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
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