MEDICAL FORMS
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Last Updated: 25 August 2004

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• Pacemaker - Discharge Instructions
• Pacemaker Wallet Identification Card
• Pain Assessment Card - Memorial Sloan-Kettering Cancer Center
• Pain Control: Equianalgesic Dosing - Pocket Card
• Pain Control Without Drugs - Patient Handout
• Pain Daily Diary - Use the downloadable ULTRACET Pain Diary as a way to help document your pain and treatments over 5 days.
• Pain Flow Sheet
• Pain Management Flow Sheet
• Pain (Post-Operative) - Discharge Instructions
• Pain Relievers: Understanding Your Options - Patient Handout
• Pain Response Scale, Rapid - Print out and complete the ULTRACET Rapid Pain Response Scale to measure your pain and its effect on your general quality of life.
• Painful Urination - Patient Handout
• Palliative Care Consultation Record
• Palliative Care Consultation Report
• Palliative Care Progress Notes
• Palliative Care Rounding Instrument
• Palliative Care, When to Consider - Pocket Card
• Panic Disorder: Panic Attacks and Agoraphobia - Patient Handout
• Pap Smear Inflammation Precautions - Patient Information
• Pap Smear: What is a Pap Smear? - Patient Information
• Patient and Family Education Record
• Patient Assessment Form
• Patient Consent Form: Medical Treatment or Surgical Procedure and Acknowledgment of Receipt of Medical Information [PDF] [Word]
• Patient Consent Form for Operation or Special Procedure, English - [PDF 59kb]
• Patient Consent Form for Operation or Special Procedure, Spanish - [PDF 58kb]
• Patient Discharge Instruction Sheet
• Patient Discharge Instructions
• Patient Discharge Instructions
• Patient Discharge Summary
• Patient Health Survey
• Patient Health Survey (Medical history)
• Patient Information
• Patient Information Card
• Patient Instruction Generator, PAIGE - Emergency Medicine Demo. Need to give patients customized written aftercare instructions? Want to do it fast? Without spending thousands of dollars? Looking for a program you can actually understand and install yourself? You need PAIGE. This program is simple to use (learn it in 30 seconds), but it's also very powerful.
• Patient Instruction Sheet For Using MDIs
• Patient Meal Count Report
• Patient Medical History and Consent Form - CDC Smallpox Pre-Vaccination Information Packet [PDF}
• Patient Notification Letter Regarding Hepatitis B Test Results - Sample letter explaining test results to patients. [PDF}
• Patient Nutritional Health Form
• Patient Progress Notes
• Patient Progress Notes (online)
• Patient Registration
• Patient Safety Forms - Safety Concern/Suggestion Report Form and Informal Quality/Risk Concern Report Form
• Patient Satisfaction Survey Example
• Patient Satisfaction Survey for Inpatients
• Patient Satisfaction Survey for Outpatients
• Patient Teaching Flow Record - Prenatal, Postpartum and Family Planning
• Patient Teaching Record
• Patient Teaching Record
• Patient Transfer Certificate
• Patient Transfer Form
• Patient Treatment Profile
• Patient's Funds & Valuables Record
• PCC Ambulatory Care Record Brief
• PCC Ambulatory Encounter Record
• PCC Multi-Visit Encounter Record
• Peak Expiratory Flow Rate Chart (PEFR) - This is a simple method of measuring airway obstruction and it will detect moderate or severe disease.
• Pediatric 24-Hour Intake-Output Summary
• Pediatric Admission - Health History and Multidisciplinary Form
• Pediatric Admission Parent Questionnaire
• Pediatric Assessment Reference Card - Pre-Hospital Care Provider Student Reference Guide. NYS Department of Health, Bureau of EMS [PDF]
• Pediatric Code Sheets - Acute Cardiopulmonary Event Documentation Sheets
• Pediatric Equipment and Supplies - Checklist for Basic and Advanced Life Support Ambulances
• Pediatric Equipment and Supplies - Checklist for Emergency Departments
• Pediatric Medical History Form
• Pediatric Prehospital Care Reference Card - NYS Emergency Medical Services for Children. The EMSC Program has made efforts to provide all NYS certified ambulance and first response services with laminated copies of the Pediatric Prehospital Care Reference Card for use in each ambulance or first response vehicle. The two-sided card contains guidance on pediatric assessment and treatment, and provides medical algorithms and charts for BLS and ALS providers. [PDF 70Kn]
• Pediatric Sedation and Recovery Flow Sheet - Virtual Hospital: University of Iowa Family Practice Handbook, Fourth Edition
• Pediatric Vital Signs Card [PDF 69Kb]
• Peer Review Form
• Performance Improvement Case Review Worksheet
• Performance Improvement Mortality Case Review Worksheet
• Performance Improvement Plan
• Performance Improvement Sample Report (Report to the Governing Body)
• Periodic Medical Examination - Statement of Exemption
• Peripheral Artery Disease - Patient Handout
• Peripheral Blood Stem Cell Collection - Information for Donors
• Peripheral Blood Stem Cell Collection - Information for Patients
• Permission to have Child Immunized Against the Flu  (Word Format)
• Permission to Treat in Case of an Accident - Trip Permission Form
• Personal Medical History - If you or a member of your family has a medical emergency, the physician will need the patient's medical history. Simply print and fill out (and don't forget to update) one of these forms for each member of your family. Make sure you keep it in an easily accessible place so that if there is an emergency, you will be know where it is and will be able to bring it to the hospital or physician's office. You should also keep a copy with you when traveling.
• Personal Medical Record - Sensitive
• Personal Protective Equipment Program - Example template to be tailored for an individual workplace
• Pharmacologic Management of Chronic Heart Failure Pocket Guide
• Pharmacologic Management of Gastroesophageal Reflux Disease - Pocket Card
• Pharmacy Chronological Control Log
• Pharmacy Operations - Quarterly Report
• Phlebotomist - Orientation/Competency Inventory
• Photography Consent Form
• Physical Evaluation Form
• Physical Exam Report
• Physical Examination
• Physician Continuation Form - Emergency Department - Physician and Nurse Forms
• Physician Continuation Form - Physician's Office - Physician and Nurse Forms
• Physician Palliative Care - Sample Job Description
• Physician Visit History Form - Physician's Office - Physician and Nurse Forms
• Physician's Medical Necessity Certification (PMNC) Form - Now required for all non-emergency scheduled and unscheduled transports.
• Physician's Orders
• PICU Progress Note Templates (version 3) - Attending Physician Pediatric Intensive Care Unit
• PICU Progress Note Templates (version 4) - Attending Physician Pediatric Intensive Care Unit
• PID - Discharge Instructions
• Pinworms and Your Child - Patient Handout
• Platelets: Appropriate Use - Summary Card
• Playing it Safe in Winter - Patient Handout
• Pneumonia - Discharge Instructions
• Pneumonia - Protocol, Criteria and order sheet
• Pneumonia (Child) - Discharge Instructions
• Pneumonia Pocket Card - Intended as a primer on the management of CAP, this page presents guidelines from the leading references. New York Presbyterian Hospital, Columbia Presbyterian Medical Center [PDF 1pp. 36Kb]
• Pocket Guide for Asthma Management and Prevention - Summary of patient care information for primary health care professionals. NIH Publication
• Pocket Guide for Asthma Management and Prevention in Children - Summary of patient care information for pediatricians and other health care professionals. NIH Publication
• Pocket Guide for Management of Acute Myocardial Infarction - Pharmacological Therapy
• Pocket Guide for Suspected Acute Myocardial Infarction
• Pocket Guide Insert: Spirometry for Diagnosis of COPD - GOLD (Global Initiative for Chronic Obstructive Lung Disease) [PDF Format  4pp  29Kb]
• Pocket Guide to COPD Diagnosis, Management and Prevention - U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute [PDF Format  30pp  287Kb]
• Poison Ivy - Discharge Instructions
• Port Placement - Patient Discharge Instructions
• Post-Op Instructions For General Anesthesia
• Post-Op Instructions For Knee Arthroscopy
• Post-Traumatic Stress Disorder - Patient Handout
• Post-Vaccination and Follow-Up Information Sheet - CDC Smallpox Pre-Vaccination Information Packet [PDF}
• Power of Attorney for Health Care - Illinois Statutory Short Form, 755 Ill. Comp. Stat. Sec. 45/4-10
• Pre-Admission Registration Form - [PDF 58kb]
• Pre-Hospital Care Reference Card - NYS Pediatric Prehospital Care Reference Card.
• Pre-Natal Health Assessment
• Pre-Operative Check List and Teaching Record
• Pre-Operative Instructions
• Pre-Surgical Checklist
• Pregnancy Questionnaire and Release
• Prenatal History
• Prenatal Record
• Preparing Your Bowel for Surgery - Home Instructions
• Preparing Your Bowel for Surgery: Fleet Phospho-Soda - Home Instructions
• Preventing Osteoporosis - Patient Handout
• PRN Orders - Adult Inpatient Psychiatry Forms
• Problem Oriented Flow Sheet - General
• Procedural Sedation - Discharge Instructions
• Procedure Consent Form - New York Presbyterian Hospital, Columbia Presbyterian Medical Center [PDF 2pp. 234Kb]
• Procedure Consent Form, Espanol - New York Presbyterian Hospital, Columbia Presbyterian Medical Center [PDF 2pp. 277Kb]
• Professional Career Questionnaire - Nurses
• Progress Note - ECT Psychiatry Forms
• Progress Notes
• Prostate High Dose Rate (HDR) Implant - Discharge Instructions
• Prostate Problems - Discharge Instructions
• Protective Device/Restraint Screen
• Psoriasis - Patient Handout
• Psychiatric Examination Form - Emergency Department - Physical Exam Forms *(Temporarily Unavailable)
• Puncture Wound - Discharge Instructions
• Puncture Wounds - Discharge Instructions
• Pyelonephritis - Discharge Instructions
• Pyelonephritis - Protocol, Criteria and order sheet

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