Harbor:Forms

Printable FORMS

Work Notes

Clinics

  1. CHC Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/CHC.pdf
  2. Dental Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Dental%20Clinics.pdf
  3. Women's (Gyn) Clinics http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Womens%20Clinics.pdf
  4. Pediatric Same-Day Clinic http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Pediatric%20Same%20Day%20Clinic%20at%20Harbor.pdf
  5. Adult Mental Health Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Psych%20Referrals.pdf
  6. Pediatric Mental Health Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Peds%20Psych%20Referrals.pdf
  7. Shelter Resources for the Homeless http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Shelter%20Resources.pdf
  8. Substance Abuse Resources http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Substance%20Abuse%20Referral.pdf

Clinical Forms

  1. Heparin Infusion http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Heparin%20Infusion%20Adult.pdf
  2. Peripheral Pressor Extravasation (pages 5-6) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Extravasation%20Management.pdf
  3. Pathology Tissue Report http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Path%20Form.pdf
  4. Pediatric Tylenol/Motrin Dosing http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Tylenol%20Motrin%20Peds%20Dosing.pdf

Legal Forms

  1. General Consent (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/General%20Consent-English.pdf
  2. General Consent (Spanish)http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/General%20Consent-Spanish.pdf
  3. Telegram http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Telegram.pdf
  4. DMV Form http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/DMV%20LOC%20Form.pdf
  5. OK to Book http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/OK%20to%20Book.pdf
  6. AMA (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/AMA%20English.pdf
  7. AMA (Spanish) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/AMA%20Spanish.pdf
  8. PHI Release http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/PHI%20Release.pdf
  9. Imaging Request http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Imaging%20Request%20Form.pdf
  10. Photo Consent http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Photo%20Consent.pdf
  11. POLST (English) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/POLST-English.pdf
  12. POLST (Spanish) http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/POLST-Spanish.pdf
  13. Dog Bite Reporting (PDF | Online Form)

Resident Procedures Direct Observation Forms

  1. Central Line http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Central%20Line.pdf
  2. Chest Tube http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Chest%20Tube.pdf
  3. I&D http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20I+D.pdf
  4. Intubation http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Intubation.pdf
  5. Laceration Repair http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20Lac%20Repair.pdf
  6. Lumbar Puncture http://www.emedharbor.edu/private/Contact%20Info/ED%20Documents/Direct%20Obs%20-%20LP.pdf

See Also

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