Forms

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

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

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


SHARING
Prevention Checklist
Checklist/Follow-up

Patient Organizing Sheet
Diagram of Clinic Rooms

Clinic Lab Test Results
Parking Map
Vital Signs
Followup Phone Call Instructions
Epic Guide for Students
Welcome to SHARING

GENERAL
Spanish Medication Example #1
Spanish Medication Example #2
EMPOWER Healthcare Maintenance
Midwest Gastrointestinal Associates Colonoscopy Referral
Midwest GI Screening Questions
Midwest GI Instructions
Annual Psychiatry Screening Tool
OUCH Exposure Documentation Form

OUCH Protocol
Eprescribing Patient Instructions

Visit Co-Payment Form

Dental Referral Phone Numbers

Controlled Substance Contract
Interdisciplinary Services Checklist
Pharmacy Rx Records
Vaccine Policy/Administration
Kubat Pharmacy (Durable Goods)

Durable Goods Check-Out Agreement
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