Patient Safety Templates

This form is used to document the conditions set by physicians and pharmacies in the state of Maine.

This document is used for conducting a restraint assessment in the state of Alaska. It helps evaluate the need for and appropriateness of physical restraints in certain situations.

This document authorizes pharmacies in North Dakota to administer immunizations.

This Form is used for documenting the administration of medication in Rhode Island.

This form is used for requesting a medical review panel in the state of Louisiana.

This quiz is designed to test your knowledge about medical errors in the state of Florida.

This document is an application for a new ambulance service license in the state of Arkansas. It is used by individuals or organizations looking to start an ambulance service in the state.

This document is for monitoring adherence to source control and respiratory hygiene in healthcare settings in California to prevent healthcare-associated infections.

This document is a template application form for Critical Care Transport Tier I, II, and Tier III in the state of Illinois. It is used to apply for certification for providing critical care transportation services.

This document is used to keep track of the release of restraints in health services in Iowa. It helps ensure that the restraints are used appropriately and released in a timely manner.

This Form is used for documenting incidents of seclusion and restraint in the state of Michigan.

This document outlines the disposition process for suicide watch cases in the state of Idaho. It provides guidance on how to assess and manage individuals who are at risk of attempting suicide.

This form is used for exempt ESRD facilities in Texas to attest their compliance with the Life Safety Code guidelines.

This document is for reporting incidents of drug diversion in Vermont. It provides a way for individuals to report suspicious activities or behaviors related to the illegal use or distribution of drugs.

This form is used for applying for an Outsourcing Facility Permit in the state of Virginia. It is required for any facility that wants to engage in the compounding of sterile drugs for human use.

This document is used for submitting a confidential mediation statement in a medical malpractice case in Washington, D.C. It contains information and arguments from both parties to aid in the mediation process.

This form is used for requesting the use of medical restraints in the state of Wisconsin.

This document is used for attesting to the chronic use of opioids in the state of Washington.

This Form is used for requesting prior authorization for opioid medications in Vermont. It ensures the safe use of morphine milligram equivalent (MME) for patients.

This form is used for requesting bed and pillow encasements in Washington.

This form is used for transferring patients between healthcare facilities in the state of Florida. It ensures all relevant medical information and care is communicated accurately during the transfer process.

This document provides guidelines and regulations for a radiation protection program specific to bone densitometry procedures in the state of Florida. It covers safety measures to ensure minimal exposure to radiation for patients and healthcare professionals.

This document provides a checklist for applying for an HDR Remote Afterloader license in Florida. It includes the required documents and steps needed for the application process.

This Form is used for facilitating the safe transfer of patients between healthcare facilities within the state of New Hampshire to prevent the spread of infections.

This document is used for transferring care in Washington state. It is available in Urdu language.

This form is used for notifying the state of Illinois about the use of ventilators in nursing facilities.

This document is a chart used in NHS Scotland to assess and monitor the health status of pediatric patients. It helps healthcare professionals track vital signs and identify any potential deterioration in a child's condition.

This document for monitoring the adherence to enhanced standard precautions in healthcare settings to reduce healthcare-associated infections in California.

This document is a tool for assessing the risk of self-medicating. It is designed to help individuals evaluate the potential risks and benefits of self-treatment.

This document provides a chart for recording the National Early Warning Score 2 (NEWS2). NEWS2 is a clinical scoring system used to assess the severity of a patient's illness and determine the appropriate level of care needed. The chart helps healthcare professionals track and monitor a patient's vital signs and symptoms to identify any deterioration in their condition.

This form is used for tracking medication usage and ensuring patient safety in Minnesota. It helps healthcare providers keep a record of medications administered to patients.

This document is a fall risk assessment tool used by the Johns Hopkins Health System Corporation to identify individuals who may be at risk of falling in a healthcare setting. It helps healthcare professionals determine appropriate interventions to prevent falls and ensure patient safety.

This document is meant to aid and guide in the creation of a comprehensive plan for transitioning patients from a healthcare facility back to their homes or another type of care facility, ensuring that all their care needs will be met upon discharge.