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Purpose and instructions along with the actual incident report form.

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To document fair employment practices.
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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.

The purpose of the Patient Discharge from Practice Policy is to direct a mechanism for review of cases where there is a serious breech in the responsibility of a patient to Cherry Street Health Services. The reviewers consist of the Medical Director and/or Dental Director and the Provider involved and any other staff involved in the case. The group may recommend a remedy, which may include the termination of the patient from the health center practice.

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To provide for a consistent method of telephone medical management by the Registered Nurse.

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Manage changes in a rational and predictable manner so that staff and clients can plan accordingly.

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Clinic policy detailing the informed consent process.
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The purpose of this policy is to define the reasons for patients being terminated from the practice and to describe the termination process. This policy statement can be downloaded and modified for use in other health centers.

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This policy is created to outline the process for the management of difficult patients. This includes those who are perceived to be difficult with respect to recurrent hostile behavior, inappropriate use of __HC services, excessive non-compliance, inappropriate use of controlled substances, or other patterns of behavior that represent excessive lack of respect or responsibility on the part of the patient.

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Clinic policy on patient flow.
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A few sample dental chart review forms/templates. 

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This policy is created to outline the process for the management and eventual discharge from service of difficult patients. This includes those who are perceived to be difficult with respect to recurrent hostile behavior, inappropriate use of FHC services, excessive non-compliance (including financial obligations), inappropriate use of controlled substances, or other patterns of behavior that represent excessive lack of respect or responsibility on the part of the patient.
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Psychosocial Assessment form to be used by providers.
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Child/Adolescent personal history form designed for an individual to fill out prior to seeing a therapist.
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Adult personal history form designed for an individual to fill out prior to seeing a therapist.

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Adolescent self-report which states that it is to be used in order to "help counselors understand--in your own words--why you are here and what difficulities you might be having".
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To promote the improvement in the quality of the assessment and care of patients, enhance the appropriate utilization of health care services, and to enhance the value of health care services.

This is an integrated risk assessment form for STD, HIV, and hepatitis A, B, and C. The risk assessment form is designed to assess at-risk clients within your clinic and determine the services they should receive. This form is designed to be self-administered. Once the client has completed the form, it should then be reviewed by the clinic staff to determine the services the client is eligible to receive. In addition to screening, testing, and/or vaccine services, all clients should be offered appropriate counseling and educational materials tailored to their specific risks.

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A one-page diabetes foot screening form.
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A sample asthma assessment form.
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A HRSA publication that looks at the basic elements of a Continuous Quality Improvement with a specific focus on HIV care.
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To outline procedures for discipline and / or termination of employees.

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To maintain a safe work environment free of controlled substances.

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To delineate the procedures for court appearances by employees.

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To maintain confidentiality of corporate and programmatic information.

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To allow leave time for employees to attend funerals of immediate family members.

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To assure relevance of the plan and ensure that all data is maintained and properly stored and all policies and procedures are followed to maximize recovery in the event of disaster.

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Provided by The El Dorado County Community Health Center

90-day Initial professional Practice evaluation with revew areas such as: medical knowledge, patient care, practive-based learning & imporovement, systems based practice, interpersonal & communication skills,  and professionalism.