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frequently needed forms for Nursing Department
Please find medication and doctor’s visits forms below. Remember to fax/email/SCOMM all pages to your PPCH Nurse within 24 hours of client’s appointment.
Once yearly, bring Annual Physical Form to PCP and Psych Diagnosis Form to Psychiatry appointments for physician to fill out and sign.
Please ensure the PRN list is signed yearly, if applicable, by the PCP.
Fill out this form whenever you administer controlled drugs to a client. This is required for all QMAPS. Once the count is down to zero, fax/email/SCOMM the completed form to your PPCH nurse. If the controlled drug is “as needed” and there are remaining pills not taken by the client, turn in remaining pills in original bottle with count sheet to your PPCH nurse or PD. Remember to fill out the entire form, including the date/ year, drug name, dosage, frequency, and RX number.
If you have any questions or need more information about how to ensure these forms are completed accurately, please contact your PPCH nurse.
After hours or on weekends, the nurse-on-call is available at 720-668-5374.