Sync template from atomicqms-style deployment
This commit is contained in:
0
Forms/Discharge-Instructions/.gitkeep
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0
Forms/Discharge-Instructions/.gitkeep
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64
Forms/FRM-001-Document-Change-Request.md
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64
Forms/FRM-001-Document-Change-Request.md
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# Document Change Request Form
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| Form ID | FRM-001 | Revision | 1.0 |
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|---------|---------|----------|-----|
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---
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## Section 1: Request Information
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| Field | Entry |
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|-------|-------|
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| Request Date | |
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| Requested By | |
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| Department | |
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## Section 2: Document Information
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| Field | Entry |
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|-------|-------|
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| Document Number | |
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| Document Title | |
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| Current Revision | |
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## Section 3: Change Description
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### Type of Change
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- [ ] New Document
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- [ ] Revision to Existing Document
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- [ ] Document Obsolescence
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### Description of Change
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*(Describe the proposed change in detail)*
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### Reason for Change
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*(Explain why this change is needed)*
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## Section 4: Impact Assessment
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### Affected Areas
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- [ ] Training Required
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- [ ] Other Documents Affected
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- [ ] Process Changes Required
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- [ ] Validation Impact
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### List Affected Documents
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## Section 5: Approvals
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| Role | Name | Signature | Date |
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|------|------|-----------|------|
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| Requester | | | |
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| Document Owner | | | |
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| Quality Assurance | | | |
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---
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*Form FRM-001 Rev 1.0*
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91
Forms/FRM-003-CAPA-Form.md
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91
Forms/FRM-003-CAPA-Form.md
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# Corrective and Preventive Action (CAPA) Form
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| Form ID | FRM-003 | Revision | 1.0 |
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|---------|---------|----------|-----|
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---
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## Section 1: CAPA Identification
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| Field | Entry |
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|-------|-------|
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| CAPA Number | |
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| Date Initiated | |
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| Initiated By | |
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| CAPA Owner | |
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| Target Closure Date | |
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## Section 2: Classification
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### Type
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- [ ] Corrective Action
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- [ ] Preventive Action
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### Source
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- [ ] Customer Complaint
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- [ ] Internal Audit
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- [ ] External Audit
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- [ ] Process Deviation
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- [ ] Nonconforming Product
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- [ ] Management Review
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- [ ] Other: ____________
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### Priority
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- [ ] Critical (5 business days)
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- [ ] Major (15 business days)
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- [ ] Minor (30 business days)
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## Section 3: Problem Description
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*(Describe the nonconformity or potential nonconformity)*
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## Section 4: Immediate Containment
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*(Actions taken to contain the immediate impact)*
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## Section 5: Root Cause Investigation
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### Investigation Method Used
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- [ ] 5 Whys
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- [ ] Fishbone Diagram
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- [ ] Fault Tree Analysis
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- [ ] Other: ____________
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### Root Cause Determination
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## Section 6: Corrective/Preventive Actions
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| Action | Responsible | Due Date | Status |
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|--------|-------------|----------|--------|
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| | | | |
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| | | | |
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| | | | |
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## Section 7: Effectiveness Verification
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| Criteria | Method | Result |
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|----------|--------|--------|
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| | | |
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Verification Date: ____________
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Verified By: ____________
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## Section 8: Closure
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| Role | Name | Signature | Date |
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|------|------|-----------|------|
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| CAPA Owner | | | |
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| Quality Approval | | | |
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---
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*Form FRM-003 Rev 1.0*
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56
Forms/FRM-006-Audit-Checklist.md
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Forms/FRM-006-Audit-Checklist.md
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# Internal Audit Checklist
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| Form ID | FRM-006 | Revision | 1.0 |
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|---------|---------|----------|-----|
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---
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## Audit Information
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| Field | Entry |
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|-------|-------|
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| Audit Number | |
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| Audit Date | |
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| Area/Process Audited | |
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| Lead Auditor | |
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| Auditee(s) | |
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---
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## Checklist Items
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| # | Requirement/Question | Reference | C/NC/NA | Evidence/Notes |
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|---|---------------------|-----------|---------|----------------|
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| 1 | Are current versions of applicable procedures available? | SOP-001 | | |
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| 2 | Are personnel trained on applicable procedures? | SOP-003 | | |
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| 3 | Are training records current and complete? | SOP-003 | | |
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| 4 | Are records properly maintained and retrievable? | SOP-001 | | |
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| 5 | Are nonconformities being documented and addressed? | SOP-002 | | |
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| 6 | Are CAPAs being completed on time? | SOP-002 | | |
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| 7 | Is equipment calibrated and maintained? | | | |
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| 8 | Are process controls being followed? | | | |
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| 9 | Are quality objectives being monitored? | | | |
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| 10 | | | | |
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**Legend:** C = Conforming, NC = Nonconforming, NA = Not Applicable
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---
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## Findings Summary
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| Finding # | Type | Description | Clause Reference |
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|-----------|------|-------------|------------------|
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| | | | |
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| | | | |
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---
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## Auditor Signature
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| Auditor | Signature | Date |
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|---------|-----------|------|
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| | | |
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---
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*Form FRM-006 Rev 1.0*
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270
Forms/Intake-Forms/FRM-UC-001-Triage-Assessment.md
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270
Forms/Intake-Forms/FRM-UC-001-Triage-Assessment.md
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# Urgent Care Triage Assessment
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| Form ID | FRM-UC-001 | Revision | 1.0 |
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|---------|-------------|----------|-----|
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---
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## Patient Information
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| Field | Entry |
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|-------|-------|
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| Patient Name | |
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| MRN | |
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| Date of Birth | |
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| Age | |
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| Sex | ☐ Male ☐ Female |
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| Date | |
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| Time of Arrival | |
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| Time of Triage | |
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---
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## Chief Complaint
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*In patient's own words:*
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**Duration of Symptoms:**
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---
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## Vital Signs
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| Parameter | Value | Normal? |
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|-----------|-------|---------|
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| Temperature | °F / °C | ☐ Yes ☐ No |
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| Heart Rate | bpm | ☐ Yes ☐ No |
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| Respiratory Rate | /min | ☐ Yes ☐ No |
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| Blood Pressure | / mmHg | ☐ Yes ☐ No |
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| SpO2 | % on ☐ RA ☐ O2 ___L | ☐ Yes ☐ No |
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| Pain Score | /10 | |
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| Weight | kg / lbs | |
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| Blood Glucose (if indicated) | mg/dL | ☐ N/A |
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---
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## Allergies
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☐ No Known Drug Allergies (NKDA)
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☐ No Known Allergies (NKA)
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| Allergen | Type | Reaction |
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|----------|------|----------|
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| | ☐ Drug ☐ Food ☐ Environmental | |
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| | ☐ Drug ☐ Food ☐ Environmental | |
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| | ☐ Drug ☐ Food ☐ Environmental | |
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---
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## Current Medications
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| Medication | Dose | Frequency |
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|------------|------|-----------|
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| | | |
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| | | |
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| | | |
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| | | |
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---
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## Brief Medical History
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☐ None significant
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| Condition | Yes | Condition | Yes |
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|-----------|-----|-----------|-----|
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| Diabetes | ☐ | Heart Disease | ☐ |
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| Hypertension | ☐ | Lung Disease/Asthma | ☐ |
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| Kidney Disease | ☐ | Liver Disease | ☐ |
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| Blood Clots/DVT | ☐ | Cancer | ☐ |
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| Seizures | ☐ | Immunocompromised | ☐ |
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| Pregnancy | ☐ (LMP: _______) | Other: | ☐ |
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---
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## History of Present Illness
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### OPQRST
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| Element | Response |
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|---------|----------|
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| **O**nset: When did this start? | |
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| **P**rovocation: What makes it better/worse? | |
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| **Q**uality: Describe the symptom | |
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| **R**adiation: Does it travel anywhere? | |
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| **S**everity: How bad is it (0-10)? | |
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| **T**iming: Constant or comes and goes? | |
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### Associated Symptoms
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| Symptom | Present | Symptom | Present |
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|---------|---------|---------|---------|
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| Fever/Chills | ☐ | Nausea/Vomiting | ☐ |
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| Headache | ☐ | Diarrhea | ☐ |
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| Shortness of Breath | ☐ | Urinary Symptoms | ☐ |
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| Chest Pain | ☐ | Rash | ☐ |
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| Dizziness | ☐ | Weakness | ☐ |
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| Cough | ☐ | Vision Changes | ☐ |
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| Sore Throat | ☐ | Numbness/Tingling | ☐ |
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---
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## Quick Look Assessment
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### General Appearance
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| Observation | Finding |
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|-------------|---------|
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| Alert and oriented | ☐ Yes ☐ No |
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| In acute distress | ☐ Yes ☐ No |
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| Skin color | ☐ Normal ☐ Pale ☐ Flushed ☐ Cyanotic |
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| Respiratory effort | ☐ Normal ☐ Labored |
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| Ambulation | ☐ Independent ☐ Assisted ☐ Wheelchair ☐ Stretcher |
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| Obvious injuries | ☐ None ☐ Present: _______ |
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---
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## Screening Questions
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### Safety Screens
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| Question | Response |
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|----------|----------|
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| Fall in past 24 hours? | ☐ Yes ☐ No |
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| Head injury? | ☐ Yes ☐ No |
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| Loss of consciousness? | ☐ Yes ☐ No |
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| Recent surgery? | ☐ Yes (When: _______) ☐ No |
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| Recent travel? | ☐ Yes (Where: _______) ☐ No |
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| Exposure to COVID-19/illness? | ☐ Yes ☐ No |
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### For Women of Childbearing Age
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| Question | Response |
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|----------|----------|
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| Could you be pregnant? | ☐ Yes ☐ No ☐ N/A |
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| Last menstrual period | |
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| Currently breastfeeding? | ☐ Yes ☐ No ☐ N/A |
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---
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## Red Flag Assessment
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**Check if ANY present (requires immediate provider notification):**
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| Red Flag | Present |
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|----------|---------|
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| Chest pain/pressure | ☐ |
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| Difficulty breathing at rest | ☐ |
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| SpO2 <92% | ☐ |
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| Severe headache (worst of life) | ☐ |
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| Sudden vision loss | ☐ |
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| Sudden weakness/numbness | ☐ |
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| Speech difficulty | ☐ |
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| Facial droop | ☐ |
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| Uncontrolled bleeding | ☐ |
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| Altered mental status | ☐ |
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| Syncope | ☐ |
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| Anaphylaxis symptoms | ☐ |
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| Suicidal/homicidal ideation | ☐ |
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**If ANY checked → Immediate provider evaluation and consider ED transfer**
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---
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## Acuity Level Assigned
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☐ **Level 1 - Emergent** (ED Transfer Required)
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→ Provider/911 notified: Time _______ Name _______
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☐ **Level 2 - Urgent** (Provider within 15 min)
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→ Provider notified: Time _______
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☐ **Level 3 - Semi-Urgent** (Provider within 30 min)
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☐ **Level 4 - Non-Urgent** (Provider within 60 min)
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☐ **Level 5 - Redirect** (Outside UC scope)
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→ Redirected to: _______
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|
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---
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## Interventions Initiated
|
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| Intervention | Ordered | Completed |
|
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|--------------|---------|-----------|
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| Ice pack | ☐ | ☐ |
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| Elevation | ☐ | ☐ |
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| Wound care | ☐ | ☐ |
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| POC glucose | ☐ | ☐ |
|
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| POC UA | ☐ | ☐ |
|
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| POC strep | ☐ | ☐ |
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| POC flu/COVID | ☐ | ☐ |
|
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| ECG | ☐ | ☐ |
|
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| Other: | ☐ | ☐ |
|
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|
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---
|
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|
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## Pain Assessment
|
||||
|
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| Field | Entry |
|
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|-------|-------|
|
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| Location | |
|
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| Quality | ☐ Sharp ☐ Dull ☐ Aching ☐ Burning ☐ Throbbing |
|
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| Intensity (0-10) | /10 |
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| Onset | ☐ Sudden ☐ Gradual |
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| Duration | |
|
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| What relieves it? | |
|
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| What worsens it? | |
|
||||
| Previous episodes? | ☐ Yes ☐ No |
|
||||
|
||||
---
|
||||
|
||||
## Injury Details (if applicable)
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
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| Mechanism of Injury | |
|
||||
| Time of Injury | |
|
||||
| Location of Injury | |
|
||||
| Tetanus status | ☐ Up to date ☐ Needs update ☐ Unknown |
|
||||
| Work-related? | ☐ Yes ☐ No |
|
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|
||||
---
|
||||
|
||||
## Additional Notes
|
||||
|
||||
---
|
||||
|
||||
## Re-Triage (if waiting time extended)
|
||||
|
||||
| Time | Vital Signs | Condition Changed? | New Acuity | Initials |
|
||||
|------|-------------|-------------------|------------|----------|
|
||||
| | | ☐ Yes ☐ No | | |
|
||||
| | | ☐ Yes ☐ No | | |
|
||||
| | | ☐ Yes ☐ No | | |
|
||||
|
||||
---
|
||||
|
||||
## Triage Nurse/MA Signature
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Name | |
|
||||
| Credentials | |
|
||||
| Signature | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
|
||||
---
|
||||
|
||||
## Provider Acknowledgment
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Provider notified at | (time) |
|
||||
| Provider seen at | (time) |
|
||||
| Provider Signature | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-UC-001 Rev 1.0 - Urgent Care Triage Assessment*
|
||||
0
Forms/POCT-Records/.gitkeep
Normal file
0
Forms/POCT-Records/.gitkeep
Normal file
0
Forms/Procedure-Consent/.gitkeep
Normal file
0
Forms/Procedure-Consent/.gitkeep
Normal file
72
Forms/Training/FRM-004-Training-Record.md
Normal file
72
Forms/Training/FRM-004-Training-Record.md
Normal file
@@ -0,0 +1,72 @@
|
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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*
|
||||
0
Forms/Triage-Forms/.gitkeep
Normal file
0
Forms/Triage-Forms/.gitkeep
Normal file
0
Forms/Visit-Documentation/.gitkeep
Normal file
0
Forms/Visit-Documentation/.gitkeep
Normal file
Reference in New Lab Ticket
Block a user