Purpose and instructions along with the actual incident report form.
To define a process for accepting verbal or telephone orders and test results directly from physicians, physician extenders (Physician Assistants, Nurse Midwives, Nurse Practitioners), labs and/or testing services.
The purpose of the Patient Discharge from Practice Policy is to direct a mechanism for review of cases where there is a serious breech in the responsibility of a patient to Cherry Street Health Services. The reviewers consist of the Medical Director and/or Dental Director and the Provider involved and any other staff involved in the case. The group may recommend a remedy, which may include the termination of the patient from the health center practice.
- 3.02.04 Discharge from Practice2.doc (33.5 KB)
To provide for a consistent method of telephone medical management by the Registered Nurse.
- Telephone Triage Protocol2.doc (25 KB)
Manage changes in a rational and predictable manner so that staff and clients can plan accordingly.
- ChgMgmntGuide2_0.doc (46.5 KB)
- InformedConsent.doc (20.5 KB)
The purpose of this policy is to define the reasons for patients being terminated from the practice and to describe the termination process. This policy statement can be downloaded and modified for use in other health centers.
This policy is created to outline the process for the management of difficult patients. This includes those who are perceived to be difficult with respect to recurrent hostile behavior, inappropriate use of __HC services, excessive non-compliance, inappropriate use of controlled substances, or other patterns of behavior that represent excessive lack of respect or responsibility on the part of the patient.
- 335_MgmtofDifficultPatients2.doc (61.5 KB)
A few sample dental chart review forms/templates.
- Chart review sheets.doc (127 KB)
- dentalpeerreviewform.pdf (345.57 KB)
- PsychosocialAssessment.doc (68.5 KB)
- ChildAdolHistoryForm.doc (84 KB)
Adult personal history form designed for an individual to fill out prior to seeing a therapist.
- AdultHistoryForm.doc (91 KB)
- AdolescentSelfReport.doc (40.5 KB)
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.
- STD_HIV_HepRiskTool.doc (43 KB)
- DemystifyingQuality.pdf (1.02 MB)
To outline procedures for discipline and / or termination of employees.
- 002.02.01DisciplinePolicy2.doc (802 KB)
To maintain a safe work environment free of controlled substances.
- 002.08.05DrugFreePolicy2.doc (58.5 KB)
To delineate the procedures for court appearances by employees.
- 002.06.11CourtAttendanceGuideline2.doc (49.5 KB)
To maintain confidentiality of corporate and programmatic information.
To allow leave time for employees to attend funerals of immediate family members.
To assure relevance of the plan and ensure that all data is maintained and properly stored and all policies and procedures are followed to maximize recovery in the event of disaster.
Provided by The El Dorado County Community Health Center
90-day Initial professional Practice evaluation with revew areas such as: medical knowledge, patient care, practive-based learning & imporovement, systems based practice, interpersonal & communication skills, and professionalism.