Healthcare Documents

This chart is used to specify the range of motion limitations for affected joints in a patient. It includes detailed instructions for each part of the body. This form is vital for providing a thorough assessment of a patient's range of motion.

This document is the Neuro Assessment Flow Sheet used by Connecticut Valley Hospital. It helps nurses to record and monitor patients' neurological status. Key indicators include consciousness level, movement, hand grasps, pupil reaction, and vital signs.

This document contains the approved product list for incontinence supplies under the Alberta Aids to Daily Living (AADL) program. It lists approved vendors, product descriptions, and pricing for individuals requiring incontinence supplies. It also provides guidelines for vendors on how to supply these products.

This form allows Molina Healthcare members to request a change of their primary care provider. The form requires member and new provider details, and must be signed and submitted via fax, email, or mail. It is applicable for Medicaid, Marketplace, Medicare, and Dual Options members.

The DWC Form PR-2 is used by primary treating physicians to report the progress of a patient's treatment for workers' compensation cases. It includes the patient's subjective complaints, objective findings, diagnoses, and treatment plan. This form is necessary for documenting changes in treatment, work status, and other relevant information.

Cardiopulmonary exercise testing (CPET or CPEX), also referred to as a VO2 (oxygen consumption) test, is a specialized type of stress test that measures your exercise ability. This document explains the common reasons for CPET, who might not be able to perform it, and how to prepare for the test. It also provides details on what to expect during the test and how results are processed.

This file contains the application instructions and requirements for the Desert Regional Center. It includes mandatory identification documentation and developmental disability documentation. Ensure all necessary forms are completed and submitted within the specified timeframe.

This file outlines the steps members of Simply Healthcare Plans need to follow to appeal a decision regarding their Medicaid Managed Medical Assistance or Long-Term Care services. It provides detailed information on how to file an appeal, what to expect after submitting an appeal, and what to do if expedited processing is needed. The guide also includes contact information for further assistance.

This file is an informed consent form for Platelet Rich Plasma (PRP) injection treatment. It includes details on the procedure, benefits, contraindications, risks, alternatives, and consent information. The form is essential for patients considering PRP treatment.

This OhioHealth Diabetes Log Sheet is used to monitor daily blood sugar levels. It includes columns for blood sugar readings before meals and at bedtime. It helps patients keep track of their target blood sugar levels throughout the day.

The CAPS-5 Past Week is an instrument for assessing PTSD symptoms occurred in the past week. It helps compare PTSD symptoms over time. It should not be used for diagnosing PTSD.

This form is used to provide information about requests for support on new training initiatives at the San Francisco Department of Public Health. Fill it out to help the CLI team understand your needs, training solutions, and project scope. Submit the completed form to cli.phd@sfdph.org.