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Pediatric health maintenance checklist, 2 weeks to 6 years.
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A series of health maintenance forms that cover adolescents and children from 1 week to 18 years.
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The U.S. Department of Health and Human Services has released an updated and improved version of the Surgeon General's internet-based family health history tool. The new tool makes it easier for patients to assemble and share family health history and can also help practitioners make better use of health history information. For more detailed information about the new tool, please visit the website listed.
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This questionnaire may be used as part of the review of systemswith patients. The clinician might begin, "I need to ask a fewshort questions about your sexual health in order to be thoroughin providing your medical care."
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A Spanish translation of the Adult Medical History Form.
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A Spanish version of the Adult Medical History Form.
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A sample oral contraceptive interval history form in English and Spanish.
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A Spanish translation of the 1-page sample social history form.

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To ensure all data is maintained and properly backed up to maximize recovery in the event of disaster and to make the file accessible to other staff.

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To implement a plan in case of any accidents or emergencies involving staff involved in official activities.

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To differentiate between different classifications of employees for purposes of determining benefits, eligibility for overtime pay, and other issues.

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This resource provides a straightforward tool to use to develop effective hepatitis risk assessment with adult clients through your clinic charting system.

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This is a one page tool used by community health workers to evaluate individuals for family violence. The tool is designed for use with low literacy populations and uses pictures instead of words to communicate.

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One page tool to use in evaluating the possibility of physical abuse.

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A 2-page sample prenatal health history form.
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The "Keep It With You" (KIWY) Personal Medical Information Form is intended to be a voluntary and temporary record that lists medical care and other health information for people who need care during disasters and similar situations.

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Two-page form specific to an individual coming into the clinic for an initial hypertension visit.
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Two-page form specific to an individual coming into the clinic for an initial asthma visit.
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One-page adult/adolescent general assessment form.
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Form to collect insurance information from new patients.
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A sample medication record for the medical chart.
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These policies were developed by OneWorld Health Center to govern their promotora program. Included in this document are policies regarding: Procedures, Follow-up Calls, Forms, Job Descriptions, Competencies and Attributes.
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These policies were developed by OneWorld Health Center to govern their promotora program. Included in this document are policies regarding: Procedures, Follow-up Calls, Forms, Job Descriptions, Competencies and Attributes.

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Sample policy on employee immunization records.
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Seven page document that provides a sample/template emergency preparedness plan.

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Two documents that can be used as a template guide for creating a pandemic flu policy.

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