U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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NC4 Clinical Resources
Clinical Forms: Organ System
· Child Health   · Endocrine
· Hematology · Prevention/Health Care Delivery
· Procedures · Radiology
· Respiratory · Rheumatology
· Substance Abuse · Women's Health

Child Health

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Endocrine

Diabetes Mellitus

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Hemataology

Prevention/Health Care Delivery

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Procedures

Radiology

Respiratory

Rheumatology

Substance Abuse

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Women's Health

PCC+ Forms for Women's Health and Prenatal Care
Please note: the Word documents are all about 160k and the PDF's are about 50k.

Colposcopy PCC+ form: Word       PDF
Did not keep appointment (DNKA): Word
PDF
Family Planning: Word       PDF
Gynecology: Word       PDF
Gynecology Comprehensive: Word
PDF
Gynecology Walk-in: Word
PDF
Labor & Delivery: Word       PDF
L / D Triage (ANMC): Word       PDF
Midwifery: Word       PDF
OB/GYN Call-in/Phone: Word       PDF
OB/GYN Walk-in: Word       PDF
OB Revisit: Word       PDF
OB Walk-in: Word       PDF
Postpartum: Word       PDF
Prenatal Revisit No. 2: Word
PDF
Prenatal flow sheet, ANMC: Word
PDF
Tobacco cessation, Cherokee: Word
Tobacco Cessation Chart form: Five A's: PDF [18k]
Well Women's Exam: Word

 

Tubal ligation Consent (30 day form) [PDF 331k]

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Please note, regarding the material described above:

  • The material presented is meant to further your local discussion of best practices. It is not meant to provide a template for care. Please share it with your local clinical staff and alter to fit your local needs
  • Material for each topic on these sites has been developed by other providers based on that person's clinical judgment and experience as an expert in that field
  • The material does not represent official policy or recommendations of the Indian Health Service or the other agencies involved
  • Its publication should not be construed as excluding other acceptable methods of handling similar problems
  • Please let the site coordinator know if you have questions or concerns about any of the material. Thanks

 

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