Division for Regional and Local Health Services Public Health Nursing - Publications and Forms

Publications

Quality Care: Client Services Standards for Public Health and Community Clinics (viewing information)

• Introduction
• Manual [pdf, 112 K]

Infection Control Manual

Forms

Health Care Record: Client/Household Information (CORE-1) English
Health Care Record: Client/Household Information Update (CORE-1a) English
Health Care Record: Physical Exam (CORE-2) English
Health Care Record: Referral List (CORE-3) English
Health Care Record: Medical/Social History (CORE-4) English
Diet History (CORE-4a) English
Diet History (CORE-4b) Spanish
Health Care Record: Flow Sheet Immunizations (CORE-5) English
Health Care Record: Medication Issued (CORE-6) English
Health Care Record: Progress Notes (CORE-7) English
Health Care Record: Triage Note (CORE-8) English
Health Care Record: Client Follow-up Record (CORE-9) [pdf, 13K)
Health Care Record Instructions (CORE-10) English [pdf, 1.6 MB]
Authorization to Release Confidential Information/Instructions for Obtaining Consent to Release Medical Information (L-30/L-30a) English [pdf, 202K]
General Consent and Disclosure (L-36) English and Spanish [pdf, 228K]
General Consent/Permission for Provision of Service and Patient Record Form (L-37) [pdf, 17k]
Nurses' Daily Report (L-2)
Referral Form / Instructions (L-29 & L-29a)
Statement of Services (L-39)