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Administrative Forms
A Tool for Identifying Migrant and Seasonal Farmworkers in Your Clinic
MCN recommends screening for migrant status at every clinic visit. This bilingual tool is designed to help clinic staff identify migrant and seasonal farmworkers.
Files
- Id Migrant Seasonal Farmworkers Mcn Sp Eng.pdf( 373.00 Kb )
HRCH Pregnancy Pamphlet- Spanish
Usted y su bebe pregnancy pamplet.
Files
- Ud. Y Su Bebe-hrch Pregnancy Pamphlet.doc( 1,658.88 Kb )
Incident Report Form
Two-page form used to report accidents or incidents in the clinic.
Files
- Incident Reportform.doc( 322.56 Kb )
Sample Service Contract
THIS AGREEEMENT made effective the date of signing below, between ****** COMMUNITY HEALTH CENTER, INC., hereinafter referred to as “***,” and *****, hereinafter referred to as “****.”........
Files
- Tallgrass+agreement.doc( 552.96 Kb )
Verbal/Telephone Orders and Test Results
To define a process for accepting verbal or telephone orders and test results directly from physicians, physician extenders (Physician Assistants, Nurse Midwives, Nurse Practitioners), labs and/or testing services.
Files
- 3.02.19 Verbal Orders And Critical Values2.doc( 312.32 Kb )
