Forms

GOODLIFE
GOODLIFE Carecast Intake Form/Word
GOODLIFE Physical Exam Temp
New Patient Diabetes H&P
GOODLIFE Clinic Lab Test Order
GOODLIFE Clinic Lab Test Results

RESPECT
RESPECT Checklist
RESPECT Clinic Lab Test Order
RESPECT Clinic Drug Administration Log
RESPECT Clinic Testing for Gonorrhea and Chlamydia

RESPECT Clinic Lab Test Results
RESPECT Spanish-English Medical Assessment
Rocephin Injection Instructions
Administration of a gluteal injection of Rocephin (diagram)
RESPECT Female Form
RESPECT Male Form


SHARING
Prevention Checklist
SHARING Checklist/Follow-up

SHARING Patient Organizing Sheet
SHARING MAP

SHARING Clinic Lab Test Results
Parking at SHARING
Vital Signs

Midwest Gastrointestinal Associates Colonoscopy Referral
Midwest GI Screening Questions
Midwest GI Instructions

GENERAL
Annual Psychiatry Screening Tool
OUCH Exposure Documentation Form

OUCH Protocol
Eprescribing Patient Instructions

Visit Co-Payment Form

Dental Referral Phone Numbers

Controlled Substance Contract
Financial Assistance: English
Financial Assistance: Spanish
SHARING Interdisciplinary Services Checklist
Pharmacy Rx Records
Vaccine Policy/Administration
Kubat Pharmacy (Durable Goods)

Durable Goods Check-Out Agreement
SHARING Durable Goods Chart

Proof of Income
Proof of Income List

DM Test Strip Policy
Instructions Procedure Manual Access

OPHTHALMOLOGY
Eyeglasses for Patients
Eye Referral/Appointment/Map
VSP Sights for Students English
VSP SIghts for Students Spanish