Patient Care Templates

This document provides information about the status of nursing facility care in the state of Colorado. It includes details about the quality and availability of care for residents in nursing homes.

This form is used for applying to the Uninsured Care Programs in New York. It is available in Yiddish.

This form is used for recording and documenting patient care information for Emergency Medical Services (EMS) in the state of Wisconsin. It helps to track and organize important details about the patient's condition, treatment, and transportation.

This Form is used for creating a medical plan for emergency incidents.

This document is used for establishing an agreement between a patient and healthcare provider for direct observed therapy in Virginia.

This form is used for creating a treatment or discharge plan for patients with tuberculosis in Virginia. It is specifically provided in the Korean language for the convenience of Korean-speaking individuals.

This document allows individuals in Idaho to request a change in their primary physician.

This Form is used for assessing the level of distress and identifying problems in patients as a part of their cancer care.

This document is an endorsement hospital agreement for pre-hospital emergency care in the state of Nevada. It outlines the terms and conditions between the hospital and pre-hospital care providers.

This document outlines the code of ethics that resident hospice workers in Maine must adhere to. It sets guidelines for their professional conduct and responsibility.

This Form is used for submitting a prior authorization request for Cimzia medication in the state of Vermont.

This tool is used for reviewing multiple charts in the Comprehensive Perinatal Services Program in California.

This form is used for notifying the state of Illinois about the use of ventilators in nursing facilities.

This Form is used for making medical treatment decisions in Illinois. It is available in both English and Spanish versions.

This document is used for an independent physician review for extended care in the state of Utah. It helps to assess and determine the need for extended care services and treatment for patients.

This document is a survey form used by the Washington State Department of Social and Health Services (DSHS) to evaluate integrated settings in residential facilities.

This document is used for the review of direct care observations conducted by clinicians for clients in North Dakota.

This document provides training on the process of presumptive eligibility for hospitals in Nevada. It explains how hospitals can determine eligibility for certain individuals to receive temporary Medicaid coverage.

This document is for creating a personalized health care plan for individuals in Oklahoma. It outlines specific health needs and recommendations for providing personalized care.

This document is used for reporting patient referrals between agencies in Connecticut.

This form is used for disclosing important information about memory care services in Texas assisted living facilities.

This document is used for obtaining prior authorization for opioids in the state of Mississippi. It includes the necessary paperwork and information required to request approval for the use of these medications.

This document is used for tracking and monitoring fluid balance and stool frequency. It can help individuals and healthcare professionals understand and manage hydration levels and digestive health.

This document is a chart that provides a pain assessment scale called the Abbey Pain Assessment Scale. It is used to measure and evaluate the level of pain experienced by individuals in healthcare settings.

This Form is used for prescribing and administering insulin medication. It helps healthcare professionals accurately record and manage insulin doses for patients with diabetes.

This document is a tool provided by the Department of Patient and Family Caregiver Resources, allowing individuals to monitor and record their blood sugar levels regularly. It's essential for patients with diabetes or other health conditions related to blood glucose management.

This document is a comprehensive chart that provides information about the drugs prescribed in hospitals. It includes details such as dosages, indications, and potential side effects for various medications. This chart is an invaluable tool for healthcare professionals in ensuring safe and effective treatment for patients.

This document is a tool for assessing the risk of self-medicating. It is designed to help individuals evaluate the potential risks and benefits of self-treatment.

This document serves as an educational template detailing examples of omissions and errors typically found within prescription charts. Ideal for medical students, healthcare professionals, and anyone looking to avoid common mistakes in prescription writing.

This document provides step-by-step guidelines for the process of emergency intubation, ensuring that all necessary procedures and safety protocols are followed correctly to aid patients in breathing.

This document is a tool employed mainly in medical fields for evaluating and managing the intensity and nature of a patient's pain. The M-Rvbpi helps to facilitate conversations between healthcare providers and patients about pain symptoms.

This document is utilized for monitoring and recording the physiological observations of an adult patient. It is also used to track any significant changes in a patient's health status and decide upon necessary medical intervention.

This document provides a sample template for healthcare professionals in Minnesota to review antibiotic use after the initial 72 hours, ensuring appropriate therapy and combatting antimicrobial resistance. Suitable for clinics, hospitals and other medical establishments.

This document is utilized for evaluating a patient's initial level of pain. It helps healthcare professionals determine the severity, location, and type of discomfort, to provide appropriate treatment.

This document is a template for tracking daily weight in individuals with heart failure. It helps monitor changes in weight, which can be an important indicator of fluid retention and heart health.

This form is used for practitioners in Illinois to record a patient's decisions regarding life-sustaining treatment. It is available in both English and Chinese Simplified languages.