BACKGROUND & OBJECTIVES: East Carolina University (ECU) Pediatrics, in conjunction with all of the private pediatric practices in Greenville, NC, operates an acute care after hours clinic. Both ECU pediatric faculty and private practice physicians supervise residents in this collaborative clinic. While the ECU Pediatrics day clinic operates using the Electronic Medical Record (EMR), the after hours clinic’s documentation occurs on paper charts due to underlying EMR access issues. The paper chart used in the after hours clinic employs a “checkbox” template for the physical exam with extra room for free text. This template lends itself to substandard documentation of the physical exam, as providers tend to simply check the “normal” box with little expansion of the physical exam. This limited documentation poses a potential compromise to patient care, as well as billing and coding. METHODS: Baseline data on review of 485 charts revealed a detailed physical exam* documentation rate of 61% in the after hours clinic. Our initial AIM statement was to improve the percentage of documented detailed physical exams in the pediatric after hours clinic by 10% over 1 month. In our first PDSA cycle, we provided both written and verbal education to the residents, as well as the ECU and private practice attending physicians. In our second PDSA cycle, we edited the actual paper chart used in the after hours clinic to include three short descriptors by the “constitutional” section of the physical exam which providers can quickly circle. Data was collected for 1 month or more after each cycle. We also collected baseline financial data, which revealed a per visit reimbursement rate of approximately $82. For our third PDSA cycle, we plan to edit the paper chart to include a statement to be utilized by medical students as a method of clarifying their role as scribe when documenting in the paper chart. *“detailed physical exam”=at least 5 systems examined with 2 of those systems expanded OUTCOMES: We exceeded our initial goal following our cycle 1 intervention as documentation of detailed physical exams improved to 88% (660 of 745 total charts). Our per visit reimbursement rate also increased by $5/visit to approximately $87. We then revised our AIM statement to improve the percentage of documented detailed physical exams by another 5% after our cycle 2 intervention. After cycle 2, our documentation of detailed physical exams decreased slightly to 87% (1956 of 2241 total charts). Financial data post cycle 2 is still pending. SIGNIFICANCE: Our quality improvement project has the potential to improve both patient care, as well as billing and coding. For example, the limited physical exam documentation in after hours clinic can make reassessment of the patient at follow-up appointments more difficult. As noted by our financial analysis, our per visit reimbursement rate increased by $5 per visit after our cycle 1 intervention. Our after hours clinic sees approximately 7,300 patients per year, which translates into an additional $37,000 per year.