Forms
Links Of Interest
Indian Health Forms Page A-Z
or
Listed by organ system
Elder Exam PCC Comprehensive (IHS 865) (PDF 643k)
PCC+ Forms for Women's Health and Prenatal Care
IHS PCC+ link, plus helpful PCC+ templates; thanks to Laurie Perrin, Phil Fleming and Jeanolivia Grant. Please note: the Word documents are all about 160k and the PDF's are about 50k.
Colposcopy PCC+ forms | Word | ||
Did not keep appointment (DNKA) | Word | ||
Family Planning | Word | ||
Gynecology | Word | ||
Gynecology Comprehensive | Word | ||
Gynecology Walk-in | Word | ||
Labor & Delivery | Word | ||
L / D Triage (ANMC) | Word | ||
Midwifery | Word | ||
OB/GYN Call-in/Phone | Word | ||
OB/GYN Walk-in | Word | ||
OB Revisit | Word | ||
OB Walk-in | Word | ||
Postpartum | Word | ||
Prenatal Revisit No. 2 | Word | ||
Prenatal flow sheet, ANMC | Word | ||
Tobacco cessation, Cherokee | Word | ||
Tobacco Cessation Chart form: Five A's | *PDF (18k) | ||
Well Women's Exam | Word | ||
*Non-PCC+ form |
Tobacco Cessation Chart Form: Five A's
Ask, Advise, Assess, Assist, Arrange (PDF 18k)
Prenatal and Pregnancy Flowsheet - Albuquerque Service Unit: Medical Record
- Revision of IHS-800-1 was completed 10/2000. Be sure to see both pages 1 and 2. Page 1 - (WORD 98k) | Page 2 (WORD 57k)
Prenatal assessment: ETOH, substances, DV (PDF 24k)
VBAC and TOLAC Consent Forms
- University of New Mexico: TOLAC consent (WORD 24k)
- Vermont/New Hampshire VBAC Project: Consent for Birth After Cesarean (PDF)
Do you need help documenting GPRA items?
Here are some helpful tips or 'cheat sheets'
- Clinical Reporting System (CRS) Version 5.0 (2005) Patch 1
- GPRA 'cheat sheet' (WORD 141 k)
- Screening documentation codes: Billings (RTF 10 k)
- Prenatal/Perinatal Patient Education and Protocols and Codes (PDF)
- Patient and Family Education Protocols and Codes manual by discipline
- Patient Education and Protocols and Codes
- Updated GPRA Clinical Cheat Sheet, 4/05 (PDF 35k)