Required forms for outreach during the COVID-19 state of emergency (at NCFHP contract sites):
*Adult and adolescent COVID-19 health assessments can be completed directly in fhases by following these instructions*
- 2020 Adult COVID-19 Health Assessment
- 2020 Adolescent COVID-19 Health Assessment
- 2020 Pediatric COVID-19 Health Assessment (Print version)
- 2020 Pediatric COVID-19 Health Assessment (Fillable version)
Additional recommended forms:
- 2020 Adult Health Assessment_Base Questions
- 2020 Adolescent Health Assessment_Base Questions
- 2020 English Adolescent Health Assessment_Base Questions
- 2020 Pediatric Health Assessment_Base Questions
- NEW! 2020 NCFHP Health Assessments (Fillable Forms in Excel)
- Behavioral Health Screening Tool (RHS-15)
- Acute Illness Reporting Form and Protocol (AIR)
- optional questions ADULT
- optional questions ADOLESCENT
- optional questions PEDIATRIC
- 2020 Enabling Encounter Form
- 2020 Medical Encounter Form
- Behavioral Health Encounter Form
- Site Register
- Migrant Clinicians Network (MCN) Enrollment Form English
- Migrant Clinicians Network (MCN) Enrollment Form Spanish