Medical Forms and Templates

This template is used for tracking weight loss progress for both women and men. It helps to keep a record of weight, measurements, and goals to stay motivated on a weight loss journey.

This document provides a growth chart for girls from birth to 36 months, specifically focusing on head circumference. The chart includes percentile ranges (3rd - 97th) to help track and monitor a child's head growth.

This document is a weight loss progress chart that helps you track your weight loss journey.

This document provides a growth chart for girls aged 2 to 20 years, showing body mass index (BMI) percentiles ranging from the 5th to 95th percentile. It is used to track a girl's growth and determine her BMI compared to other girls her age.

This chart provides a guide to understanding your horse's body language and determining its mood.

This document is a weekly weight loss chart that is varicolored. It can help you track your weight loss progress over time.

This Form is used for evaluating an individual's functional capacity in relation to their SSA (Social Security Administration) listed disorders.

This Form is used for assessing an individual's residual functional capacity in relation to a personality mental disorder.

This Form is used to assess an adult's ability to function with an anxiety-related mental disorder. It helps determine their limitations and capabilities for work.

This Form is used for conducting a standardized assessment of cognitive function as part of the Alzheimer's Drug Therapy Initiative in British Columbia, Canada.

This Form is used for assessing drug abuse in individuals and helping to identify those who may need treatment or intervention. The DAST template was developed by the US Preventive Services Task Force.

This Form is used for creating an Advance Directive for Health Care in the state of Virginia. It allows individuals to make decisions about their medical treatment in the event they become unable to communicate their wishes.

This document provides a chart outlining the typical developmental milestones that babies achieve in different areas such as motor skills, communication, and social interactions. It serves as a helpful reference for parents and caregivers to track their baby's growth and development.

This Form is used for assessing the condition and health of the skin surface using anatomical diagrams.

This form is used for evaluating the range of joint motion in Washington state. It helps medical professionals measure and document the movement capabilities of patients' joints.

This type of document is a Cat Body Language Chart that helps you understand and interpret your cat's mood based on their body language cues.

This document is a Braden Scale Chart used for assessing a patient's risk for developing pressure ulcers. It helps healthcare professionals determine the appropriate preventative measures and interventions needed to prevent skin breakdown.

This Form is used for assessing and screening depression symptoms in patients. It consists of nine questions that help healthcare providers determine the level of depression experienced by a patient.

This form is used for conducting an annual foot examination for individuals with diabetes. It helps healthcare professionals assess the risk and complications associated with diabetic foot problems.

This Form is used for screening and assessing the foot health of individuals with diabetes to prevent complications and promote overall health.

This form is used for conducting a thorough examination of a diabetic patient's foot to assess their risk of complications and monitor their overall foot health. It includes various assessments such as sensory perception, vascular status, and foot deformities.

This document is for conducting an annual comprehensive diabetes foot exam. It helps healthcare professionals assess the foot health of individuals with diabetes to prevent complications.

This form is used for conducting a thorough examination of diabetic foot health to detect potential complications and assess overall condition.

This document is used for data collection to determine payer status in cases when a beneficiary has additional health insurances. It is also used to provide information about changes in the beneficiary's health insurances.

This type of document is used when a patient chooses to leave the hospital against the advice of medical professionals.

This document is a template for a Medicare Secondary Payer Questionnaire that helps assess whether Medicare or another insurer should be the primary payer for medical claims. It includes specific lines to gather necessary information.

This document provides a template for a Medicare Secondary Payer Questionnaire. It includes eight sections to gather necessary information.

This document is a template checklist for a Medicare Secondary Payer Questionnaire. It helps ensure that all the necessary information is gathered to determine if Medicare should be the primary or secondary payer for medical expenses.

This Form is used for measuring the ability of individuals to perform daily activities related to the foot and ankle.

This form is used for documenting the results of a TB (tuberculosis) test. It provides a record of whether the person being tested has been found to be positive or negative for TB infection.

This document provides information about the Tuberculosis Skin Test results at Faulkner University in Alabama.

This Form is used for declining the seasonal influenza vaccine in California.

Use this simple and convenient tool called Barthel index scale for self-evaluation of everyday activities and abilities. The form is a four-page document that consists of a table for a self-care assessment and two tables for an interpretation of the results.

This document is a template used to record the administration of routine drugs. It helps healthcare professionals keep track of the medications given to patients on a regular basis.

This form is used for documenting and tracking clinical supervision sessions between a supervisor and a supervisee in a professional setting.

This document provides a comprehensive advance directive for healthcare in Virginia, with specific provisions for mental health conditions. It allows individuals to outline their healthcare preferences and designate a trusted person to make decisions on their behalf, taking into account their mental health needs.

This form is used for assessing the risk of tuberculosis and administering a PPD test. It helps healthcare professionals evaluate the likelihood of individuals contracting tuberculosis and determines if further testing is necessary.