Skip to main content
To promote the improvement in the quality of the assessment and care of patients, enhance the appropriate utilization of health care services, and to enhance the value of health care services.

This is an integrated risk assessment form for STD, HIV, and hepatitis A, B, and C. The risk assessment form is designed to assess at-risk clients within your clinic and determine the services they should receive. This form is designed to be self-administered. Once the client has completed the form, it should then be reviewed by the clinic staff to determine the services the client is eligible to receive. In addition to screening, testing, and/or vaccine services, all clients should be offered appropriate counseling and educational materials tailored to their specific risks.

A one-page diabetes foot screening form.
A sample asthma assessment form.