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Sample policy on employee immunization records.
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Seven page document that provides a sample/template emergency preparedness plan.

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Two documents that can be used as a template guide for creating a pandemic flu policy.

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Any patient presenting or calling with any of the following conditions will receive immediate attention. If present in the clinic, the patient will be taken to an exam room immediately and the RN, PA , or physician will be called to make further evaluation. If the patient calls, the urgent call message will be taken director to the provider and in their absence, to the clinical coordinator or available RN for a plan of care.
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The Workbook provides a process that can support state, local,and tribal planners as they advance in their efforts to reach all populations—and specifically, special populations—in day-today communication and during crisis or emergency situations.

The Workbook is divided into three primary sections, each representing a major stage in the process of communicating with special populations,and provides a baseline of research plus selected resources that should substantially reduce the work required of health departments to begin this process.

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Sample clinic policy for scenarios that constitute emergencies requiring immediate attention by an auxiliary medical personnel or physician.

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Sample year-long calendar outlining emergency preparedness activities.
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The goal of this Emergency Management plan is to describe the organization�s approach to responding to emergencies within the organization or in its community that would suddenly and significantly affect the need for the organization�s services, or its ability to provide those services, and to protect staff, patients, and visitors from harm and to ensure an effective response to disasters or emergencies affecting the environment of care.
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Sample policy stating the procedure for a medical emergency.
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To document fair employment practices.
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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.

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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.

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To provide for a consistent method of telephone medical management by the Registered Nurse.

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Manage changes in a rational and predictable manner so that staff and clients can plan accordingly.

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Clinic policy detailing the informed consent process.
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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.

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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.

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Clinic policy on patient flow.
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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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To outline procedures for discipline and / or termination of employees.

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