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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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A few sample dental chart review forms/templates. 

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This policy is created to outline the process for the management and eventual discharge from service of difficult patients. This includes those who are perceived to be difficult with respect to recurrent hostile behavior, inappropriate use of FHC services, excessive non-compliance (including financial obligations), inappropriate use of controlled substances, or other patterns of behavior that represent excessive lack of respect or responsibility on the part of the patient.
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Psychosocial Assessment form to be used by providers.
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Child/Adolescent personal history form designed for an individual to fill out prior to seeing a therapist.
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Adult personal history form designed for an individual to fill out prior to seeing a therapist.

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Adolescent self-report which states that it is to be used in order to "help counselors understand--in your own words--why you are here and what difficulities you might be having".
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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.
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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.

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A one-page diabetes foot screening form.
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A sample asthma assessment form.
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Lifetime Card for adults. MCN, along with CHEC (Community Health Education Concepts), has developed patient-friendly, low literacy, bi-lingual immunization cards for you to use with your clients. The cards are 5x7, and can be printed from your clinic computers.

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A Child and Teen Card, both in Spanish/English. MCN, along with CHEC (Community Health Education Concepts), has developed patient-friendly, low literacy, bi-lingual immunization cards for you to use with your clients. The cards are 5x7, and can be printed from your clinic computers. MCN designed the card to be as simple as possible, and to include only the most important information. If the information is meaningful and understandable to the clients, they are more likely to understand the importance of keeping their shots up to date.

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