None of this is visible in a consultation about a sore throat unless a system surfaces it. Evidence-graded preventive services — the ones with proven benefit — must be tracked systematically: for each patient, which are due, which are done, which are overdue. The system can be a register, an EHR alert, or a spreadsheet; what matters is that it exists and is used.
What good looks like
- A real, systematic tracking process identifies due preventive services for every patient.
- Tracking genuinely reflects individual age, sex, and risk factors.
- The system is actively consulted and used, not maintained separately from real care.
Common failure modes
- Preventive care identification relies on clinician memory during busy visits.
- Tracking is generic, not reflecting the specific patient's actual risk profile.
- A tracking system exists but isn't genuinely consulted during real encounters.
Worked example
In practice
A 6-room health centre with an EHR that had preventive care alerts switched off.
BeforePreventive care happened when a clinician remembered or a patient asked. No register of who was due for what. The Coordinator audited 50 records of patients over 50: 60% had no documented colorectal screening; 45% of eligible women had no cervical screening recorded. Clinicians said they 'tried to remember.'
ActionThe EHR's preventive care module was configured for grade A and B services by age and sex, with alerts at every visit. A monthly overdue report by service is generated. A nurse runs a recall list for the highest-yield services. The alerts and the report were tested against a sample of records for accuracy.
AfterThe Monitor reviewed the alert configuration, three monthly overdue reports showing declining gaps, and 30 consultation records with alerts acted on. Verified.
If you are starting from zero — do this first
- Pick three preventive services — cervical, colorectal, and one vaccine. Audit 30 eligible records: how many are documented?
- Switch on or build a tracking system by age and sex.
- Generate a monthly overdue list.
- Assign a nurse to run recalls.
The most common mistake: Relying on clinicians to remember who is due for what — memory is not a system.
Self-assessment questions
1. Does the practice use a systematic process to identify which preventive services each patient is due for? — A real, structured tracking system, not reliance on the clinician remembering during a busy visit.
Evidence: Preventive care tracking system documentation
Evidence: Preventive care tracking system documentation
2. Does this tracking genuinely account for the patient's actual age, sex, and risk factors, not a generic checklist? — Individualized, accurate tracking, not a one-size-fits-all list.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
3. Is the tracking system actively used at or before each visit, not maintained separately from actual care? — Genuine, integrated use, not a system that exists without informing real encounters.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
Common reasons for a PARTIAL answer
- Tracking exists for common services like blood pressure but not for less frequently considered ones like lung cancer screening. — Every genuinely indicated service deserves the same systematic tracking, not only the most familiar ones.
- The system flags due services but doesn't account for a patient's specific risk factors beyond basic demographics. — Genuine individualization requires more than age and sex alone for many preventive services.
- Tracking is reviewed for scheduled visits but not consulted during same-day or urgent encounters.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current preventive care identification practice for reliance on memory versus systematic tracking. |
| Week 2 | Build or strengthen a systematic tracking process reflecting individual patient risk factors. |
| Week 3 | Integrate tracking consultation into standard visit workflow, including same-day visits. |
| Ongoing | Audit tracking accuracy and actual use across visit types. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Tracking system review | Reviews the actual tracking system used to identify due preventive services. |
| DOCUMENT | Individualization review | Reviews whether tracking accurately reflects individual patient age, sex, and risk factors. |
| OBSERVE | Visit integration observation | Observes whether the tracking system is genuinely consulted at or before an actual visit. |
Supervisor tips
- Ask to see the actual tracking system for a specific patient and compare against their real risk profile. — A real, specific example reveals genuine individualization, not a generic checklist.
- Ask a clinician how they identify due preventive services during a same-day, non-preventive visit. — This reveals whether tracking genuinely extends beyond scheduled preventive visits.
Evidence base
[6] Research estimates that delivering all recommended preventive services for a standard patient panel would require approximately 14.1 hours per day on top of acute and chronic disease care, with surveyed primary care providers reporting they prioritize only one to three preventive services per visit due to time constraints.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
2.2
Preventive Care Delivery Doesn't Depend on the Patient Remembering to Ask
Non-Negotiable
The practice proactively offers grade A and B preventive services when a patient is due — flagged, discussed, and offered as a matter of standard practice — not delivered only when a patient happens to specifically ask about a particular screening or vaccination.
In plain terms: When a patient is due for a preventive service, the practice raises it — at the visit, by recall — without waiting for the patient to ask.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | N/A | Full | Adapted | Full |
Why this matters
Patients do not know they are due for colorectal screening. They do not know their child is behind on vaccines. They do not ask. The tracking system (2.1) tells the practice; this criterion asks that the practice acts on it: the alert is seen and discussed, the recall letter is sent, the vaccine is offered at the visit for the sore throat. 'Proactively offered as a matter of routine' means the clinician raises it, the nurse raises it, or the recall system raises it — every time, not when convenient. Preventive care delivered only on request is delivered to the informed few.
What good looks like
- Grade A and B services are genuinely, proactively offered when due.
- Proactive offering happens consistently regardless of patient assertiveness or literacy.
- Real evidence shows proactive offering genuinely improves completion.
Common failure modes
- Preventive services are delivered only when a patient specifically asks.
- Proactive offering varies based on how informed or assertive a specific patient seems.
- No evidence connects proactive offering to genuine completion improvement.
Worked example
In practice
A 5-room health centre with tracking (2.1) in place but low completion rates.
BeforeAlerts appeared on the screen; clinicians dismissed them under time pressure. Recall letters went out but were not followed up. Cervical screening rate remained at 48% despite the alert system. Clinicians said 'there isn't time in a ten-minute consultation.'
ActionPreventive care became a nurse-led responsibility: at check-in, the nurse reviews due services, discusses them with the patient, and either delivers (vaccine, blood pressure) or schedules them before the clinician consultation. Recall letters are followed by a phone call at four weeks. A monthly team meeting reviews the completion rates by service.
AfterThe Monitor observed a nurse offering a due vaccine at check-in for an unrelated visit; reviewed six months of completion rates rising (cervical 48% → 71%). Verified.
If you are starting from zero — do this first
- Count how many alerts were dismissed without action last month.
- Move preventive care to the nurse at check-in.
- Follow recall letters with a phone call.
- Review completion rates monthly as a team.
The most common mistake: Building an alert system and letting clinicians dismiss the alerts.
Self-assessment questions
1. Are grade A and B preventive services proactively offered when a patient is due, not only when specifically requested? — Genuine, proactive offering, not passive availability dependent on patient initiative.
Evidence: Proactive offering documentation
Evidence: Proactive offering documentation
2. Does proactive offering happen consistently regardless of the patient's apparent health literacy or assertiveness? — Equal, consistent proactive practice, not dependent on how informed or confident a specific patient seems.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
3. Is there real evidence that proactive offering actually results in higher completion, not just occurs without measurable effect? — Genuine, measurable impact, not an assumption that offering alone is sufficient.
Evidence: Completion rate evidence
Evidence: Completion rate evidence
Common reasons for a PARTIAL answer
- Offering happens for well-known services like vaccination but less consistently for less familiar screenings. — Every grade A or B service deserves the same proactive practice, not only the most commonly discussed ones.
- Proactive offering happens during dedicated preventive visits but not during other visit types. — Any visit is a genuine opportunity to proactively offer a due service.
- Offering is generally consistent but staff report being less thorough during high-volume periods.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current preventive care delivery for reliance on patient-initiated requests. |
| Week 2 | Establish a standard proactive offering practice across all visit types. |
| Week 3 | Train staff on consistent offering regardless of patient assertiveness or literacy. |
| Ongoing | Track completion rates to confirm proactive offering is genuinely improving uptake. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| OBSERVE | Proactive offering observation | Observes actual visits for genuine proactive offering of due preventive services. |
| ASK | Consistency interview | Asks staff whether proactive offering happens consistently regardless of patient assertiveness. |
| DOCUMENT | Completion evidence review | Reviews whether proactive offering correlates with genuine completion rate improvement. |
Supervisor tips
- Observe an actual visit where a patient doesn't raise preventive care themselves. — This tests whether proactive offering genuinely happens, not just when the patient prompts it.
- Ask about offering practice specifically during a high-volume period. — This is where proactive practice is most likely to lapse under real pressure.
Evidence base
[7] Established evidence-graded preventive service recommendation systems identify high-priority services as those with high or moderate net benefit for eligible patients, recognized in various forms across many countries' preventive care guidance.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
2.3
Screening Completion Rates Are Actively Measured and Acted On
Core
The practice actively measures its own completion rates for key preventive screenings across its patient panel, with a genuine response when rates fall short — not a general sense that screening happens without ever actually checking the real numbers.
In plain terms: The practice knows its own screening completion rates — cervical, colorectal, breast, whatever applies — and has a response when a rate is low.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | N/A | Full | Adapted | Full |
Why this matters
A rate is the difference between hoping and knowing. 'We do a lot of screening' is a feeling; '61% of eligible women had cervical screening in the last three years' is a fact that can be compared to a target, tracked over time, and improved. Measuring by service and by clinician reveals the gaps: the doctor who never raises colorectal screening; the age group that is missed; the community that does not attend. A response — a recall campaign, an outreach event, a change in approach — follows from knowing. A practice that does not measure cannot improve, and does not know whether it needs to.
What good looks like
- Real completion rates are actively measured for key screenings.
- A genuine response follows when rates are found to fall short.
- Measurement covers the full eligible panel, not only engaged patients.
Common failure modes
- Screening adequacy is assumed without genuine measurement.
- Low completion rates, if identified, produce no real response.
- Measurement only captures patients who already attend regularly, missing disengaged patients.
Worked example
In practice
A 4-room health centre serving 5,000 patients that had never calculated a screening rate.
BeforeNobody knew the practice's screening rates. When the Coordinator calculated them from the register: cervical 44%, colorectal 22%, mammography 38%. All well below national targets. There had been no response because there had been no measurement.
ActionScreening rates are now calculated quarterly by service and by clinician from the register. Each rate has a target. Rates below target trigger a defined response: a recall campaign for that service, review with the clinician, or community outreach. The first campaign — colorectal screening kits mailed with a phone follow-up — raised colorectal screening from 22% to 51% in six months.
AfterThe Monitor reviewed four quarterly rate reports with targets, the campaign records, and the resulting rate improvements. Verified.
If you are starting from zero — do this first
- Calculate your cervical, colorectal, and breast screening rates from your register today.
- Compare each to the national target.
- For the lowest, plan one recall campaign.
- Recalculate quarterly.
The most common mistake: Believing screening is going well because patients who come for screening are screened — the ones who don't come are invisible.
Self-assessment questions
1. Does the practice actively measure its own completion rates for key preventive screenings across its panel? — Real, calculated completion data, not a general assumption of adequacy.
Evidence: Screening completion rate documentation
Evidence: Screening completion rate documentation
2. Is there a genuine response when completion rates for a specific screening fall short? — Real, active improvement effort, not a rate tracked without consequence.
Evidence: Completion rate response record
Evidence: Completion rate response record
3. Is completion measured for the full eligible panel, not just patients who happen to attend preventive-focused visits? — Genuine, full-panel measurement, not a skewed sample of already-engaged patients.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
Common reasons for a PARTIAL answer
- Completion is measured for one or two screenings but not systematically across all key services. — Every key preventive screening benefits from the same genuine measurement discipline.
- A shortfall is identified but the response addresses only the immediate finding, not the underlying reason for the gap. — Genuine improvement requires understanding why a gap exists, not just noting that it does.
- Measurement happens but doesn't specifically account for patients who haven't visited the practice recently.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current screening completion measurement for real, panel-wide coverage. |
| Week 2 | Establish systematic completion rate calculation for key preventive screenings. |
| Week 3 | Build a genuine response process for identified shortfalls, addressing underlying causes. |
| Ongoing | Review completion rates regularly and track improvement over time. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Completion rate measurement review | Reviews whether the practice genuinely calculates real completion rates for key screenings. |
| DOCUMENT | Response to shortfall review | Reviews evidence of genuine action when completion rates are found to fall short. |
| DOCUMENT | Panel coverage review | Reviews whether measurement covers the full eligible panel, not only actively engaged patients. |
Supervisor tips
- Ask for the practice's actual, current completion rate for a specific screening, not a general impression. — A specific, real number reveals genuine measurement, not an assumption.
- Ask what the practice did the last time a completion rate was found to be genuinely low. — A real example reveals whether measurement leads to real action.
Evidence base
[8] National data from multiple countries document a persistent gap between long-established, high-priority screening recommendations and actual completion rates, demonstrating that completion rates require active measurement rather than assumed adequacy.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
2.4
Shared Decision-Making Happens for Screening With Genuine Tradeoffs
Non-Negotiable
For preventive services carrying genuine, documented tradeoffs between benefit and harm — such as lung cancer screening — the practice conducts real shared decision-making with the patient, not presenting the service as an automatic, default recommendation identical to lower-tradeoff screenings.
In plain terms: For screening tests where the benefit is real but so is the harm — lung cancer CT, PSA, some breast screening — the patient hears both sides and decides with the clinician, not just gets a test ordered.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | N/A | Full | Adapted | Full |
Why this matters
Not every screening test is straightforwardly good. Lung cancer CT screening saves lives in heavy smokers and generates false positives, invasive biopsies, and anxiety in many more. PSA screening detects cancers that would never have caused harm and leads to treatments that cause impotence and incontinence. For these tests, guidelines recommend shared decision-making: the clinician explains the trade-off in plain terms — how many benefit, how many are harmed — and the patient decides. Ordering the test without that conversation, or not offering it because the conversation is hard, both fail the patient. A decision aid helps; a documented conversation is the evidence.
What good looks like
- Genuine shared decision-making occurs for screenings with real, documented tradeoffs.
- The conversation honestly conveys both benefits and harms, not benefits alone.
- Patients can explain back the genuine tradeoffs in their own words.
Common failure modes
- High-tradeoff screenings are presented as automatic defaults, without genuine discussion.
- Conversations emphasize benefits without honestly conveying potential harms.
- Patients cannot describe any tradeoffs, suggesting the conversation didn't genuinely happen.
Worked example
In practice
A 5-room health centre where PSA tests were ordered routinely for men over 50.
BeforePSA was on the annual check-up panel for men over 50. No discussion of harms. Several men had undergone biopsies for elevated PSA; two had prostatectomies for low-grade cancer with lasting side effects; none recalled being told about over-diagnosis. Lung cancer screening was not offered because 'it's complicated.'
ActionPSA was removed from the routine panel. A shared decision-making protocol was written for PSA and lung cancer CT using national decision aids: the clinician presents benefits and harms in absolute numbers, the patient's values are elicited, the decision is documented — including a decision not to screen. Clinicians completed a one-hour training on the conversation. Eligible smokers are identified by the register and offered the conversation.
AfterThe Monitor reviewed 20 records of PSA or lung screening decisions: all documented the shared decision-making conversation with the decision aid; eight documented a decision not to screen. Verified.
If you are starting from zero — do this first
- Check whether PSA is on your routine panel. If so, remove it.
- Obtain national decision aids for PSA and lung cancer screening.
- Train clinicians on the conversation — one hour.
- Document the decision every time, including 'not to screen.'
The most common mistake: Ordering PSA routinely because it is easy — the harm from over-diagnosis is real and the patient was never asked.
Self-assessment questions
1. Does the practice conduct genuine shared decision-making for screenings with real, documented tradeoffs? — A real, substantive conversation, not the service presented as an automatic default.
Evidence: Shared decision-making documentation
Evidence: Shared decision-making documentation
2. Does this conversation genuinely convey both potential benefits and potential harms, not benefits alone? — Balanced, honest information, not a one-sided presentation favoring screening.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
3. Can a patient who underwent such screening explain back the genuine tradeoffs they were told about? — Tests genuine understanding, not just that a conversation technically occurred.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
Common reasons for a PARTIAL answer
- Shared decision-making happens for the most well-known high-tradeoff screening but not consistently for others carrying similar genuine tradeoffs. — Every screening with genuine tradeoffs deserves the same substantive conversation, not only the most familiar example.
- The conversation covers benefits thoroughly but harms are mentioned only briefly. — Genuine shared decision-making requires honest, balanced weight given to both sides.
- Documentation shows the conversation occurred but doesn't capture what the patient actually understood.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current practice for genuine shared decision-making versus automatic default screening. |
| Week 2 | Build a structured shared decision-making conversation covering honest benefit and harm information. |
| Week 3 | Establish documentation capturing genuine patient understanding, not just conversation occurrence. |
| Ongoing | Spot-check patient understanding after shared decision-making conversations. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Shared decision-making documentation review | Reviews records for genuine shared decision-making conversations for high-tradeoff screenings. |
| OBSERVE | Balanced information observation | Observes whether the conversation genuinely conveys both benefits and harms. |
| ASK | Patient understanding check | Asks a patient who underwent such screening to explain back the tradeoffs they were told about. |
Supervisor tips
- Ask a patient who underwent a high-tradeoff screening what they remember being told about potential harms. — This tests genuine understanding, not just that a conversation occurred.
- Compare how thoroughly harms are discussed relative to benefits in actual documentation. — This reveals whether the conversation is genuinely balanced or benefit-weighted.
Evidence base
[9] Established evidence-graded preventive service guidance recommends annual lung cancer screening for eligible patients based on sufficient evidence of net benefit, while specifically requiring a thorough process of informed and shared decision-making prior to screening given the genuine tradeoffs between benefits and harms involved.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
2.5
Immunization Status Is Actively Tracked and Gaps Are Closed
Non-Negotiable
Every patient's immunization status is actively tracked against the current recommended schedule, with any identified gap actively addressed — not assumed current because no concern was raised, or left to the patient to remember and request.
In plain terms: Every patient's vaccination status is checked against the current schedule, gaps are identified, and the practice actively closes them — not just when the patient asks.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Full | Full | Full | Full |
Why this matters
Vaccination is the highest-value intervention in primary care and the one most easily neglected between the childhood schedule and old age. Adults miss tetanus boosters, pneumococcal, influenza, shingles, hepatitis B; children fall behind after a move; adolescents miss HPV. The register should show each patient's status against the schedule; every contact is an opportunity to close a gap; recalls target the overdue. Herd immunity depends on the practice reaching the patients who do not come asking.
What good looks like
- Immunization status is actively, genuinely tracked for every patient.
- Identified gaps are actively addressed, not just documented.
- Status is checked across any visit type, not only dedicated immunization visits.
Common failure modes
- Immunization currency is assumed without active verification.
- Gaps are noted but not actively followed through to closure.
- Status is checked only during specifically scheduled immunization visits.
Worked example
In practice
A 6-room health centre with a paediatric vaccination focus but no adult vaccination tracking.
BeforeChildhood vaccines were tracked by the nurse. Adults were vaccinated on request. No register of adult vaccination status. Influenza uptake in over-65s was 30%. Pneumococcal vaccination was rarely given. HPV coverage in adolescents was unknown.
ActionThe register was configured to track vaccination status for all ages against the national schedule. Every contact includes a status check at check-in (linking to 2.2). An annual influenza and pneumococcal campaign targets over-65s and at-risk groups with recall and outreach. HPV is offered at every adolescent contact. Coverage is reported quarterly.
AfterThe Monitor reviewed the register configuration, quarterly coverage reports (influenza in over-65s 30% → 62%), and 20 records showing gaps identified and closed at routine visits. Verified.
If you are starting from zero — do this first
- Calculate influenza coverage in your over-65s. Below 50% is a problem.
- Configure your register to show vaccination status for all ages.
- Check status at every check-in.
- Run an annual campaign for over-65s and at-risk groups.
The most common mistake: Tracking childhood vaccines carefully and adult vaccines not at all.
Self-assessment questions
1. Is immunization status actively tracked against the current recommended schedule for every patient? — Real, active tracking, not an assumption of currency without verification.
Evidence: Immunization tracking record
Evidence: Immunization tracking record
2. Is an identified gap actively addressed, not just noted and left for the patient to raise? — Genuine, active follow-through, not passive documentation of a known gap.
Evidence: Gap closure record
Evidence: Gap closure record
3. Is tracking checked at any visit, not only during a visit specifically scheduled for immunization? — An active check at any opportunity, not limited to a narrow visit type.
Evidence: N/A — tested directly
Evidence: N/A — tested directly
Common reasons for a PARTIAL answer
- Tracking happens reliably for childhood immunizations but less consistently for adult boosters and updates. — Adult immunization schedules carry genuine, real importance too, not only childhood series.
- Gaps are identified but follow-through to actually close them isn't consistently tracked to completion. — An identified gap that isn't closed provides no more protection than one never noticed.
- Status is checked during well-visits but not during acute or urgent encounters.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current immunization tracking practice across all age groups and visit types. |
| Week 2 | Establish active tracking extending to adult immunizations, not only childhood series. |
| Week 3 | Build a gap closure process tracked through to actual completion. |
| Ongoing | Audit gap identification and closure rates periodically. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Tracking system review | Reviews the immunization tracking system for genuine, active currency checking. |
| DOCUMENT | Gap closure review | Reviews evidence that identified gaps are actively addressed, not just documented. |
| OBSERVE | Visit-type coverage observation | Observes whether immunization status is checked across different visit types, not only dedicated immunization visits. |
Supervisor tips
- Ask whether immunization status is checked during an acute or urgent visit specifically. — This is where verification most commonly lapses relative to dedicated well-visits.
- Ask for a real example of an identified gap and how it was actually closed. — A real example reveals whether gap closure is genuine practice, not just identification.
Evidence base
[10] Systematic immunization tracking against current recommended schedules, with active identification and closure of gaps, is established practice in primary care preventive medicine, distinct from reliance on unprompted patient request or assumed currency.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.