Section 421.424 - Quality Assurance(A)Medical.(1) The medical director or his or her designee must perform an on-site review of all physicians, nurse practitioners, and physician assistants within the first three months of their employment and thereafter annually for physicians and semiannually for nurse practitioners and physician assistants. Written reports of these reviews must be included in the personnel file. The on-site review must include observation and assessment of the clinical skills of the practitioner in caring for a variety of patients.(2) The medical director or his or her designee must review at least four times a year a sample of the agency's records for adequacy of documentation and appropriateness of treatment and follow-up.(B)General. A family planning agency must have ongoing evaluation processes and appropriate plans of action for all program activities (including counseling and outreach services), clinic management, and availability of services.Amended by Mass Register Issue S1277, eff. 1/2/2015.