Sync template from atomicqms-style deployment

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# Document Change Request Form
| Form ID | FRM-001 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: Request Information
| Field | Entry |
|-------|-------|
| Request Date | |
| Requested By | |
| Department | |
## Section 2: Document Information
| Field | Entry |
|-------|-------|
| Document Number | |
| Document Title | |
| Current Revision | |
## Section 3: Change Description
### Type of Change
- [ ] New Document
- [ ] Revision to Existing Document
- [ ] Document Obsolescence
### Description of Change
*(Describe the proposed change in detail)*
### Reason for Change
*(Explain why this change is needed)*
## Section 4: Impact Assessment
### Affected Areas
- [ ] Training Required
- [ ] Other Documents Affected
- [ ] Process Changes Required
- [ ] Validation Impact
### List Affected Documents
## Section 5: Approvals
| Role | Name | Signature | Date |
|------|------|-----------|------|
| Requester | | | |
| Document Owner | | | |
| Quality Assurance | | | |
---
*Form FRM-001 Rev 1.0*

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# Corrective and Preventive Action (CAPA) Form
| Form ID | FRM-003 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: CAPA Identification
| Field | Entry |
|-------|-------|
| CAPA Number | |
| Date Initiated | |
| Initiated By | |
| CAPA Owner | |
| Target Closure Date | |
## Section 2: Classification
### Type
- [ ] Corrective Action
- [ ] Preventive Action
### Source
- [ ] Customer Complaint
- [ ] Internal Audit
- [ ] External Audit
- [ ] Process Deviation
- [ ] Nonconforming Product
- [ ] Management Review
- [ ] Other: ____________
### Priority
- [ ] Critical (5 business days)
- [ ] Major (15 business days)
- [ ] Minor (30 business days)
## Section 3: Problem Description
*(Describe the nonconformity or potential nonconformity)*
## Section 4: Immediate Containment
*(Actions taken to contain the immediate impact)*
## Section 5: Root Cause Investigation
### Investigation Method Used
- [ ] 5 Whys
- [ ] Fishbone Diagram
- [ ] Fault Tree Analysis
- [ ] Other: ____________
### Root Cause Determination
## Section 6: Corrective/Preventive Actions
| Action | Responsible | Due Date | Status |
|--------|-------------|----------|--------|
| | | | |
| | | | |
| | | | |
## Section 7: Effectiveness Verification
| Criteria | Method | Result |
|----------|--------|--------|
| | | |
Verification Date: ____________
Verified By: ____________
## Section 8: Closure
| Role | Name | Signature | Date |
|------|------|-----------|------|
| CAPA Owner | | | |
| Quality Approval | | | |
---
*Form FRM-003 Rev 1.0*

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# Internal Audit Checklist
| Form ID | FRM-006 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Audit Information
| Field | Entry |
|-------|-------|
| Audit Number | |
| Audit Date | |
| Area/Process Audited | |
| Lead Auditor | |
| Auditee(s) | |
---
## Checklist Items
| # | Requirement/Question | Reference | C/NC/NA | Evidence/Notes |
|---|---------------------|-----------|---------|----------------|
| 1 | Are current versions of applicable procedures available? | SOP-001 | | |
| 2 | Are personnel trained on applicable procedures? | SOP-003 | | |
| 3 | Are training records current and complete? | SOP-003 | | |
| 4 | Are records properly maintained and retrievable? | SOP-001 | | |
| 5 | Are nonconformities being documented and addressed? | SOP-002 | | |
| 6 | Are CAPAs being completed on time? | SOP-002 | | |
| 7 | Is equipment calibrated and maintained? | | | |
| 8 | Are process controls being followed? | | | |
| 9 | Are quality objectives being monitored? | | | |
| 10 | | | | |
**Legend:** C = Conforming, NC = Nonconforming, NA = Not Applicable
---
## Findings Summary
| Finding # | Type | Description | Clause Reference |
|-----------|------|-------------|------------------|
| | | | |
| | | | |
---
## Auditor Signature
| Auditor | Signature | Date |
|---------|-----------|------|
| | | |
---
*Form FRM-006 Rev 1.0*

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# Mental Health New Patient Intake Form
| Form ID | FRM-MHO-001 | Revision | 1.0 |
|---------|-------------|----------|-----|
---
## Patient Information
| Field | Entry |
|-------|-------|
| Last Name | |
| First Name | |
| Preferred Name | |
| Date of Birth | |
| Age | |
| Sex | ☐ Male ☐ Female ☐ Other |
| Gender Identity | |
| Pronouns | |
### Contact Information
| Field | Entry |
|-------|-------|
| Address | |
| City, State, ZIP | |
| Home Phone | |
| Cell Phone | |
| Email | |
| Preferred Contact Method | ☐ Home ☐ Cell ☐ Email |
| OK to Leave Detailed Message? | ☐ Yes ☐ No |
---
## Emergency Contact
| Field | Entry |
|-------|-------|
| Name | |
| Relationship | |
| Phone | |
| Address | |
---
## Referral Information
| Field | Entry |
|-------|-------|
| Referred By | |
| Referring Provider Phone | |
| Primary Care Physician | |
| PCP Phone/Fax | |
| Current Therapist (if any) | |
| Current Prescriber (if any) | |
---
## Reason for Seeking Treatment
**What brings you in for treatment today?**
**What are your main symptoms or concerns?**
**When did these symptoms start?**
**What do you hope to get out of treatment?**
---
## Symptom Checklist
*Check all symptoms you are currently experiencing:*
### Mood Symptoms
☐ Depressed mood
☐ Loss of interest/pleasure
☐ Hopelessness
☐ Guilt
☐ Irritability
☐ Mood swings
☐ Elevated/euphoric mood
☐ Decreased need for sleep
☐ Racing thoughts
☐ Increased energy
### Anxiety Symptoms
☐ Excessive worry
☐ Restlessness
☐ Difficulty concentrating
☐ Muscle tension
☐ Sleep problems
☐ Panic attacks
☐ Fear of social situations
☐ Specific phobias
☐ Obsessive thoughts
☐ Compulsive behaviors
### Trauma Symptoms
☐ Flashbacks/intrusive memories
☐ Nightmares
☐ Avoiding reminders of trauma
☐ Emotional numbness
☐ Hypervigilance
☐ Easily startled
### Psychotic Symptoms
☐ Hearing voices
☐ Seeing things others don't see
☐ Paranoid thoughts
☐ Unusual beliefs
☐ Confused thinking
### Other Symptoms
☐ Difficulty concentrating
☐ Memory problems
☐ Impulsivity
☐ Anger problems
☐ Relationship difficulties
☐ Work/school problems
☐ Appetite changes
☐ Weight changes
☐ Fatigue/low energy
☐ Chronic pain
---
## Suicidal/Self-Harm History
| Question | Response |
|----------|----------|
| Are you currently having thoughts of suicide? | ☐ Yes ☐ No |
| Are you currently having thoughts of harming yourself? | ☐ Yes ☐ No |
| Have you ever attempted suicide? | ☐ Yes ☐ No |
| If yes, when and how? | |
| Have you ever engaged in self-harm (cutting, burning, etc.)? | ☐ Yes ☐ No |
| If yes, describe: | |
---
## Psychiatric History
### Previous Treatment
| Treatment Type | Yes/No | Where | When | Helpful? |
|----------------|--------|-------|------|----------|
| Outpatient therapy | ☐ | | | ☐ Yes ☐ No |
| Outpatient psychiatry | ☐ | | | ☐ Yes ☐ No |
| Intensive outpatient (IOP) | ☐ | | | ☐ Yes ☐ No |
| Partial hospitalization (PHP) | ☐ | | | ☐ Yes ☐ No |
| Psychiatric hospitalization | ☐ | | | ☐ Yes ☐ No |
| Residential treatment | ☐ | | | ☐ Yes ☐ No |
| ECT | ☐ | | | ☐ Yes ☐ No |
| TMS | ☐ | | | ☐ Yes ☐ No |
### Previous Diagnoses
*Check all that you have been diagnosed with:*
☐ Depression
☐ Bipolar Disorder
☐ Anxiety Disorder
☐ Panic Disorder
☐ PTSD
☐ OCD
☐ ADHD
☐ Schizophrenia/Schizoaffective
☐ Personality Disorder (type: _______)
☐ Eating Disorder
☐ Substance Use Disorder
☐ Autism Spectrum Disorder
☐ Other: _______________
---
## Current Medications
| Medication | Dose | Frequency | Prescriber |
|------------|------|-----------|------------|
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
### Past Psychiatric Medications
*List medications you have tried in the past:*
| Medication | Helpful? | Side Effects? | Reason Stopped |
|------------|----------|---------------|----------------|
| | ☐ Yes ☐ No | | |
| | ☐ Yes ☐ No | | |
| | ☐ Yes ☐ No | | |
| | ☐ Yes ☐ No | | |
---
## Allergies
☐ No Known Allergies
| Medication/Substance | Reaction |
|---------------------|----------|
| | |
| | |
---
## Substance Use History
| Substance | Ever Used | Age First Used | Current Use | Amount/Frequency | Last Used |
|-----------|-----------|----------------|-------------|------------------|-----------|
| Alcohol | ☐ | | ☐ | | |
| Marijuana/Cannabis | ☐ | | ☐ | | |
| Cocaine/Crack | ☐ | | ☐ | | |
| Heroin/Opioids | ☐ | | ☐ | | |
| Methamphetamine | ☐ | | ☐ | | |
| Benzodiazepines (non-Rx) | ☐ | | ☐ | | |
| Tobacco/Nicotine | ☐ | | ☐ | | |
| Other: | ☐ | | ☐ | | |
**Have you ever had treatment for substance use?** ☐ Yes ☐ No
If yes, describe:
---
## Medical History
### Current Medical Conditions
☐ None
| Condition | Notes |
|-----------|-------|
| | |
| | |
| | |
### Past Surgeries/Hospitalizations
| Surgery/Hospitalization | Year |
|------------------------|------|
| | |
| | |
### For Women
| Field | Entry |
|-------|-------|
| Are you pregnant? | ☐ Yes ☐ No ☐ Maybe |
| Are you breastfeeding? | ☐ Yes ☐ No |
| Last menstrual period | |
| Using contraception? | ☐ Yes ☐ No |
---
## Family Psychiatric History
*Check all that apply to biological relatives:*
| Condition | Mother | Father | Sibling | Grandparent | Other |
|-----------|--------|--------|---------|-------------|-------|
| Depression | ☐ | ☐ | ☐ | ☐ | ☐ |
| Bipolar Disorder | ☐ | ☐ | ☐ | ☐ | ☐ |
| Anxiety | ☐ | ☐ | ☐ | ☐ | ☐ |
| Schizophrenia | ☐ | ☐ | ☐ | ☐ | ☐ |
| Substance Abuse | ☐ | ☐ | ☐ | ☐ | ☐ |
| Suicide/Attempt | ☐ | ☐ | ☐ | ☐ | ☐ |
| ADHD | ☐ | ☐ | ☐ | ☐ | ☐ |
| Other: | ☐ | ☐ | ☐ | ☐ | ☐ |
---
## Social History
### Living Situation
| Field | Entry |
|-------|-------|
| Who do you live with? | |
| Type of housing | ☐ Own ☐ Rent ☐ With family ☐ Homeless ☐ Other |
| Housing stability | ☐ Stable ☐ At risk ☐ Unstable |
### Relationships
| Field | Entry |
|-------|-------|
| Marital/Relationship status | ☐ Single ☐ Married ☐ Partnered ☐ Divorced ☐ Widowed |
| Children (ages) | |
| Quality of relationships | ☐ Good ☐ Fair ☐ Poor |
| Social support | ☐ Strong ☐ Some ☐ Limited ☐ None |
### Education/Employment
| Field | Entry |
|-------|-------|
| Highest education | |
| Current employment | ☐ Full-time ☐ Part-time ☐ Unemployed ☐ Disabled ☐ Retired ☐ Student |
| Occupation | |
| Work/school problems? | ☐ Yes ☐ No |
### Legal
| Field | Entry |
|-------|-------|
| Current legal issues? | ☐ Yes ☐ No |
| If yes, describe: | |
| History of incarceration? | ☐ Yes ☐ No |
### Trauma History
*Have you experienced any of the following?*
☐ Physical abuse
☐ Sexual abuse
☐ Emotional/verbal abuse
☐ Neglect
☐ Domestic violence
☐ Witnessed violence
☐ Military combat
☐ Serious accident
☐ Natural disaster
☐ Other trauma: _______________
---
## Current Stressors
*Rate your current stress level (1-10):* _____
*What are your main stressors right now?*
---
## Strengths and Supports
*What are your strengths?*
*Who are your supports (family, friends, community)?*
*What coping strategies do you currently use?*
---
## Goals for Treatment
*What would you like to accomplish through treatment?*
1.
2.
3.
---
## Signature
| Field | Entry |
|-------|-------|
| Patient Signature | |
| Date | |
| Guardian Signature (if minor) | |
| Relationship to Patient | |
---
## For Office Use
| Field | Entry |
|-------|-------|
| Date Received | |
| Entered By | |
| Appointment Date | |
| Assigned Provider | |
| Notes | |
---
*Form FRM-MHO-001 Rev 1.0 - Mental Health New Patient Intake Form*

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# Training Record Form
| Form ID | FRM-004 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: Employee Information
| Field | Entry |
|-------|-------|
| Employee Name | |
| Employee ID | |
| Department | |
| Job Title | |
## Section 2: Training Information
| Field | Entry |
|-------|-------|
| Training Title | |
| Training Date | |
| Training Duration | |
| Trainer Name | |
| Trainer Qualification | |
### Training Type
- [ ] Initial Training
- [ ] Retraining
- [ ] Refresher
- [ ] Procedure Update
### Delivery Method
- [ ] Classroom
- [ ] On-the-Job
- [ ] Self-Study
- [ ] Computer-Based
- [ ] Other: ____________
## Section 3: Training Content
*(List topics covered or attach training materials)*
## Section 4: Assessment
### Assessment Method
- [ ] Written Test
- [ ] Practical Demonstration
- [ ] Verbal Assessment
- [ ] Observation
### Assessment Results
| Metric | Result |
|--------|--------|
| Score (if applicable) | |
| Pass/Fail | |
## Section 5: Signatures
| Role | Name | Signature | Date |
|------|------|-----------|------|
| Trainee | | | |
| Trainer | | | |
| Supervisor | | | |
---
*Form FRM-004 Rev 1.0*

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