Outreach Forms

Required forms for outreach (at NCFHP contract sites):

• 2018 Adult Health Assessment
• 2018 Adolescent Health Assessment
• 2018 Pediatric Health Assessment
• Behavioral Health Screening Tool (RHS-15)
• Acute Illness Reporting Form and Protocol (AIR)

Additional recommended forms:

• 2018 Enabling Encounter Form
• 2018 Medical Encounter Form
• Site Register
• Migrant Clinicians Network (MCN) Enrollment Form English
• Migrant Clinicians Network (MCN) Enrollment Form Spanish