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[DOCX File]Baseline TB Screening Tool for HCWs
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Number of patients with suspected or confirmed active TB disease in your health care setting during the past five years: _____ TB screening of health care personnel Is baseline TB screening of all health care personnel performed at time of hire as required:If you answer “no” to this question contact MDH TB Prevention and Control Program at ...
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[DOC File]SUICIDE RISK ASSESSMENT GUIDE - Mental Health Home
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Referrals for mental health assessment and follow-up: Any reference to suicidal ideation, intent, or plans mandates a mental health assessment. If the patient is deemed not to be at immediate risk for engaging in self-destructive behaviors, then the clinician needs to collaboratively develop a follow-up and follow-through plan of action.
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[DOC File]Facility Record Of: First: -Connecticut's Official ...
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A copy of the DCF/ Connecticut Behavioral Health Partnership (CTBHP) Child and Adolescent Needs Survey (CANS)* for the child is placed in the case record 10.2 A copy of the DCF/CTBHP Registration Form for this level of PNMI rehabilitative services is in the case record
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This is a sample Personal Protective Equipment Program of ...
XYZ Corporation certifies that a hazard assessment of the workplace was performed at our facility located in , CT. This assessment consisted of a review of prior injury and illness records and a walk-through inspection of all areas of the facility. The purpose of this assessment was to identify sources of hazards to workers that are present, or ...
health assessment record

[DOC File]CT.GOV-Connecticut's Official State Website
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Norwich, CT 06360-9903. Phone: 860-885-0630. Fax: 860-885-0631 ... SECTION C. MENTAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT. ... A licensed master social worker may complete this form with respect to mental health disorders, but the co-signature of a supervising physician, advanced practice registered nurse, psychologist, professional ...
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[DOC File]Trainees’ Guide to Workplace Based Assessment
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Trainees’ Guide to Workplace Based Assessment. Introduction. ... You must note that, since they form the basis for feedback and educational planning, you must arrange WPBAs at appropriate intervals throughout your training rather than leaving them until the end of each stage. ... ensuring that health problems do not put patients at risk.
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[DOCX File]ADA aCCOMMODATION MEDICAL CERTIFICATION fORM
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Upon receipt of a healthcare provider note or this completed form, employers must ensure that the documentation is kept in a locked file that is separate from the employee’s personnel records. For questions or concerns about this form or the interactive process, please contact your HR representative or the ADA Coordinator at the Office for ...
ct health assessment record

[DOC File]Hazard Communication Program - OSHA
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Hazard Communication Program. Introduction. In order to fulfill its obligation to protect the health and safety of employees, [company name] has developed the following hazard communication standard (HCS) program to comply with Occupational Safety and Health Administration (OSHA) standards 29 CFR 1910.1200 and 29 CFR 1926.59.
ct health assessment record form

[DOC File]OUTCOME MEASURES TOOL KIT - VA
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Assessments may be in the form of provider consultation reports, provider progress notes, or completed pain assessment templates. Note that the presence of numeric pain scores in the medical record is not sufficient evidence that pain assessment has occurred.
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[DOCX File]Environment of Care Management Plan Templates for ...
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1.Goal. This management plan describes the framework used to manage safety risks and improve safety performance. The scope and objectives of this plan are consistent with the Command’s values, vision, and mission to provide quality healthcare to Soldiers, retirees, and their families, and to provide a safe and healthy workplace for all employees.
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Ct health assessment form pdf