Forms: Difference between revisions
From Guide to YKHC Medical Practices
No edit summary |
No edit summary |
||
| (5 intermediate revisions by the same user not shown) | |||
| Line 6: | Line 6: | ||
**[[Media:death certificate worksheet.pdf|Death certificate worksheet]] | **[[Media:death certificate worksheet.pdf|Death certificate worksheet]] | ||
**[[media:Expected_home_death.pdf|Expected Home Death]] (Links to pdf form for printing) | **[[media:Expected_home_death.pdf|Expected Home Death]] (Links to pdf form for printing) | ||
*[[media: | *[http://manuals.medicaidalaska.com/docs/dnld/Form_CMN_Enteral_Nutrition.pdf Alaska Medicaid Enteral Nutrition Certificate of Medical Necessity] | ||
**please chart in a note/alert note the following: | |||
**#Target Weight | |||
**#Total Daily Calories | |||
**#Total Daily Calories from Ingested/Oral foods | |||
**#Calories from Enteral | |||
*[[media:Medevac_Ride_Along_Form.pdf|Medevac Ride Along Form]] ([https://www.lifemedalaska.com/copy-of-ride-along-program Online Medevac Ride-along Participant Application]) | |||
*[[media:ptos.pdf|Patient Transport Order form]] | *[[media:ptos.pdf|Patient Transport Order form]] | ||
*[[media:controlled substance agreement.pdf|Pain Contract]] | *[[media:controlled substance agreement.pdf|Pain Contract]] | ||
Latest revision as of 22:47, 29 September 2021
- CME Request Form (Can only be accessed within RAVEN system)
- Death Packet Forms
- Disposition of Body
- Notification of Death
- Transit Burial Permit Procedures and Request Form
- Death certificate worksheet
- Expected Home Death (Links to pdf form for printing)
- Alaska Medicaid Enteral Nutrition Certificate of Medical Necessity
- please chart in a note/alert note the following:
- Target Weight
- Total Daily Calories
- Total Daily Calories from Ingested/Oral foods
- Calories from Enteral
- please chart in a note/alert note the following:
- Medevac Ride Along Form (Online Medevac Ride-along Participant Application)
- Patient Transport Order form
- Pain Contract
- Orthopedic Teleradiology Request.pdf
- Proctoring—Medical Staff
- Peer Review Request form
- Visitor Confidentiality Statement
- Special Consent Forms for Operations or Other Procedures (links to pdf)
- Other Facility Computer Access Request for ANTHC (links to fillable pdf)
Please search Document Library for any other forms you might be trying to find.
